2 1/2 yr old w/ sacral dimple consitpated and not urinating for MANY hours - Mothering Forums

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#1 of 16 Old 12-11-2009, 11:51 AM - Thread Starter
 
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I am posting this for a friend who would really appreciate any input you might have. Thank you.

2 1/2 year old DD with sacral dimple had a couple of hard bms a week ago and has been withholding bm until unable to stand it and have a little hard pieces come out at a time. She has been taking miralax, fish oil, pumpkin pie, olive oil, lots of fluids and is now for last several days have been withholding urine. She has gone 22, 17, 17, 10, 19 hours between urination. We have contacted the ped and her neurosurgeon but I cannot seem to get a urine sample since the sample cup is always out of reach when the flood occurs. The urine seems clear and so far she hasn't complained when she has urinated (she also doesn't have a fever and the urine just smells like urine although i am still worried about a UTI). I gave her glycerine suppositories 2 days ago and the hard poo has passed and now bms are fairly soft and a little firm(and the dr said she could not feel any stool upon pressing on her stomach) so I don't think that it is a physical barrier that is keeping her from going. She actually wants me to hold her on my hip to help her hold in the pee and I have seen her also cross her legs and even at the end hold her hand over her pee pee or booty to keep from going. She is very head strong and this might be a control issue. I got her special toys to play with on the potty and got her toys she loves to give her if she goes potty and still she waits until she is about to pop b/4 she goes. I am frantic at this point and I know I should be more calm but I am worried that something is wrong or will go wrong (UTI, lose ability to get signals to go potty). Has anyone had similar issues with the withholding urine?
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#2 of 16 Old 12-11-2009, 11:57 AM
 
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It sounds like an obstructive issue due to the constipation, perhaps. Here is an old post with alternatives for stool softening and mobility.

Quote:
Here are a few ideas. Be sure that he is getting plenty of fluids before and during outdoor activities.

The binding foods to avoid are BRAT: bananas, rice, apples and toast. Prune juice increases motility, but just use a little!

You could increase animal fats, butter, coconut oil, magnesium, bone broths, vitamin C, probiotics (specifically Lactobacillus casei Shirota). Try aloe tea, Rhubarb root extracts, carrot juice 1:1 with spinach juice, plantains, dandelion tea, coconut, Blackstrap molasses, cabbage juice, almond oil with milk. All have stool softening properties, or increase motility.

Additionally, foods high in potassium help bowel function as it improves peristaltic movements of the colon: kale, cabbage, yellow tomatoes, spinach, carrots, broccoli, cucumbers, cauliflower, alfalfa sprouts, goat milk, sesame seeds, wheat germ brewers yeast, flax seed, green peppers, pineapple, beets, potatoes with skin, Blackstrap molasses.

http://altmedicine.about.com/od/cons...nstipation.htm

You might offer some rescue remedy in juice or water just before and during a bowel movement, if it is uncomfortable. Trying to stool in warm water (bath tub) seems to help some young children to relax the anal sphincter. Rubbing the abdomen clock-wise gently with lavender essential oil helps to increase motility also.

Epsom salt baths, or a itsy bitsy pinch of Epsom salts in water or juice (has magnesium) will often help constipation. Or a larger dose of vitamin C has a tendency to cause loose stools. Warm drinks also trigger a peristalsis movement of the bowels in some folks. So, just a warm tea might do the trick. Or warm soup.

Most of us are deficient in magnesium. Some Natural Calm for Kids helps with constipation and relaxation.

I trust that one of these possibilities will be agreeable to her. And if she is uncomfortable, you could try a glycerin suppository. (not my first choice) But, I'd just add some whole food probiotics on a regular basis and that will help his gut health, all around. :-) I just add a tablespoon of kefir to juice. That is a ton of beneficial probiotics. I wouldn't waste money on bottle probiotics. Dairy is constipating for many though, in quantity.
HTH,

Pat

P.S. Be sure she is getting adequate food folate.

