A five-year-old boy who was so scared of going to the toilet he didn't for four months has now been fitted with a colostomy bag as a last resort.
Jake Clark stopped passing stools when he was just 18 months old and has since been hospitalised three times - once vomiting faeces.
His phobia became so bad that it took his parents six months to reassure him that it was normal to break wind.
Prior to that, the youngster from Warrington, Cheshire, would either hold it in or go and hide because he was embarrassed.
His worried mother Carrie Brocklebank, 23, said Jake had been developing normally until then.
Jake Clark, five, was fitted with a colostomy bag after refusing to go to the toilet for up to four months
'Jake was absolutely fine until he was about 18 months and we don't know what happened but all of a sudden he was refusing to go to the toilet,' she said.
'It might have been that he'd tried going once and it had caused him pain but after that he just didn't want to do it any more.
'I think what he'd done must have really traumatised him because after that every time he needed the toilet he would scream and cry and wouldn't let you anywhere near him.
'It was awful, it had started off as just being mild constipation which he was being medicated for but we knew it was something more serious when he went four whole months without passing poo properly.'
After more than three years of being assessed, doctors decided it would be best to fit him with a colostomy bag because the problem was getting no better.
Doctors spent more than two-and-a-half of the four hour operation clearing his bowel because it had become so full.
He underwent the procedure at Alder Hey Children's Hospital in Liverpool, just after his fifth birthday.
'We were told that because Jake had been holding the poo in for so long his bowel had become over-stretched and their only option was to have a colostomy bag fitted,' she said.
Jake Clark, 5, now wears a colostomy bag after developing a fear of going to the toilet. His mother, Carrie Brocklebank, said she hopes it will help him live a normal life after his phobia started at 18 months
'The build up to the operation was horrendous, looking at his tummy knowing it wouldn't be the same ever again, I actually took a picture of his tummy the morning of the operation because I knew it would be the last time it would be scar free.
Ms Brocklebank, who also has a daughter, Ellie-May, three, believes Jake's avoidance of going to the toilet is caused by a psychological issue.
WHY STOOL WITHOLDING HAPPENS
Stool withholding is when a child feels the need to use the toilet but resists it.
Resisting the need might involve crossing the legs, sitting on the back of the heels, clenching the buttocks and being fidgety.
The stool gets bigger the longer the child holds on to it and eventually when they absolutely have to go it is very painful and difficult to pass.
This can lead to a vicious cycle of holding on and pain.
A child might start withholding stools for several reasons – they may have experienced passing a painful or difficult stool; they may have a sore or anal fissure which makes pooing painful; or they might not want to use strange or smelly toilets and prefer to hold on until they get home.
the Bristol Stool Form Scale can help you identify whether poo is becoming constipated.
The ideal stool is number 4 on the scale - a soft, smooth sausage shape.
Source: Children's continence charity ERIC
He is also being tested for autism.
'We're still waiting for him to be tested for autism or to see if he has sensory issues so for now we have no idea what's been causing this.
'He's having play therapy at school at the minute to help him through the trauma of going to the toilet and also so he can be a bit more in control of his condition - hopefully this will help him quite a lot.'
She is now trying to raise awareness of the severity of constipation and to stop the stigma around colostomy bags.
When Jake first had his bag fitted he was so embarrassed he would hide it from his family, but is more confident now his mother pretends to wear one.
Children's continence charity ERIC, which recently launched its Let's Talk About Poo campaign to offer to support and advice to parents.
According to its website, about 100,000 children in the UK were treated by their GPs for constipation and soiling problems.
A spokeswoman for the charity said: 'Toilet avoidance in young children is common, particularly around potty training time.
'It usually results initially from constipation – the child passes a poo that hurts, and they learn to hold it in to stop it happening again.
'So more poo accumulates, so it hurts even more next time and the vicious circle has started.'
Brenda Hill, stoma nurse specialist at Alder Hey, said she couldn't comment on Jake's case specifically but said children of all ages can have formation of stomas for a variety of reasons.
'The decision to form a stoma is taken after a child and their individual condition has been assessed and all treatment options explored.'
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