On being the poo queen.

It’s my 25th blog (google tells me this is a ‘quadranscentennial’ event, what a lovely ridiculous Latinate word!) and I reckon it’s pretty amazing that I’ve got this far without dedicating some time to my Mastermind specialist subject: poo.

Apparently, to make a go of blogging, you’re supposed to give tips and advice, which I find difficult, as I don’t feel I can claim much wisdom, and to be honest I'm basically here because I enjoy talking about myself. But I’m pretty sure I know more than average about children’s constipation, and it’s one area where I feel qualified to dish out advice. So if you’re here for general entertainment, or for actual useful information, I’ll aim to please, and as it’s a rather long blog, I’ll organise things with our story (spoiler: it's a long one but has a happy ending), followed by a few tips at the end, so you can pick and choose which bit to bother with.

Our poo journey

There is a certain relief or smugness that comes with your children hitting milestones. Our boys weren’t exactly early developers, for example, one son started walking at 18 months, just in time to avoid the ‘interventions’ the health visitor was threatening. But I was quite pleased to have a son toilet trained at age two. Whilst I appreciate this is nothing compared to past generations of terry towel nappy-ed children whose mothers had them on the potty ASAP, or indeed to my friends dedicated to elimination communication (one friend had a fully toilet trained ten month old, who would sign whenever she needed to go) but still, it's earlier than average for a modern day boy, and so prompted some smugness/relief that I was doing ok at one area of parenting. So there were lots of reasons to be displeased when after several months of successful potty-use, said son started doing bits of poos in his pants. I began the descent into feelings of mum guilt and failure, and my time, thinking and conversation increasingly began to be about poo.

The health visitor and the mums around me had various suggestions: Was he just under the weather? Was it behavioural? What events at home might be reacting to? Was he seeking attention? Had we just started a bit young? etc. But it got worse, more frequent, was accompanied by frequent complaints of tummy ache and temper tantrums, we saw the GP a couple of times and eventually, after weeks of daily cleaning out of pants and then resorting back to nappies, we figured out the cause: constipation. The leaking wasn’t poor control, behaviour, or a tummy bug, it was ‘overflow’ poo caused by being so completely bunged up. The GP suggested prune juice (we had to syringe this in – he hated the taste), then prescribed Senna, then Lactulose, and we watched and waited. And waited. Nothing happened. An American friend suggested I try Miralax (British name: Movicol) which apparently American children frequently use if they are backed up. She lent me a tub, and warned me, “Be careful – a little goes a long way!”

My goodness, she was right. A long way like out of the nappy, down the legs, across the floor, kind of a long way.

There were a few really spectacular events and I thought, Hoorah! That’s cleared it. Maybe things will be sorted now...?

But they weren’t. In fact, this was just the start of a years-long obsession with poo.

We had six months of more GP visits. They always felt his little round tummy and said he felt fine – no evidence of being backed up. One suggested a maintenance dose of movicol, another warned us to come off it because she thought it causes a lazy bowel. We persevered. Whenever anyone asked how they could pray for us, I asked for prayer for poo. Meanwhile, his discomfort and soiling continued. At one point, things were so out of control that it was just constantly oozing out of him, like a tube of toothpaste under slight pressure. I just couldn’t keep up with it, couldn’t keep him clean. I warned his childminder that she might want to resort to just scooping out poo from the back of his nappy like I had to do, as otherwise the whole day would be about changing him (she sensibly declined because of the smell). I had a desperate phone appointment with a doctor to ask for more medication which she wasn’t keen to prescribe, and she told me to carry on trying lots of vegetables and to get back in touch if things got any worse.

I burst into tears on the phone: “Get any worse? How can things get any worse? I’ve got a little boy who cries all the time that his tummy hurts and constantly soils himself. His nursery aren’t happy that he’s not toilet trained and if he can’t go there I won’t be able to go to work! How could it get any worse?”

She said she’d phone me back and hung up. Five minutes later she rang back with a new suggestion: actually, she would write us a prescription, a big one, and we were to give the maximum dose for his age.

It was a relief when we were finally referred to hospital to see paediatricians who seemed to know a bit more of what they were talking about. There were many questions which made me feel defensive about my parenting (“No, he doesn’t eat lots of processed foods. Yes, he does drink quite a lot. Actually, he was toilet trained, it’s just that he regressed a lot with the constipation.” etc). Then there was a physical examination at which point the doctor had his hand on my son’s abdomen and met my eye with a sort of apologetic sympathetic smile and said, “He’s absolutely LOADED with poo.”

