Need help! DD holding onto poop (a long term behavioural problem)

[francesruben]

DD (5) holds on when she needs to poop. The issue started about the time I took of the diapers and introduced the toilet at 2.5years and she's been on laxatives prescribed by the dr for 2 years now, the dose varies according to whether we're going through a good stage or a bad one. I feel that we have exhausted all the avenues for dealing with possible allergies and intolerances and have eliminated dairy. We've also tried other things like homeopathy, osteopathy, massage etc, but I think it's in her head. 

When she holds on her behaviour is pretty unpleasant- she'll be too rough with her brother and rude to me (lots of attitude). She also gets urinary tract infections from becoming blocked up- we initially treated these with antibiotics but on the advice of a specialist now treat only with probiotics, cranberry, water, and an attempt at prevention. This has meant me ensuring she goes to the bathroom. Candy worked for a while as a bribe but hasn't solved the problem (of course, I never really expected it would) and is no longer really effective. 

Ok, so that's the background.... I'm EXHAUSTED by this! I love DD like crazy but I feel like running away from her at the moment. She yells at me when I tell her to go to the bathroom but she refuses to do it herself. If she doesn't go and I try to ignore it (almost impossible) I have a child who is constipated, has a UTI, and behaves terribly. I'm damned if I do and damned if I don't! 

I've struggled with depression over the past 6 years and this is really affecting me right now. I saw a psychologist who's only advice was contrary to my docs advice and very difficult to follow- she said to just let DD work it out on her own. I know that is sensible in theory but truly I do not have the saintliness to do this and withstand DD's moods and ill health. 

I'm not sure where to go from here, lately I've tried a tough approach. She has been soiling her pants and changing them- leaving the dirty ones in the laundry basket (but still failing to take herself to the bathroom to poop). In response I removed all her underwear and now give her one pair in the morning to last all day, and have explained that is what the rest of us do. This morning I yelled at her (and feel terrible about it)- told her that if she can't go to the bathroom by herself she can't do other nice things we have planned and can't stay at her cousin's house for a sleepover (her favorite thing in the whole world) until she can go to the bathroom like a big girl. 

I really feel like I'm failing here- I feel like positive incentives are not working and now I'm relying on negative ones which could lead to a bigger problem of self esteem for her. She has total control of this situation and it's not a healthy one. Has anyone else been here too?

[porcelina]

This has definitely turned into a power struggle for the two of you. What used to be you trying to help her with a health issue has become her trying to exert her independence because she can (yup, you can't make her poop). My DS1 (age 4) also has this problem. It started when he was about 8 months. He was constipated a few times, he started holding it in, it hurt, he got scared and held it more, it hurt more, etc., etc. We tried all the dietary changes too (he literally only ate fruit, meat and fiber) and nothing changed, so we gave up and did the prescribed routine. Our doctor at the time prescribed Miralax. This has worked very well for us. We still put it in his milk every morning, and it keeps him regular. The times we forget, or times that he doesn't get enough, he still gets constipated and has trouble. So, we know it's still necessary.

Here's my advice, from someone who has dealt with a lot of power issues AND the poop issue. First, use lots of miralax, like maybe 1 capful per day in her milk (if she doesn't drink milk, you can even put it in water, though of course juice is an option ). Miralax has no long term issues associated with it. If you need more than a capful, use more than a capful. (we use half a capful per day for my DS)

Second, follow what the psychologist said, LAY OFF COMPLETELY!! Do not even ask if she needs to go to the bathroom. She's 5. She's only fighting it to exert her independence. As long as physiologically something is in her system to make her go, there is absolutely no need for you to ever talk about it. No rules about underwear, no comments, nothing. This will take the heat off of both you and her!!

And, on a side note, start a new project together, build some positive power (get her involved in something with you), and work on giving her ways to assert her independence in positive ways.

[azzeps]

I'm so sorry! It must be so hard!  I can sort of relate because my DD, who was totally potty trained, started pooping and peeing in her pants in the last couple months of my pregnancy with DS, and still does.  It totally became a power struggle.  I think it's only improving in the last month or so because I have totally given in.  I have resigned myself to the fact that she is in charge, she can do it if she wants to, and I can't get her to do it if she doesn't want to.  I quit all the reminders, nagging, bribery, etc.  I only ask her to use the potty before we leave the house, if we're going to be in the car a long time or something.  It is really hard to let go, though, I know.  I am always wondering when the next giant poop mess that I am going to have to clean up is going to happen.  I would sit your daughter down and tell her she is in charge of her pooping and that you are not going to be involved anymore and if she wants your help she can ask and you are happy to help but that you know she can take care of it on her own. I hope it works out for you.  Sounds like the Miralax is a good idea too.

