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Dr. Stoll,
I have been following the protocol using the mineral oil and fiber choice tablets (which you OKed). She is going daily now so it is working!!! My question is this: the protocol says to increase fiber amount until she is have 2-3 stools a day. However, the one that she is currently doing is extremely soft (thick and soupy). Do I continue to increase the fiber eventhough she is already having one that is that soft? Thank you for your patientence and your assistance as I continue to ask questions that my doc doesn't have time to listen to. This is the only place that I have found where I have gotten decent support for this frustrating problem and I appreciate it immensely.
Tracy
In Reply to: Withholding stool (another question) posted by Tracy on January 17, 2001 at 17:34:50:
Congratulations, Tracy.
Your situation was easier than most to resolve. You need not increase the dose at all. You might even be able to reduce it a little in a week or so (carefully).
When this is over, you might reassess what your doc should have done since he knows this stuff as well as I do!
Let us know how she does.
Walt
In Reply to: Re: Withholding stool (another question) posted by Walt Stoll on January 19, 2001 at 11:47:04:
Don't get me wrong. She's still attempting to hold it by laying on the floor and crawling instead of walking etc. etc., but when it comes out it is very loose. I don't know how to get her over that psychological hurdle. Up to two weeeks ago she was holding for 5 or 6 days straight. I thank you because it has enable me to relax a little. THANK YOU!!!!!!
In Reply to: Withholding stool (another question) posted by Tracy on January 17, 2001 at 17:34:50:
Dear DR. SToll and Tracy: My granddaughter has a withholding problem also. My daughter was advised by her pediatrician to give milk of magnesia (this was almost a year ago). She had some success with that, but it became more and more difficult to get my granddaughter to drink it, and she continued to withhold stool, sometimes for 4 days. My daughter would end up giving her a suppository, which worked immediately - without dissolving. The pediatrician did not want her to give a suppository, but that is the only thing that worked most times.
When I started reading this bulletin board, I told my daughter about it, and she tried giving the MO, which the granddaughter absolutely refused. So, she has been giving more and more Metamucil, which does work but it still takes 3 to 5 days and is rarely soft. She does sort of the same things as Tracy's child - she has a weird way of moving her knees up as if she is exercising, and it happens constantly when she is withholding the stool.
She is two and a half years old and a very bright, child (of course! - :-). And she insists that it doesn't "hurt" when she has a movement (in a diaper), but my daughter did notice a drop of blood about 6 months ago, and she also saw a small hemorrhoid which disappeared and has not come back. She has not attempted to toilet-train her (except to show her the potty and read a book about it to her). She doesnt go to daycare.
She continues to make a big fuss and do her "thing", as we now call it, everytime she has a BM. The last time was a few days ago and my daughter finally had to give her a suppository because she (my daughter) said that my granddaughter's tummy felt hard (this was after 5 days). AS usual, it worked immediately.
I was wondering why they don't have something like Colace for children - or is this totally different from MO?
Also, is my daughter hurting her in some way (psychological or otherwise) by giving the suppository. Is there any way to give the MO except by force if a child refuses to take it? Is it O.K. to continue to increase the amount of Metamucil beyond 3 tablespoons per day? Why wouldn't these children develop cramps from so much fiber? My granddaughter shows no sign of discomfort - she just continues to do that weird "thing" that I mentioned above.
Thank you for any advice you can give us. I hope this letter isn't too confusing. I wrote to you about a month ago, but it went to your son! He was kind enough to write back and tell me to write you on this bulletin board. Raisa
In Reply to: Re: Withholding stool (another question) posted by Tracy on January 19, 2001 at 17:33:52:
Tracey - I forgot to ask you how old your daughter is, and how do you get her to take the mineral oil? Also, when did she start withholding? What had your doctor recommended? My daughter's doctor told her that the reason she withholds is to have control over things - that she is a very strong-willed child. She did tell her mother after the last movement that she wasn't going to go again "for a year"! But, of course, she has no idea of time. Thanks. Raisa
In Reply to: Re: Withholding stool (another question) posted by Tracy on January 19, 2001 at 17:33:52:
Hi, Tracy.
This means that you need not cut the dose yet. She will get through this phase as soon as she is convinced that there will be no more discomfort with stools. Some are more stubborn than others but, finally, the discomfort of stinky messes in her pants will overcome her habit.