I have a blog.
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#3 of 16 Old 12-11-2009, 03:12 PM - Thread Starter
 
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Thanks, Pat! I passed your info on to my friend.
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#4 of 16 Old 12-11-2009, 03:54 PM
 
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Has she had an MRI? Has a ped. neuro looked for a tethered cord or similar in this child? You mentioned neurosurgeon so I'm wondering if she has a known cord issue.
My understanding is that a child with a tethered cord (sacral dimple is a sign of that) can be asymptomatic and then as they grow the cord is damaged and you get symptoms/damage. The things you are mentioning are, I think, possibly signs of damage. And if she was untethered I think it can retether as well.
I'm going by what I've read on the special needs board and don't know about this area particularly/personally so I may be off in what I'm saying. Please contact KatWrangler about this/she'd know.

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#5 of 16 Old 12-11-2009, 04:02 PM
 
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Yes as Rachelle said, since she has a sacral dimple has she had a diagnosis for spinal cord issues?

Is she really withholding urine? Or just has the urge to go, but can't?

I guess first I need an answer about the spinal cord issue or not.

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

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#6 of 16 Old 12-11-2009, 07:15 PM - Thread Starter
 
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Rachelle and Anne--I have passed your posts on to my friend and I am hoping she will sign on here and reply soon. She just called, aftere having gone to the doctor (just the regular pedi). They were able to take some urine in for a test, and they did a sonogram and maybe blood work. Hope she is here to give you more info and ask more questions. Thanks to you both.
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#7 of 16 Old 12-11-2009, 07:23 PM
 
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Thank you!

FTR - My daughter has Lipomyelomeningocele, Tethered Spinal Cord, Neurogenic Bladder and Neurogenic Bowel.

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

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#8 of 16 Old 12-13-2009, 01:21 AM
 
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Thanks for the replies. My daughter has seen ped neurosurgeon and ped urologist in the past. MRI showed fatty tissue at end of cord but no evidence of tethering. We will continue to see the doctor as she grows to try to make sure that we don't miss some unseen tethering as she grows. The nurse said that the witholding urine is unusual and so is the sudden onset of constipation (usually it occurs more gradually). She does not have a UTI and she might have thickening of the bladder wall (but the radiologist said he/she was not an expert in peds so wants a second opinion by a ped urologist) and blood work ruled out the other scary stuff associated with thickening of bladder wall. Read online that bladder wall can thicken due to withholding urine so maybe that is all it is. Finally tried to put her in a diaper (again, before she refused) after a friend's prompting and she urinated last night and three times today. She also had a bm three times today. They were very soft from pumpkin pie and massive quantities of fluids (silly straws worked well) and miralax adult dose the last few days. We also have focused on running like mad through the house b/c it is cold outside. If it is just the head strong two year old refusing to go potty the only way I am seeing it is that she had an accident and urinated without having bm and she was very excited that it was pee pee without poo poo. I think it clicked that she didn't have to do both and adding the diaper after that she was happy b/c she didn't urinate all over herself. She has been very happy about that. She is also getting over her distrust of the bathroom (she thinks the potty made her go poo?).
She is very persistent but I don't know how she could sleep and not release urine 20 hours of not going. I am almost certain the reason is mental b/c she would dance and complain for hours prior to finally going (usually 17 hours was her limit) and she wanted me to hold her on my hip or put her on my shoulders (my head and hip to hold it in i figured it out later) and she would cross her legs or even put her hand on her crotch or booty.
I am curious as to whether anyone else has heard of a child withholding urine for so long a period. Sorry for the epically long post. I am too tired to edit.
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#9 of 16 Old 12-13-2009, 07:00 PM
 
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I don't know much about the spinal issues, but on the bladder side of things, I would be pretty concerned about a child witholding urine and bms for that amount of time, especially if she is doing it often and/or for extended periods of time. When you withold, it can put extra pressures on the bladder, and can lead to UTI's and other problems. Over time if witholding patterns continue it can cause a number of serious urinary and renal problems. It's good that she is going again regularly, and I would work really hard to reinforce good bathroom habits, and encourage her to go often. I know for us, it's often hard to convince dd that it's ok to poo once she gets constipated b/c she knows it will hurt. It starts a terrible cycle of constipation and witholding, so for us making sure she doesn't get constipated is a biggie.

fwiw, dd has a grossly enlarged bladder, and in theory I think she would be able to hold her urine for extended periods of time, but she has a urinary diversion (vesicostomy) to prevent that from happening (b/c of her other urinary problems).
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#10 of 16 Old 12-14-2009, 09:16 AM
 
