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Enquiry about toilet training
Question:
She is 3 and 1/2 years old and we were wondering about how to help her with doing poos on the toilet. She has been weeing on the toilet no problems independently for the last year and is dry at night. She has only ever done one poo on the toilet when she turned 3 in January this year. She became constipated around this time and didn't pass a bowel motion for 10 days. She started to overflow (sneaky poo I think it is called). We ended up giving her lactulose and coloxyl to help move her bowel and clean her out. This worked after a few days and for the next few months I let her poo in her knickers or pullup as I was concerned about not letting her get blocked up again. She understands that she should be pooing in the toilet but refuses to do a poo on the toilet (although she will sit on it and try from time to time with encouragement but never any success) instead she usually goes outside or into her room and sits on the steps or a stool to poo in her knickers/pullup. When I see her starting to push I try to get her to come to the toilet but she tries to push me away and will stop pushing till I go away. In the last month we have started an incentive to get her to poo on the toilet instead of her knickers and have told her it is her "job to get the poos in the toilet". She doesn't care about the incentive and seems resigned to never doing a poo on the toilet. She also often has "skids" in her knickers or pullup and we are now wondering whether she has a physical problem with pooing or if it is just a bad habit that can't be changed.
Answer(s):
You have certainly got some challenges there, primarily because your daughter is so young and one cant rationalise with a 3.5 year old!
Firstly, take the pressure off both your daughter and yourself. You have 1.5 years to get this sorted before she starts school, plenty of time.
I am presuming that you saw the GP when she was constipated for the 10 days. You need to go back to your GP and have her reassessed. Palpating her abdomen will give the GP some information about whether she has a large amount of poos in her bowel. Skid marks usually indicate that the bowel/rectum is loaded with poos. If this continues for any length of time the nerves in the bowel become stretched and cannot function and the child loses awareness that a poo is coming. The poo then catches them by surprise (sneaky poo).
It would be useful to know what caused the initial constipation 6 months ago. Has she always been sluggish with her bowels? (slow transit constipation) or was it something that came on after a period of illness, reduced fluids, change of diet?
After the initial episode of constipation it would have been useful to have kept up a small maintenance dose of laxative to ensure that her bowel kept functioning regularly. (Movicol Half would be ideal). Keeping a poo chart and assessing each poo using the Bristol Stool chart (attached) would be useful. Sometimes after a period of sustained constipation small tears can occur in the anal area (anal fissures) and children are often reluctant to poo after this as it is very painful. Sitting on the toilet can make it more painful.
A quick tool for assessing how long it takes for poo to transit the bowel is the sweet corn test. The child is given a meal that includes sweet corn and then the poo is checked over the next few days to see how long it takes for the sweet corn to reappear.
In terms of pooing on the toilet - give the reward/incentive for the actual sitting on the toilet, not for the result. I would suggest letting her continue to poo in the pull up but encouraging her to do this in the bathroom, and then gradually work towards doing the poo in the pull up on the toilet, and then finally removing the pull up (tear at the sides) and letting the poo fall into the toilet. This process could take several weeks. Using a gentle laxative to ensure a nice soft poo that is easy to pass will help.
I hope that you find this advice helpful, please dont hesitate to get back in touch if things dont improve.
