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Holding on


We started toilet training our 4 1/2yr old son just before he was 2 and we still going. When he was 6mths old he was constipated and again at 2. He constantly holds tries to stop his poos from coming out and tries do this very discretly. It seems he feels the urge and he works very hard at holding it in which looks quite distressing, small soft smears do come out and hence we change his pants a number of times a day.Eventually that day or usually the next he will pass a bowel motion which is soft logs(it seems to be when he can't hold on any longer.) He usually always has wet pants from urine leakage as well-also white stains which i presume are slat stains? In the last few months he has aslo started checking his bottom with his fingers and then trying to wipe it off on his clothesetc. We went to the GP afew months ago and she siad latulose but that didn't last long as it was very hard to get in to him and I really don't think constipation is an issue as after all this time when are concious to give him plenty of kiwi etc. The Gp has now refered us to a soling clinic but the wait is 6 months. Therefore my question is any ideas/suggestions as to what we can do while waiting-he is to start school before 6mths but I won't start him if he still has this issue. So over it after 2 1/2 years of washing underpants all day and now the smearing!He has also wanted to toilet train at night but I don't feel like I can/want to start that until the day is sorted. We only just went to the GP as every month/ year we thought it would get better. Thank you


Some children with a history of constipation can develop behaviours to avoid passing a bowel motion as it has been an unpleasant or painful experience in the past.  A laxative can be helpful as it stimulates the gut, therefore making ‘holding on’ very difficult.  Have you tried hiding the Lactulose in a drink/smoothie or such like?  There are alternatives to Lactulose such as Movicol.  This is a powder that is mixed with water and has a lime flavour. 

Get him to practice sitting on the toilet, the aim being to make him comfortable about going to the toilet, not focussing on whether he produces results.  Use a foot stool to support his feet, and get him to lean forward with his elbows on his knees.  This opens the passageway for the bowel motion to come out.  Eating stimulates the passage of bowel motion through the gut, so sitting him on the toilet about ten minutes after he has eaten may result in a bowel motion being passed.

The white stains in his pants may be mucus from the bowel.  This can indicate an irritation in the bowel, or may be a case of the mucus the bowel normally produces passing around the outside of the bowel motion he is withholding. 

Get his urine checked to rule out urinary tract infection as a cause of his daytime wetting. It could also be due to him delaying going to the toilet.  If he is with holding his bowel motions, his rectum may be full, and this can bulge against the bladder and irritate it, causing the bladder muscle to spasm, and urine to leak out.  Hopefully once his bowel problem is resolved this daytime wetting should reduce also.  If not, and he is passing small volumes of urine frequently and urgently it may be overactive bladder, which your GP should be able to help with.

Good luck and I hope all goes well.