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Thanks. She urinated only twice yesterday but she had a bm twice also. We are going to see the urologist and the neurosurgeon but I have noticed that we get the best results when we run her around like crazy. She has a cold (like the rest of the family now) and I haven't made her play outside b/c of that but I broke down yesterday and she had one of the bms after running for 20 minutes. She also realizes that if she moves around she is more uncomfortable so she has been wanting us to read to her on the couch or in bed. Whenever she starts something like that I try to get her to start moving since that means she's having cramps like she needs to eliminate. In your personal opinion do you think that a week of this crazy pattern constitutes an extended period?
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#11 of 16 Old 12-14-2009, 03:35 PM
 
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I know you mentioned both diapers and the potty, is she now using diapers? Is it possible that she urinated a small amount when she had the bms? If so, I wouldn't be as concerned about her going 4 times total in a day. Based on what our uro has told us, as long as they are going every 6 hours or so you're probably ok. It's when you get past that point that you need to start looking at a reason (which could still be just witholding). Is she completely potty trained? I would say at 2 yrs old, that would be a lot of control (to hold urine 17+ hours) for that age.

You mentioned blood tests, if you don't mind my asking, what other tests have they done? How did they discover the bladder wall thickening? I do think it's good that your seeing the urologist. As far as time goes (in my personal opinion), I wouldn't consider a week an extended period, especially if you feel like it is just a stubborn 2 year old learning to control her body. Are there days in there where she does pee normally (4-6 times a day) or has it been 10+ hours between every wet diaper for a week? I would be more concerned if it were 10+ every time, and I would be concerned if the pattern continues once she is feeling better, and she is having consistent soft bowel movements again.

Again, this is just my opinion, and I may be overly concerned about the urinary tract b/c of dd's condition, but I would have her checked out. If she looks healthy, is eating well, has no signs of infection or discomfort, is playing normally, etc then she probably is healthy, but with the combination of symptoms, including the spinal issue, I would want to make sure.
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#12 of 16 Old 12-15-2009, 01:15 AM
 
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The most natural and easiest diet for infants and toddlers to solve the constipation problem is grated carrot and grated apple...

raw grated carrot is totally enough to do .. after eating one or two fine grated carrot poop is guaranteed to come out within hour to two hours

you can grate carrot on the finest side of potato grater of this kind..
any one will do, this picture is just for reference and there are tons of different ones in any kitchen suppy stores:

http://www.realsimple.com/food-recip...055/index.html

use finest side with the sharpest holes that look like stars made with putting nail through them :-) sort of kind off..

or.. use any juicer, put carrots through it, and then mix pulp with the juice back.. and there you have the grated or carrots aka carrot pulp.

the beauty of it is that it does not have any extra callories or irritated other organs like too much oil can do to cause adverse reaction.. .as in.. too loose poop.. carrots make it just right.



I always put my lo on grated carrot immediately if there is any poop issue that is rare but if it is then it is frustrating for them.

before I got this thousand years old tip I struggled with so many things and it is total nonsense. it works, it works fast and it has no choice but to work because it is pure fiber and delicious to it too..

I ad some sugar to grated carrot and althouhg sugar is not so healthy yet little do no harm and make the medicine go down :-)
and so much better then any pharmaceutics anyways..

raw grated carrots! can be fed few times a day to solve the problem .
then try to pay attantion to the foods listed above and
also
- any food with white flour like white bread, it does not have to be toasted to cause constipation.

- beef.. is a really good stool hardener in little ones.

grated apple is also very good, when I need the action and I need fast I do both carrots and apples, but I don't mix them as my little one likes each separately and I do to since the apples make carrots sour and tastes yacky.

separetely they taste just right.

good luck!
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#13 of 16 Old 12-16-2009, 05:02 PM
 
