How common is chronic constipation in young children really? / some wider problem?

(37 Posts)
perceptionreality Fri 04-Jan-13 20:56:59

Dd3, aged 3 years, 8 months is terrified to poo. This has been going on now for about 18 months at least. She will use the toilet to wee, but given the choice will not poo at all. Movacol does absolutely nothing. When she needs to poo she goes to lie down on her front and holds her buttocks together until it goes away. The GP gives me suppositories which I have to put in which is the only thing that will result in the poo coming out. Then what follows is about 20 minutes of crying and screaming until she finally goes in a nappy. When she is going she looks terrified. I have tried endless things to reassure her - stories etc and will always help her and talk her through it when it's happening, saying it's normal etc.

I have taken her to the GP many, many times but they say there isn't anything they can do about it except prescribe movacol and suppositories and of course I do see that the problem is psychological anyway.

The GP said this problem is very common in her age group - is it though? I have started to worry because she is due to begin school this year. I have also started to note other things about her which cause me to wonder if she has some undiagnosed problem - ie she hates having her teeth cleaned or her hair brushed and she screams the house down unless she can leave with her dummy, blanket, bear and drink - which she has to hold all of. She also needs to be in control of everything and gets very stressed if she can't. Lately I have noticed she wanders about the house reciting scripts from television programmes - this concerns me! (my older dd with ASD did exactly this). I always thought dd3 was unlikely to be autistic as her first word was 'no', which she used properly and in context well before the age of 2.

Nursery were concerned about her language development last year but then over the summer holidays she progressed a lot and they are now happy with that. It was put down to the fact she has glue ear. When the HV tested her language it was found to be slightly above average.

I am not sure if she seems quite normal though. Any thoughts?

MrsMushroom Sat 05-Jan-13 01:24:58

OP she sounds so similar to my friends DS who also recites scripts and uses lines from books in context instead of coming up with his own thoughts and impressions.

He zones out too and hasn't yet referred to her as Mummy or Mama....he talks but it's all from books and tv or songs he's learned. He doesn't ever ask for anything and as a result she just keeps drinks to hand and offers regular snack.s

He can't ever comment on things off his own bat...so if it's dark then he'll say something from the Gruffalo about the deep dark wood....he also has chronic constipation.....but he does have some good eye contact and social smiles...no pointing....he plays beside others.

He's on lactulose but it doesn't really help and my friend is worried but wants to see how he progresses as he's just about to turn 3 in Spring. I will tell her to do as you've been advised with the list.

ItsOkayItsJustMyBreath Sat 05-Jan-13 00:58:30

Oh, I forgot to say that we were referred to the constipation clinic by the local paed and we were told that ds, who is now 23 months and has been constipated since 6 months (start of weaning), had toddlers' diarrhoea, HE"S NEVER HAD DIARRHOEA! We are now getting him tested for hirschsprung's disease as apparently it might be that after all hmm

ItsOkayItsJustMyBreath Sat 05-Jan-13 00:53:26

As this has been going on for a lot longer than 3 months then I would say she does need an x-ray or scan to eliminate the chance of an obstruction somewhere.

It really could be that she has been constipated in the past and had a fissure/ piles which has/ have taken a long time to heal and created a cycle of stool witholding but I would insist on seeing a paed to make sure as GPs aren't specialists in this.

It's so incredibly frustrating when you know something isn't right with your child and yet the professionals look at you as some hysterical mother angry (sorry, having a vent here!).

perceptionreality Sat 05-Jan-13 00:40:47

No, no blood or anything. I have found that they best way to get it out is not to use movacol and to just use a suppository every few days. That way a very normal looking, large poo comes out. The problem is, of course that she doesn't like me putting it in and we can't go on like this really. I am not sure if she might need a scan to see what's inside?

ItsOkayItsJustMyBreath Sat 05-Jan-13 00:25:32

Sadly that's what's happened to ds too. He's been on Senna in the evenings and Movicol in the mornings for almost a year now and still has problems confused. Lactulose and Movicol don't encourage the poo to move, they just soften it so that when you go, it isn't hard iyswim.

