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Holding poo's in
Question:
Hi, my youngest daughter (just turned 2yrs) has been holding on to her poo's. This has been going on for about 3 months. She got constipated, it was the start of summer and her juice/water cup had not been properly cleaned and tasted bad so she didn't drink for a few days. Added to this was a heat wave and no water and she got constipated, I did not notice the signs, small smears for a few weeks when a friend pointed it out to me! Went to the Dr's and got her onto the lactulose and she then had a few big blow outs. However the behaviour of holding on seems to have not left her. Prior to this she would just squat down in a corner and go poo, now she stands up and goes rigid and tense and she appears to be stopping the poo from coming out. We end up having a continual stream of small stinky smears / amounts over the day. Plunket said to contact you. My oldest daughter (11yrs old) has encopresis and I am dreading that this child will end up the same way. Youngest child is currently on 8mls of lactulose per day, Dr said to do 3 days of suppositries but I have done this in the past and she just poos it out straight away in a tiny bit of poo. I am really interested in how to try and stop the behaviour she has developed of 'holding' the poo in. I cannot sit her on the loo with her nappy on as suggested by plunket as she gets very upset / angry if I come near her when she is holding on. She is not ready for toilet training yet however I am anxious to try and sort out this now before it gets worse. Thanks from, 'desperate to avoid a 2nd child with encopressis'
Answer(s):
This is a very tricky situation isn’t it. The behavior is often more difficult to resolve than the constipation/soiling. I think your first step would be to ask the GP to refer her to a Paediatrician for further investigation and to ensure correct medication as per your child is given. Medication may be necessary for some time.
I think your daughters ‘holding on’ is occurring as she subconsciously remembers passing a bowel motion as being a painful occurrence. It is very hard to rationalize with a two year old however that the more frequently she passes a bowel motion the less likely it is that it will hurt.
I would suggest that you forget about the trying to get her to pass a motion in the toilet or nappy for now, and get her more confident about the toilet. Make the toilet a friendly place – posters, books, toys for playing with only when she sits on the toilet. Encourage her to sit on the toilet for several minutes a couple of times a day. Use a foot stool to support her feet, and get her to lean forward with her elbows on her knees. This opens up the passage so bowel motions can come out more easily. Practicing on the toilet about ten minutes after eating may result in her passing a bowel motion, as eating stimulates the movement of faeces through the bowel. Blowing up a balloon while sitting on the toilet helps the child ‘bare down’ with the correct muscle action without trying too hard. Though the goal is just to get her confident about sitting on the toilet and it being a comfortable place, if she did pass a bowel motion while practicing it would be wonderful for her (and you) and a reason to celebrate and reward. A sticker chart may be useful for her practicing, with the reward being small and significant to her – time alone with Mum, a trip to the library without siblings etc.
Getting her to move closer to the toilet room over time, but still allowing her to pass a motion in her nappy is a useful but slow process. The medications are useful through this process as the child just can’t hold on if the bowel is stimulated and the motions are softer and easier to pass. Eventually she should get to the stage where she can be in the toilet room to open her bowels, then on the toilet with a nappy, then without a nappy. You will find what works and doesn’t work for your daughter, and adjust things to suit her and you more.
Best of luck with all of this.