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Thanks for the idea with the grated carrots and apples. She has eaten two pumpkin pies without the crust this past week and we need some variety!
We went to the ER yesterday where the specialists we normally see are located. We actually didn't see the Pediatric Urologist but he was able to read her sonogram that she had last friday. He was very positive that she had not had back pressure on her kidneys (they were not dilated) and this would occur if she were unable to urinate. I was a little disappointed initially because I was ready to get a MRI (would be her second) b/c my friend's husband (a neurologist) who was nice enough to talk with me said that he would suggest to get it done. I just talked with him over the phone and obviously he had no access to any of her records. His concern was that she was getting the signal from her bladder to her brain that she was full of urine or poo and thus her dance, but she was unable to send a message from the brain to the bladder or bowel to release. So... I was glad that the urologist said that there is no irreversible damage that was being done that is consistent with tethered cord, BUT i was still a little concerned that she is just presenting oddly or just the first stages of cord tethering. BUT at the hospital she peed and pooped twice and was very happy to tell anyone who would listen. And today at her sister's school christmas party she peed (after 4 hours from this morning) and pooped 3 times. She was so jazzed to get accolades from a giant audience. We still have a ped urologist appointment in a week to follow up and hopefully this was all mental. But she was consistently going about 17 hours on average between urination sometimes a few times as long as 22 hours and 19 hours(3 times). I am certain despite the diaper she was not going pee with the poo. She would tell me instantly after going to chagce her and also I have been her shadow for so long that even if she didn't i would catch it within half a minute! poo wetness is more on the surface and pee pee gets lower down. I have had a lot a time to study this. Her blood test was essentially used to rule out cancer or infection (from what I inferred). She also had a sonogram on Friday that was to rule out kidney stones and to look at organ sizes. That was how the thickened bladder wall was picked up by the radiologist at the hospital near us and the ped urologist at the childrens hospital saw that the kidneys were not dilated. I brought all of the cds and blood test results from past test so that the drs could look at everything at once. The ER doctor said that she was also glad that i made a point of capturing her urine with a cup (near miracle) instead of having her tapped or catherized at the drs office since she said that if it is mental it would have set her back even further and the same with the urodynamic study if we were to do it later. so we are still really pushing liquids obviously.
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#14 of 16 Old 12-16-2009, 05:22 PM
 
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Some kids don't show tethered cord till much older. There lots of kids on the lists I am on (Tethered Cord Syndrome, Spina Bifida Lists and LMC), have happened to. They have all kinds of ortho and bladder/bowel problems as infants/toddlers that is unexplained. Then it finally shows up.

My daughter's was severe. Thats why she started showing symptoms at 2 months of age. By 4 1/2 months she was having emergency surgery.

I am very glad you can talk with your friends husband. That is awesome to get his perspective. He is so right about the brain to bladder/bowel. That eventhough your daughter has the sensation to go, the brain's signal to the bladder/bowel is getting lost in between. With my daughter her bladder doesn't contract at the time her spincter should release. She basically gets to overflow and then urine is pushed out. Which when this happens its not good. That means there is a strong possibility urine is being pushed back up to the kidneys. But so far all tests she has had (VCUG, Urodynamic Studies and Renal Ultrasounds) don't show Urinary Reflux. However, her bladder pressures have increased which is a concern since we know her spinal cord is re-tethered again.

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

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#15 of 16 Old 12-16-2009, 05:39 PM
 
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Didn't completely answer workjw. She has been potty trained for a year since i never wanted to repeat the urodynamic study if possible. she is completely acting normally except for when she is cranky doing her potty dance up till she is doubled over mostly 19 hours plus. She just went pee again (not a full amount but I have lost the ability to tell what is normal. 1 1/2 oz according to the kitchen scale (taring with an empty diaper). The last three pees were 3 to 4 hours apart. Now seems a little too close but now i am just paranoid.
Thanks for all the input.
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#16 of 16 Old 12-16-2009, 05:50 PM
 
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dear katwrangler,
did you daughter first have the urine leak out? That is what our pediatric neurosurgeon's office tells me is more or a concern or that she slowly develops constipation issues. As i mentioned in the last post she NOW is going every three to fours hours the last 3 times but it is all at once (b/c it is hot and she announces it and runs to the bathroom to get changed). She is also concerning me b/c she is saying that she went pee or poo interchangably and I am wondering whether she is just 2 1/2 year old or that she can't tell the difference b/c she is not controlling it come out. How did the bladder pressure get determined with your daughter? Would that also show up with thickened bladder wall?
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