[MelodyNelson]

Hi everyone,

My son is 4 in July. We started toilet training him last year, and he has been weeing well pretty much since day 1. Poo, however, is a huge problem. He has a tendency to hold on to it, causing himself constipation and great discomfort. It's not unusual for him to go once a week. We have tried bribery, reading him stories while he sits on the toilet, taking him to the GP, giving him Actilax, increasing his fibre, increasing his water and so on. All to little avail.

The worst part about it is that he screams the house down when it is poo time. My otherwise sweet natured son becomes a shrieking banshee. I'm sure half the street can hear him screaming and me losing my temper. He would seriously rather poo his pants than sit on the toilet. It can take anywhere from half an hour to an hour to get him to push it out when it's apparent it's coming. We feel like we've tried every tactic in the book to get him to be more relaxed about poo. It is something we've been dealing with since July last year (!) and I really want to sort it out before his little brother/sister arrives in October!

So tell me, what are your tactics for dealing with poo evasion/constipation?

[roses99]

I don't know the answer to your question, but my dad is a child psychologist and I know he's worked with small children who have anxiety issues around doing poos, like you've described.

Have you spoken to your GP? Maybe he/she can give you a referral to a good child psych who could help with a few strategies.

He's not likely to need more than a session or two, but it could be really helpful to get some strategies and for your son to talk through his concerns with someone who can help him.

FTR my dad uses puppets and drawing therapy when encouraging small children to open up, so it's not like traditional counselling.

[TwiceThe Woman]

Sorry to be brief and gross but does he see Mum or Dad "going"? as to be there with you or his Dad gives them confidence that all will be ok.
If you've already tried that, have a little friend come over who is also TT and ok with then pooing part - he will soon copy.
Good luck and hope this situation resolves soon OP.

[Tesseract]

This was me as a kid. Turned out bananas really bound me up and made it hurt, once bananas were cut things were much I got over the anxiety.

[soapy]

DS would hold on and still does sometimes. Also only doing one poo a week. My GP told me to use Parachoc. I would use it if he hadn't been for a couple of days. Another GP told me that his bowel will need to be retrained to go more often and to use Parachoc until he would go once a day. I thought that was a bit extreme so would just do it every three days. He now goes once every two to three days. I had to explain to him that it makes it harder to go if you hold on.

[MelodyNelson]

TwicetheWoman - yes, he has seen us on the toilet doing our business. He often comes in to talk to one of us while were in there!

Tesseract - he doesn't eat bananas unfortunately :S. We're being mindful to increase his fibre and water intake, so have got him to eat prunes and apples. That seems to do the trick in making him more regular, but he will still resist the urge and scream the house down in the process.

Soapy - we've tried that with Actilax. Like you, I also think it's extreme to give it every day. Have explained that do him as well that the longer he holds it, the harder and more painful it is.

Roses 99 - thanks, I'll give that a shot. The last GP I saw regarding this wasn't hugely helpful so I will take him to the one I'm currently seeing for my pregnancy as she's proactive in giving referrals and offering alternative suggestions.

[Milamum09]

My DD was having the same problem. Then we introduced Psyllium husk sprinkled on her muesli and yoghurt each morning and have seen a huge improvement. It doesn't hurt to poo anymore and she therefore doesn't hold onto it causing her to be more constipated. She is now doing a nice soft poo every day. It was horrible to see her in pain every time she did a poo. She used to hold onto it so much she would only do it in her sleep when she was fully relaxed. Good luck.

[dogged]

Hi OP

I don't know which state you are in so I won't post a link to the Victorian site, but the Continence Foundation of Australia has various links and resources on their site - there may be some ideas there to assist. I've found their materials very helpful in the past; admittedly a different situation (DS has SN).

It sounds as if your DS has both some physical issues but more the psychological fear, so obviously helping him along with plenty of fibre and fluids is going to help, but perhaps not be sufficient alone; you'll need some other tools and suggestions to help him get over the barrier he's building in his mind.

I wish you well with it - poor little chap, no fun for you or for him.