This phase will be in the range of a few weeks--ESPECIALLY if you are in no hurry to change her when she messes.
Let us know how she does. She will finally find a less onerous (to her) method of establishing her independence. For now, you must consider that the more attention you give her about this the longer she will hold to it.
Walt
In Reply to: Re: Withholding stool (another question) posted by Raisa on January 20, 2001 at 12:15:47:
Hi, Raisa.
Colace would also work but it would take a lot of it. There is no danger to taking a lot as it is not a laxative like the MOM is.
See my notes about this within the past week. The MO is not required to resolve this but the fiber or colace IS. Of course it takes a few days since it is not a laxative and is dependent on the person's "transit time".
You have to get here stools soft enough (every time) that not only will she not be able to hold it but cannot have pain. If she is getting hemorrhoids and bleeding she IS having pain--no matter what she says.
ALSO, you have to know that she is using this as an attention getting mechanism. You need to separate what you do with the fiber from the BMs (in her mind). One of the reasons the suppository works so well is that she has been able to control her mother's actions and rewards her mother by having the bowel movement.
Once you get her having a soft and bulky movement at least twice a day, the next thing is to not be real quick to help her change. Eventually she will figure out a better way to control her mother and how uncomfortable and stinky it is will help her do that.
Her mother is damaging her more by letting her (the child) control her by this problem than she (the child) is being damaged by this "problem".
You could give her 20 tablespoons of metamucil a day without risk. NONE of it is even absorbed--that is how it works.
Let us know how she does.
Walt
In Reply to: Re: Withholding stool (another question) (Archive.) posted by Walt Stoll on January 22, 2001 at 12:40:19:
Dear Walt:
Thank you for your help! I hope you won't think this is a dumb question - I really need to know so that we don't do the wrong thing. Did you mean that she can use Colace INSTEAD OF Metamucil or with it? We were looking for something to give instead of the mineral oil. I just want to be sure that it's O.K. to give both of these (the Colace and the Metamucil)
Also, does it matter what time of day the Colace is given (if you say it's all right to give it plus the Metamucil)? I know that the MO is supposed to be given only at night.
Thank you so much for clearing this up! I hope I haven't totally confused you! Raisa
In Reply to: Re: Withholding stool (another question) (Archive.) posted by Raisa on January 23, 2001 at 12:57:37:
Hi, Raisa.
The MO is just so that movements will be lubricated and not cause pain. The colace could only take the place of the metamucil. You CAN combine them but it would be harder to figure out the dosages.
Both the colace and the metamucil needs to be taken at least twice a day (3 times wouldn't hurt).
Hope this helps.
Walt
In Reply to: Re: Withholding stool (another question) (Archive.) posted by Walt Stoll on January 25, 2001 at 10:00:42:
Dear Walt - Thanks again for your prompt answer!
I do have a few more questions, and then hopefully the next time you hear from me will be a Testimonial!!! (I hope!) And I promise that no matter when it happens, I WILL write a testimonial.
My granddaughter's stools are semi-hard, but, as I said, she insists it doesn't hurt. And we have watched her, and she does "push" a lot sometimes, and , of course, the movements are large; but I wouldn't call them "hard" and they are not "pellets".
Did I understand you correctly about being able to conquer this with only the Metamucil? (if she gives her enough). Or should my daughter keep trying to slip a little mineral oil in juice? Sometimes the stools came out looking like jelly, but this hasn't happened lately.
Would it hurt to give the MO during the day - a little at a time - or would that deplete her body of vitamins and minerals?
Thanks very much for any advice you can give!!! Raisa
In Reply to: Re: Withholding stool (another question) (Archive.) posted by Raisa on January 25, 2001 at 10:52:34:
Hi, Raisa.
For the short time (6 months) she might have to take the MO, you do not have to wrooy about the fat soluble vitamins since they are stored in the body and would take a year or so to make a difference.
Don't let her tell you that this doesn't hurt. She is not old enough to KNOW what a normal bowel movement feels like. At this time, her self-talk is something like this: "This is an uncomfortable bodily function that I would sooner avoid all together. If I withold long enough perhaps I will grow out of having to ever do it again." Her bleeding is because her skin at the anus has already split. Don't believe that that did not hurt.
