Stories & News Blog Potty Training Diaries #4: Breaking the cycle of stool withholding ERIC’s Helpline Advisor Alina knows a thing or two about problems that can develop when children start learning to wee and poo on the potty. She has successfully toilet trained her two boys and has helped many parents train their children. Armed with so much knowledge meant she was well prepared for the eventualities that potty training her two-year-old Nella would throw at her. Alina helped Nella have her first wee on the potty and learn to use the potty away from home. Nella then began to displays signs of stool withholding. In the final chapter of the Potty Training Diaries Alina explains how she managed to get Nella to poo on the potty and offers some handy advice for mums and dads for reaching this milestone in their child’s life. Alina's daughter Nella After overcoming wetting accidents in our first weeks of potty training, then mastering using the potty away from home, we struggled to get Nella to poo on the potty. I finally watched her succeed at passing a tiny pellet of poo, but this was followed by a weekend of holding on. Over the weekend, she would forget about pooing for a while then rush around clutching her bottom, crying and wanting to be cuddled. Stool withholding Seeing her in pain and discomfort was hard for the whole family, but no amount of persuasion or reassurance seemed to work. She would sit on the potty and then jump off shrieking. She became even more distraught when she soiled her pants a couple of times on Sunday afternoon. I wasn’t surprised though, as by this point she hadn’t done a ‘normal’ sausage shaped poo for three days. She usually loves her bath but even that couldn’t relax or distract her that evening. The warm water did have the effect of helping her do a poo, which seemed to take her by surprise (she was also very tired by this point so probably not able to hold on with as much determination). I’d just got to the point where I was so relieved to see poo bigger than a Malteser – even if it meant I had to get a fishing net out… Macrogol laxatives to the rescue On Monday morning after dropping Nella with her childminder Jan as usual, I called our GP. I told her I was aware of what NICE recommends for treating childhood constipation and asked if she could prescribe some macrogol laxatives. She agreed that Nella now needed some laxatives to help soften her poo and clear the backlog. She asked me to call back in a few days to let her know how we were getting on. From speaking to lots of parents and carers at ERIC, I know how easy it is for children once they’ve started to withhold poo to get into a vicious cycle of constipation and withholding. The longer the poo stays in their bottom the harder it is for them to fully empty their bowel and the more it hurts when they try to push it out. Macrogol laxatives make sure the water they’re mixed with is delivered straight to the child’s bowel so their poo stays soft and on the move. Contrary to popular belief, they don’t make the bowels lazy – holding on to poo does that! Sometimes children will need to be cleared out of poo if they have ‘faecal impaction’ otherwise the cycle is very hard to break. When I collected Nella at the end of the day she’d had another accident and her tummy was very bloated. Jan said she’d wanted lots of cuddles and hadn’t fancied eating much all day. It’s very common for stool withholding to affect children’s behaviour and appetite – the full up feeling means they may not want to eat as usual. Movicol + Cbeebies = recipe for success I mixed a sachet of Movicol Paediatric Plain with the recommended amount of water and topped it up with milk and gave it to Nella before bed. She was happy to sit on the potty watching an episode of the Cbeebies show ‘Get Well Soon’ which is all about poo and eating her favourite marshmallows as a treat for having ‘toilet time’. Praying the laxatives had worked, we got up early the next morning so I had plenty of time to sit Nella on her potty after breakfast. She asked to watch the poo song again and to my delight after a couple of minutes she announced “I’ve finished”. She’d produced a decent sized poo and seemed pretty pleased with herself. I breathed a huge sigh of relief. Keeping up the good work I’ve kept giving her either half a sachet of laxatives in the evening and another half in the morning if she’s skipped a day without pooing. I make sure she has plenty of water based drinks and opportunities for toilet time (if you’re struggling to get your little one to stay hydrated, check out these tips on how to get kids to drink more water). She seems to be in a regular routine again and has even done a poo at Jan’s house, but I can tell she still holds on sometimes. By keeping going with the maintenance dose of laxatives, this should help to avoid her getting constipated again, make it more tricky for her to hold on to her poos and keep them soft. For now life has settled down again and isn’t so dominated by poo! More help with toilet training or managing constipation If you’re thinking of potty training or are having trouble, take a look at ERIC’s Guide to Potty Training for practical information or contact the ERIC helpline. For help with a child’s stool withholding see the NICE Guidelines on Constipation in Children and Young People, download ERIC’s Guide to Children’s Bowel Problems or contact the ERIC Helpline.