[Triniity]

sorry, crying exhausted baby on my lap - 

p.m. me, i am dealing with this kind of problems for a living. maybe you know a solution for my baby crying in exchange 

[francesruben]

I know that leaving it up to her is the right thing to do I'm just not sure I can live with her and do this!!! I am not entirely serious but really it's pretty unbearable for me. It was my new year's resolution to leave it all up to her and clearly I haven't managed more than a week! When she's squirming around in discomfort and getting really moody I find it really difficult not to tell her to go to the bathroom... I didn't up the dose of laxatives though, so I'll give that a go too. 

[Wild Lupine]

I'm dealing with much the same thing with my daughter, also. I know- I KNOW - how frustrating it is, the power struggles over the bathroom, the clean up, the worries about going outside the house. With my daughter it comes and goes, so we do have many 'clean' months, but when it is happening it is really tough.

I've done a lot of research (as in google-searching type of research, I'm not a professional), and my understanding is that this isn't totally behavioral. Where I am there are special clinics that help families with this. Have you looked into this? The advantage of a clinic is that it takes the power struggle off of your shoulders; the professionals help your daughter learn what she needs to do (and reinforce it, and get the right dose of laxatives so she can follow through), and you get to be mom. Your daughter does need an adult's help with this but if it is another adult than you, you can focus more on other aspects of your relationship.

The problem with just leaving it up to her is that there are very real medical and hygiene issues involved. At five your daughter probably isn't capable of cleaning herself well enough to prevent UTI's and other issues. I can't see how you can not be involved at least with the clean up and still have a healthy daughter.

It is also possible she has an impaction that the laxatives aren't touching; if that's the case, she's going to keep being constipated and the staining will continue. The clinics I know of do x-rays to make sure the intestines are fully clear before working on the behavioral stuff. And it can be really tricky to get the dosage of laxatives to what they need to be; too many and she'll have diarrhea, not enough, and she'll stay constipated.

Good luck, and hugs! My understanding is that children do eventually outgrow this, but it is so hard when you are in the middle of it.

[francesruben]

I don't know of any clinics that deal with this, so far we've been treated very well for the physical symptoms but not at all for anything behavioural or emotional. When I have sought advice I've been brushed off and I don't think many people have an understanding of how difficult this is- it really makes my other parenting issues seem like a total breeze!! 

The health and behavioural effects have made this feel so hard to step back from- how could I let DD just give herself a continual UTI which could be very dangerous for her kidneys? Antibiotics are ineffectual in her case so the only avenue has been to ensure she stays regular and clean. But I am at a point of giving up trying to help her because I think it's counter-productive, behaviourally and for our relationship. I mean I really resent her over this, and that makes me so incredibly sad.

She's had x-rays done, although not recently, and everything was fine then. How did you find the clinic you mentioned? What do I need to look for? I'm in Australia, so something like this may not exist here but I'd be interested anyway. 

Thanks!

[Wild Lupine]

Originally Posted by francesruben 
 How did you find the clinic you mentioned? What do I need to look for? I'm in Australia, so something like this may not exist here but I'd be interested anyway. 

Thanks!

The clinical name for this is encopresis, so I googled that along with the area of the country I live.

[umsami]

My eldest has encopresis--and has had it for sometime now.  A few mamas on here told me about Soiling Solutions--and it has helped us.  We've weaned him down to half dose 1x/day of Miralax...and he hasn't had any issues lately.  Basically, it's more of a bottom-up than a top-down approach.   Once per day you have a "power hour" of scheduled sits on the toilet.  If need be, you administer a saline enema.  Goal is to get them to learn to release their bowels.  I was weirded out by the enemas at first, but honestly, they helped a lot--and don't phase me now.  Key also is to do a clean out if they're soiling.  We've gone from numerous soiling incidents to having them only when we stop the protocol.  Made a gigantic difference in our son's life.  

[porcelina]

It sounds like you have gotten a lot of good advice here for the clinical issues! Best of luck and hugs to you!!