Potty training a 4 yr old with constipation problems due to hypotonia

Melanie - posted on 08/08/2011 ( 17 moms have responded )

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My son Ian was born 2 mths premature, weighing only 2 lbs! He has several developmental delays and potty training has been difficult!! Ian is the kind of child who does things on his terms, but once he decides he's doing something, he does it full speed ahead! Well he has decided that he's gonna go potty on the potty (which he has done excellent with)!! The problem is Ian has stomach problems due to hypotonia, so he doesn't know when he has to have a bowel movement, which is causing him to have them in his pants, and that is discouraging to him!! His little sister has been potty trained for 2 yrs now and he doesn't understand why she doesn't go in her pants but he does!! I'm just wondering if anyone else has dealt with such a situation and if so how? I feel so bad for him and I'm concerned this is going to discourage him from going at all!! He's such a little fighter and has overcome many opstacles but this has been the hardest!

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Jenny - posted on 08/09/2011

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My daughter has constipation problems also due to her having spastic quad CP. She also has PVL, sensory processing disorder, low muscle tone, and cognitive delayed. She takes miralax every morning to help her have bowel movements. We are still working on potty training and she is 7 1/2 years old.

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Yadira - posted on 09/18/2011

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my daughter has hypotonia she is 3 and a half. i was not aware that hypotonia had anything to do with constipation. is this something that the doctor told you? because my doctors will just tell me she'll be fine with any concerns i have....a bit frustrating that i have to come to the internet to get more info.
my daughter seems to have a bowel movement at around the same time everyday. and sometimes she will say that she has to pee and will sit and then not do anything then she will say it again and not do anything....so i've noticed that that is when she needs to have a bm.
Ian will do great it will just take a little longer.

Kris - posted on 09/17/2011

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This thread is eye-opening! My 4.5 year old son started OT a month ago for hypotonia & dyspraxia. We've struggled with the potty training since he initiated interest at 15 months old! Why didn't the OT tell us it could be related? So frustrating. How are we supposed to help our kids if the medical "professionals" don't? Arrrgh. Mini-vent - sorry. But, seriously I can relate. My son started getting constipated with the start of OT. Weird coincidence... or so I thought. He was getting over stimulated with the brushing & joint compressions so much that we had to stop doing it. He normally doesn't respond to pain like you'd expect (absence of reaction). Now, he's holding his BMs because it hurts. And if you saw the size of some that he passes! I can't believe he can even pass them. He also has a special diet (very limited) due to allergies & a metabolic issue, so we tend not to do medications if alternatives are available. He doesn't tolerate most meds. We are going to try doing prune juice this morning. Fingers crossed that it will loosen him up just enough to pass without it turning to diarrhea. I don't know if Ian can have it but a food to consider that naturally loosened up my son was Amaranth grain. It got him going a little too loose. But we since figured out that he doesn't tolerate any whole grains, just the flours & gluten free. Good luck with Ian!

Delana - posted on 08/31/2011

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Try to explain to him that his muscles don't work the way they are supposed to and to try and be patient, but to keep trying. He will eventually out grow it. My daughter had this same exact problem. She was finally completely potty trained at 6 yrs old. One thing that helped was going potty on a schedule whether she felt the urge or not. BTW, If you want to talk about the hypotonia issue more I can be reached @ delanagolden@hotmail.com

Melanie - posted on 08/09/2011

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Thanks Jenny! Ian's Miralax is also prescription! He gets his as needed and some times it's daily, sometimes weekly, and sometimes I have to give it to him 2 times a day depending on what he's eaten! for the most part it's daily though but there are some weeks where he's had so much he has diahrrea for days so then I have to stop it for a day, which ends up getting him all backed up again, so then he needs it twice in the day!! It's really a pain with him because it has to basically be diahrrea in order for him to get it out but his dr doesn't want him having diahrrea for to long because he doesn't eat much so could become dehydrated quickly!! So it's really a never ending battle which I hope gets better with age but so far seems to have gotten much worse!!!