[ninjamummy]

Hi,
I wish I had the answers - but I can only share some insights from my experience/journey with you. DS1 turned 4 in March of this year and he has been having toilet trouble since January 2011. There's a long story (and, no doubt a therapist would have a field day with hearing my re-telling of the last year-and-a-half) but we have, at times, had him taking Movicol, Parachoc and Osmolax). He had an X-ray and it showed significant faecal loading. We have changed his Paediatrician and the new one seems to be a better fit for us (and the situation). He now has Osmolax and Parachoc on alternate days and the Paed has referred us to a Gastroenterologist and she wants us to start seeing a Psychologist (we have those appointments in the next few weeks). Whilst I am anxious about it all and find it VERY CONFRONTING, I am willing to go to the ends of the earth (and back again, if I have to) to help him. I'm sure your situation is dfferent to ours (and I don't tell you about it to add more worry) but I wish I had done more, sooner. I spent a lot of time, floundering around or just not being confident that we were doing all we could to help him. The great thing is that there's a lot of people who have replied to your post that have been able to sort it out quite quickly and easily. I hope that's the case for you, too!

My advice to you is as follows (and like all advice, some of it will be useful and other bits will be a "crock"):

* Trust your instincts - no-one knows your son as well as you do - does your gut tell you that it's something that needs more (or less?) medical assistance?
* Easier said than done (I know) but try not to put too much pressure/emphasis on it. We tried to teach our son all of the steps (starting with him going into the bathroom, pulling his own pants dow and sitting on the toilet (because we thought we might want to copy the other kids at day care and be able to do it himself)but one thing we learnt from taking him to the OT was to try and break things down into smaller tasks. So we just focussed on getting him to do one big poo every day, and not worry if he did it in his nappy (i.e., forget about the sitting on the toilet bit).
* It is best to get this sorted before his bowel/colon gets stretched - though that can take a long time to happen. If it DOES get stretched, it CAN be sorted but it can take a LONG time
* Apparently, it is OK to treat "withholding" quite aggressively with laxatives (I was worried about long-term use of laxatives and any damage that could be done - but apparently, there is a greater risk of long term damage/stretching of the colon if kids with faecal loading are not "cleared out")
* We found Osmolax to be the easiest type of laxative - it apparently has no taste, so can be dissolved in any drink. You can buy it over the counter at chemists (but you may have to ask for it)
* When we give him Parachoc, we mix it with his yoghurt (let him choose the flavoured yoghurt that he wants the chocolate-flavoured "medicine" to go in)
* Make sure you are happy with the Dr that you are seeing - they're like any other service or tradesman - if you're not happy with what thay are doing (or telling you, or if they don't seem to be on the same page), go see someone else
* We have a few books that he sometimes asks us to read. We started just having them around the house and, after he showed an interest in them, we would read one to him He will sometimes ask us for one of them, now:
"Even Firefighters go to the Potty" (but we change it to "Even Firemen go to the Toilet");
"It Hurts When I Poop" (this one is about a boy who is scared to go to the toilet, because he is afraid it's going to hurt. His parents want to help him, so they take him to see a Dr, who tells him a story about a coyote named Bill, who doesn't get rid of his rubbish, so his house gets so full the walls start to stretch, bulge and shake. He decides to get rid of all the rubbish and sees how much better it is. He gives himself a reward at the end of it. After the Dr finishes the story, she asks Ryan if he wants to take care of his rubbish/poo. She tells him about a "Poo Program" that teaches him about foods to make poo go hard or soft, plus some other things he can do to help. My DS still asks us if various foods will make his food go hard or soft)

All the best with things!

This post has been edited by ninjamummy: 07/05/2012, 02:00 PM

[MelodyNelson]

Thanks everyone! Some really good advice and I'm glad to have different ideas to try out.

Most recently we've tried to distract him from the pain. We sit him on the toilet and read a story or sing a song and try to make him laugh instead of us losing our cool. Although he still cries a lot, the screaming is less. We got him to poo on the toilet twice last week so hoping that this is the thing that eventually works for us.

The in-laws had him yesterday (they babysit him every Monday) and said that he was showing signs of wanting to do a poo, but they decided to "leave it to us as they didn't want to deal with it", by which time he had lost interest and the urge to do it. I found that really frustrating to deal with!