The movements do not have to be "hard" do cause this. If they are large enough to hold their form, and are large as an adult's, they will still dilate the anus enough to cause discomfort. Remember, this is a 2 1/2 year old!
The metamucil, alone, will resolve the problem IF you can get enough into her to cause several movements a day.
Walt
In Reply to: Re: Withholding stool (another question) posted by Raisa on January 20, 2001 at 14:10:02:
Sorry I never responded. I've been out of pocket for a while. We are having tremendous success right now. My almost 3 and a half year old is now having BMs twice a day. As for your mineral oil question, we give it to her in chocolate milk every night for dessert. It is whole milk so it is kind of thick anyway and she doesn't seem to notice the tablespoon and a half we put into it. You could also melt icecream and mix it into that--desperate times call for desperate measure. As for the fiber, I have found something that is working very well for us. It is called Fiber One cereal and it has 14 grams of fiber per one half cup serving. She eats it for one serving for breakfast and one for lunch. I sprinkle a little sugar on it and she likes it. I could never get her to take enough metamucil. There are also chewable fiber tablets out there that I can get her to take. Get the sugar free kind since you get more fiber per tablet. I have been dealing with this since she turned two. Thanks to Dr. Stoll there is light at the end of the tunnel. I hope you come back and read this. If you have any further questions or need some words of support just let me know as I know this can be maddening.
In Reply to: Re: Withholding stool (another question) (Archive.) posted by Walt Stoll on January 22, 2001 at 12:40:19:
After many many many months (7) with huge doses of mineral oil and metamucil (she had anal leakage of the mineral oil which was orange-stained from beta carotene and made laundry virtually impossible), I found we needed serious behavior modification as well. I worked with a great multi-disciplinary clinic (with pediatric gastroenterologists who spend enough time with the kids and nurse practitioners who follow up by phone and spend over 1/2 hr with you!). They prescribed short term use of senna for us (which I think is a bad idea unless under a physician's care since it's a laxative) and a FABULOUS stool softener called LACTULOSE. It is only available by prescription but is much easier to get in your kid (since it is an undigestible milk sugar and tastes like corn syrup). Whereas I once spent much of my days thinking up ways to cajole my kid into her three adult-sized doses of metamucil, I was able to stick this medicine in food and drink easily (or in an oral medicine syringe).
I THINK THE METAMUCIL/MINERAL OIL TREATMENT IS A VERY GOOD ONE, BUT FOR OUR REALLY HARD CORE Cases (more than a year), SOME BEHAVIORAL TREATMENT COACHING (two different therapies on two different visits based on her potty-training and intellectual development levels) AND A PRESCRIPTION FOR LACTULOSE (generic name) HAS BEEN BENEFICIAL FOR US. AMAZING BUT TRUE, SPECIALTY PHYSICIANS AT A HIGH-TECH TEACHING HOSPITAL CAN PROVIDE WHOLISTIC HEALTH CARE!
Just thought you should know Walt and others that there is hope for our medical establishment yet (as a former hospital administrator I never thought I would see this).
In Reply to: Stool Withholding - Found another help! posted by Edie Mom of almost 4-yr old on February 11, 2001 at 12:36:28:
Where do I find a place like that? I mean for the behavioral side of things. We, using Dr. Stoll's therapy, with one cup of Fiber one cereal instead of metamucil are having success in getting her to go now twice a day, but we are not making any headway with the bowel training side of things. She had beem doing the withholding for a year and a half when we finally got her to stop, but she is afraid to even try to go on the toilet. Any suggestions that you've learned would really be appreciated.
In Reply to: Re: Stool Withholding - Found another help! posted by Mom of 4 on February 11, 2001 at 21:32:18:
Hi, Mom of 4.
You are well on your way to resolving the physical parts of this problem. Psychological help, which some kids need, is MUCH more effective at this stage than it would have been before you got here.
Let us know how she does.
Walt
In Reply to: Stool Withholding - Found another help! posted by Edie Mom of almost 4-yr old on February 11, 2001 at 12:36:28:
Thanks, Edie Mom.
I am gratified to see progress in the profession.
I appreciate your sharing with us these advances.
The thing about psychological help is valid AND, once the physical part is dealt with successfully, is MUCH more effective than it would have been before such was done.
Namaste`
Walt
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