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I understand, it can be frustrating trying to figure out what works. My son who is 16 has a slow small intestine so it takes forever for him to have a bm. He does have bm's when he takes Mirlax but we also started him on ADHD medication Focalin xr and it actually has helped keep him regular finally. I am thinking his is aggravated by stress and the slow small bowel. Surely the coconut oil will do it for your little guy! Be encouraged and just keep trying! :)

Jenny - posted on 08/09/2011

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PVL is damage to the white matter in her brain. We get my daughters miralax by prescription as she has to take it everyday and then her insurance pays for it, so it makes it cheaper than buying it over the counter. She has to have loose stools in order to be able to go. If we miss a day then it gets hard for her to push it out.

[deleted account]

My son also has ADD/ODD and takes meds that kill his lunchtime appetite and he never cared for the Pediasure shakes didn't matter what flavoour it was. So weight has been a struggle from the get go he is 8 and a half now and is just creeping up on 50 lbs but he loves his steak and potatoes!

Sherri - posted on 08/09/2011

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My son also wouldn't chew certain foods especially meat - he would always store the food in his cheeks like a chipmunk. I think he also didn't have the strength to chew it but I'd say in the last year he's gotten sooo much better. He eats a lot more meat, still small portions compared to other kids his age (5 1/2). And for the first time (with the help of the pediasure) he was in the "normal" range for his height and weight at his preemie follow up this past year. Hopefully your little guy will be able to eat better too as he gets bigger.

[deleted account]

We did the Miralax and Laxaday thing every morning as well just to loosen the bowel movements, we had to even do Duloclax once in a while just to 'clean' things out. It was a long and very frustrating process but it has finally gotten better but I think fibre pills will always be a daily thing. Because my son stretched out his inner rectum by holding when he was constipated I don't know if it will ever be the same again but right now things are good.

Melanie - posted on 08/09/2011

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Thanks Shannon! I just feel bad for my little man because it's really discouraging to him when he feels like there is poop in there but he can't push to get it out!!

Melanie - posted on 08/09/2011

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Jenny may I ask what PVL is? My son has a sensory disorder also which was why it took him until now to even start to potty train! Ian gets miralax also, but it only helps to an extent because his stomach muscles were affected most by his hypotonia! I just feel like it's a never ending battle with his bowels because basically he has to have diahrea in order to clear the bowels out!!

Melanie - posted on 08/09/2011

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Sherri he gets pediasure with fiber also but his is because he doesn't have the strength to chew food especially meat, so he's underweight! His pediatrician feels part of the weight is because of the prematurity plus I'm very thin so he's got that against him also

Melanie - posted on 08/09/2011

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Julia because of the hypotonia (weakened muscle tone) his stomach muscles just don't have the strength to cause him to have bowel movements! He is on a prescription medication and gets pediasure with fiber, but it's still a matter of the bowels loosening up enough to just come out without him pushing them out!! Basically he has to have diahrrea once a week in order to empty his bowels!! This is why were having such an issue! Thank you for the advice! I'll try the coconut oil and see if maybe it can help him out!!

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My son had a GI tract issue and we had to re-potty train him at 4 years old! He actually went to the 'Poop' psycholgist, which was just a pediatric psychologist but she had 'poop' discovery sessions with my son. They learned to recognize 'sneaky poop' and built a model of him. He also has a book called 'It hurts when I poop' There is a lot of literature on it. He is now 8 and it has been about a year since we had an accident. He takes to Metamucil Fibre pills a day and fish oil and it seems to help. I hope this helps I know how frustrating it can be.

Sherri - posted on 08/09/2011

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Wow your son sounds so much like my little guy! He was also 2 months premature and has constipation problems. He is also the kind of kid who does things on his terms - he will get something (ie potty training) then stop doing it and then all of a sudden he decides that he'll do it now and never looks back. It's frustrating to think you have a milestone mastered only to have him revert for a while, but we've learned that it's only a matter of time until he decides to do it! Regarding the constipation - we use Pediasure fibre and fibre powder to help because he doesn't sit still long enough to eat his food. I think I will try the coconut oil like Julia posted about. Good luck!

[deleted account]

A couple of thoughts; you might try adding a teaspoon of coconut oil on high fiber bread to help get him regular then try regular intervals to find out if there is a pattern to when he has bowel movements. The coconut oil is great about making bowels move but if to much will give you diarrhea. I suffer from IBD with constipation and amazing how coconut oil gets things going. So working on the constipation may help get him regular to regulate when he goes. Also drinking plenty of water to get fiber moving is important. It is a tweaking situation with how much cocnut oil but one tablespoon gave me almost water diarreah.

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