We quickly learnt the lingo of poo. There’s this thing called the Bristol stool chart to help you monitor type (consistency) of poo. We had to do the first of several disimpactions, whereby you give loads of laxatives until the poo flows out like gravy, and then reduce to a maintenance dose so (in theory) you don’t get so backed up again. The problem is that a stretched bowel is prone to getting full again, and the child has lost sensation, so relapse is very frequent.

It went on for years. We saw several different doctors in different clinics and tweaked doses and strategies. There were even storm troopers (see https://sarahhadfi.wixsite.com/website/post/on-hospitals-and-storm-troopers ) I pushed for blood tests which revealed nothing and the doctor told me this is why it was unhelpful when parents insist on this. We practised timed toilet sits three times a day for twenty minutes, with knees hoisted and blowing on instruments or bubble wands. We kept records, offered rewards, yo-yo-ed on and off dairy products. Every time we wanted to leave the house we needed to take the kit (spare clothes, bags, wipes) to deal with all the soiling; I was constantly staking out the nearest toilet or place to clean up; and every night before bed I would scrub out dirty pants. The smell permeates – it’s like you never really get rid of it. Sometimes my son would pray that God would make his sore tummy better and a couple of times he cried that God hadn’t healed him, and I wanted to cry along with him.

I get that people deal with poo all the time. Infants have nappies which need changing. Some people are incontinent. But there’s something about having a constipated, soiling child where you feel like your whole life is thinking about poo.

He started school. I feared for the worst. What would the other children say about a boy who has constant accidents and sometimes needed to wear pull ups? Was it fair to ask the school to deal with this – the timed visits and the daily cleaning up? I’m a teacher and I felt so embarrassed about explaining our situation and asking them for provisions.

The school staff COULD NOT have been nicer. His lovely reception TA was so sweet and matter-of-fact about it all. She told me it was a real treat to have a nice one-one chat with him on his midday toilet sit. After a disastrous episode where he came home in his PE kit and she calmly and kindly discreetly handed me his bag of soiled clothes, I returned the next day with wine, and she just laughed and said we didn’t need to do that. I’m on online forums and there are so many horror stories about schools either leaving children soiled all day or constantly phoning home to insist the child is collected, and there are parents feeling forced to quit their jobs and home school their children. We’ve recently moved house but kept the boys all at the same school on the grounds that I simply can’t believe that another mainstream school would be as supportive.

Meanwhile, our pastor’s wife was on a conference and happened to start chatting to a man who was a specialist in childhood constipation, a Doctor David Campbell, Consultant Paediatric Gastroenterologist at Sheffield Children's Hospital. She thought of us, and asked if she could put us in touch. He was lovely. Full of sympathy and practical advice: I needed to ask for another referral, I needed to ask for imaging, we needed a proper maintenance plan. Ideally this could be delivered locally, if not we could travel to Sheffield to see him. I felt armed with information and a plan. We escalated to an X-ray (totally impacted again), they suggested a week’s stay in hospital for a full clear out (but then let us manage it at home) and then monthly appointments and monitoring. We tried various things: a transit marker study, suppositories (extremely effective, but unpleasant for child and parent) and transanal irrigation, by which you heat a solution, pump it in, and it helps wash out the poo. He started sometimes lasting through a school day without an accident, which felt like an incredible relief and victory.

You should have seen our prescriptions, though. The doctors joked we’d need an extension just to house all the stuff and we actually did consider it. There were the standard boxes of laxatives and bottles of stimulants but now also 30 one litre bottles of saline and bags of equipment. A few times I took an actual wagon to load up at the pharmacy, and then as it was all so crazy the company arranged home delivery (great system, and very cheery phone calls!). I remember once the delivery man was really grumpy because the boxes were too heavy. It wasn’t possible for me to carry them into the house so I had to unload on the front drive and carry them in a bit at a time.

And things started to get better. Fewer tummy aches, fewer tantrums, fewer accidents. I remember the first time he realised the sensation of needing to go to the toilet unprompted – it was a sign of the beginning of the end. We gradually weaned off the medications. We cut down on the transanal irrigation from twice a day to once a day to only when he didn’t manage to go by himself.

It is pretty amazing to go from having a child who constantly soils to one who can use the toilet by himself. Things now are way better than I thought they would be. We still keep an eye on things, he has issues with needing to go very quickly, but he is now pretty much a normal boy able to do normal things, like go to a friend’s house without me and a spare clothes bag.

