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holding on


My 5 year old, holds onto her poo with a vengance. We have tried star charts and though we had it solved , but since she started school 6 weeks ago its got worse. We have always seemed to have a bowel issue with her, from skids, to actually soiling. She had been alright for about 8 months with only the occasional blip. When she does move her bowels, they are very large, its painful and traumatic for all concerned, i have to sit on floor of toilet and cox/encourage her, sometimes it works some times it doesn\\\'t. The GP says its a control issue and my worrying is amking it worse. She has spoonfull of olive oil everymorning, plenty of fruit and veg but isn\\\'t a big drinker of any fluid. we\\\'ve tried coloxly drops, kiwifruit and kiwifruit juice. Am at my wits end of what to try next, gp says she\\\'s too young to be reffered to continence service. Can you please offer some suggestions. Many thanks


You are doing the right thing by addressing the bowel problem now. Some continence services do not see younger children, but there are other health professionals that can see them.

Bowel problems such as your daughters are more common than many people realise. She seems to be withholding the urge to open her bowels until a little works its way out (soiling) or there is so much there that she can’t hold on any longer (large motions).

I would suspect that she has had some difficulty passing bowel motions in the past, so subconsciously resists experiencing that again by holding on. Diet and fluid are vital, so well done for working on this. A laxative should soften the bowel motion, making it easier to pass, and perhaps a stimulant medication will help it travel through the bowel quicker so it does not have time to become hard and difficult to pass. This also makes it more difficult to hold on and delay opening her bowels. The down side is that she will soil more frequently with a stimulant medication as the bowel motion will be softer and more urgent.

It will take some time for her to get past her toileting fears. Try and sit her on the toilet after meals. Eating stimulates the gastro colic reflex (bowels moving) and can make a bowel motion more likely to occur then. Make sure she is comfortable on the toilet. Give her a foot stool to rest her feet on so she is more comfortable and secure. Get her to sit with her bottom well back on the seat, and to lean forward with her elbows on her knees. Holding the side of the toilet seat or tensing up will actually draw the pelvic floor muscles up and the bowel motion can’t come out. Reward her for sitting on the toilet, not for whether she has a bowel motion there. She needs to feel more comfortable with the environment before she will be confident enough to pass a motion.

It may be some time before it is resolved entirely, and with the history of large bowel motions, it may be that she has had some stretching of her rectum. Keeping the bowel motions soft and regular will allow the rectum to regain its tone in time. Be patient and it should resolve in time. If there is no improvement after several months, ask your GP or other health referral to refer her to a Paediatrician for investigation. (It may pay to do this now as there is usually a long waiting list)