So that it our poo story and I am unbelievably delighted for him (and for me) with how well it ends, and please let that be an encouragement for you if you are struggling with a constipated child, that even if things are pretty bad, it can get hugely better. And of course the hero of the story is my wonderful, very resilient son who went through all of that really unpleasant stuff and still came out a smiling and unresentful human being.

So to the advice part…

Once a friend dropped off his son for a playdate but said he’d need to collect him early as he was taking his son to the doctor because he hadn’t gone in days. I said, “Let me see what I can do…” Two hours later the dad arrived to his son wearing a borrowed outfit and all our windows open. What had happened? We drank lots of fruit juice and had a heat pack and practised some jumping up and down and cycling and then THIS happened!

I am proud to be the local poo queen; if you ever want to talk poo, I'm happy to oblige.

Here are just a few tips I’d give people whose children are struggling:

1) It’s not “just” constipation, something a bit silly and embarrassing. It’s worth getting sorted. Get good advice - go to your GP. If it goes on, it’s ok to ask for another opinion or a referral.

2) Get yourself educated. Here is a really helpful video: https://vimeo.com/179497116?fbclid=IwAR01AAQKSP185pFCo6CHZ8Gu79BTFYKW1FFnC8osFI7ZqIsOffES-R8DvA8 and a really helpful website: https://www.eric.org.uk/guide-to-childrens-bowel-problems (Eric also has a specialist advice phone line, plus lots of helpful leaflets eg for giving to your child’s school).

3) There’s plenty of good practice to help children who are a bit prone to constipation: encouraging plenty of liquids, eating soluble fibre, p fruits (peaches, pears, plums, etc), plenty of exercise - active things like trampolining and cycling can get things moving, have a toilet routine with a good position (knees higher than hips). Encourage all of them. But it might be that your child is at the stage where you are beyond what you can deal with ‘naturally’ and will need medication and other interventions, and that’s ok. Thank God for the NHS.

4) Communicate well with caregivers or school. Speak to a SENCo, make a care plan. Make sure they understand the importance of avoiding negative associations.

5) You can apply for a ‘Just can’t wait’ card for free. Flash it around to get to the front of the toilet queue and to get shopkeepers to take pity on you and let you use their facilities. https://www.bladderandbowel.org/help-information/just-cant-wait-card/

6) Pantyliners in pants are cheap and discreet and cut down on the amount of scrubbing.

7) It’s ok to feel rubbish about it. It’s lonely being the mum of the child who struggles with poo. I found online forums very supportive. Lots of stories which will make you laugh and feel better about your day. I discovered a university friend, also a mum of three boys, was also on one with me, and I can’t tell you how much better this made me feel. Misery loves company.

8) Prioritise the relationship with the child. It’s normal to feel really frustrated when a child won’t go, or soils themselves. But added emotions only make the situation worse. We signed up to care for these creatures’ needs, and we have to do it with good grace, so they are secure in their relationships with us. Smile and chat and love them whilst you deal with them and your millionth toilet visit that day, and sound off to a friend later when you’re totally sure the child is asleep. It’s also a really tricky balance to make your child do things he doesn’t want to for the sake of his health. Turn things into games, offer rewards, like an advent calendar where you open a window every time the child does his timed sits. Make your bathroom as fun and inviting an environment as possible – spending time in there isn’t a punishment. For us, prioritising the relationship meant giving up on suppositories as it was just too traumatic to force the issue. Another example would be a couple of occasions when we’ve had a really stressful toilet time in the morning and I’ve just emailed school and kept him home for a little while to calm down before taking him in (obviously not possible on work days). Or we might follow up a hospital visit with a stop at a garden centre to look at the fish, so our time together isn't just about poo. But also know that every parent has lost their temper and if you find yourself saying “What – again?” in a cross ironic voice, then you’re not the worst parent ever and your child will still love you.

9) It will probably get better. For us, it got way way better after years of it all feeling quite desperate. Most children mature out of it. But if yours doesn’t, you’re not alone. And there will be treatment options and a supportive bowel community. You’ll cope; people do.

And if all this talk of poo wets your appetite, I've blogged on other bodily fluids here: https://sarahhadfi.wixsite.com/website/post/on-the-yuckiness-of-little-children and milk here: https://sarahhadfi.wixsite.com/website/post/on-appreciation-of-dairy-cows