Has she had any other symptoms like mucus or blood mixed with her stools?

<disclaimer, i am NOT medically trained in this!>

perceptionreality Sat 05-Jan-13 00:20:51

Thank you so much, ItsOkay - that is very helpful. She has been on movacol for a long time - I found it doesn't seem to make the poo come out. At nursery they also said that in their experience it doesn't seem to help the children they have known to be on it.

ItsOkayItsJustMyBreath Sat 05-Jan-13 00:14:35

Hi perception, so sorry to hear about your dd, it is so distressing to see them like this (I have history of bowel problems with ds and have faced some very apathetic doctors angry).

Have a look at the guidance page for HCPs regarding the management of chronic constipation here. It says that you need to continue the movicol for several weeks after normal bowel movements have been established but if they do not establish after 3 months then referral is necessary (NICE guidelines). Maybe you could print this page out and take it to your doctor to show him and give him a kick up the backside for not doing his properly?

My ds has an appt on Monday for his ongoing bowel problems and I have said that I am not going to leave the hospital until something is done; sometimes you have to become a little more than assertive in order to get things moving.

Good luck and I hope your dd's condition is treated promptly.

perceptionreality Fri 04-Jan-13 23:58:37

Thank you all again. I am going to explore all possible angles, but one thing's for sure - this can't go on with no answers!

Firstly, you definitely should see a paediatric gastroenterologist.

Secondly, Movicol does work but what you're describing doesn't sound right for a child on Movicol. Your DD could have chronic faecal impaction which is never resolving itself. That would explain the leakage issues she has. Again, a gastro would be able to look into this and review the Movicol dosage accordingly.

Thirdly, yeah it is very common. My DD has been on Movicol since she was 7m.

incywincyspideragain Fri 04-Jan-13 22:26:30

my advice would be focus on the phsyical affects before looking at ASD - even if she is ASD you still need to address her pooing and any sensory issues will be affected by that and her glue ear. How bad is the glue ear? Can she hear all the pooing strategies and reassurance?
Some good advice about seeing another GP for advice, good luck x

spookycatandfluffydog Fri 04-Jan-13 22:13:05

Also look at the ERIC website (they are very helpful

spookycatandfluffydog Fri 04-Jan-13 22:11:05

Definitely try lactulose (and prune juice smile as an alternative. Also making the loo a fun place (blowing bubbles can help!)

perceptionreality Fri 04-Jan-13 22:09:11

Thank you seaweed - I will start to write a list of her behaviours.

seaweed74 Fri 04-Jan-13 22:06:44

I'd write down all your concerns re dd3 so you don't forget anything when you see gp, and mention your older dd's diagnosis as new gp should be made aware of family history.

Good luck.

perceptionreality Fri 04-Jan-13 22:01:08

Well she did a poo yesterday and it looked totally normal but just a lot of it. It is only when I give her movacol that it goes runny.

perceptionreality Fri 04-Jan-13 21:59:55

She was very late sitting and walking - sat at nearly 1, walked at 18 months. She still runs a bit like a baby (iyswim). The GP doesn't know of my other concerns because it's only recently that I've noticed how obsessive she is about everything.

I have made an appointment now with a GP who is known to be good. Hopefully I will be able to get him to refer. If not looks like I'll be paying £1000+ for a full assessment again. I can't let her start school without these things being investigated first - it wouldn't be fair on her I feel.

seaweed74 Fri 04-Jan-13 21:59:40

I don't have the Movicol patient info sheet to hand so can't check what it says, but remember our paediatrician saying that my dd was taking a tiny amount of Movicol compared to many children. He mentioned some dc being on 10 sachets a day! Definitely sounds like a blockage somewhere. Liquid seepage indicates some solid matter somewhere blocking the passage. Some dc end up with a sort of "pocket" in their bowel where poo collects.

perceptionreality Fri 04-Jan-13 21:51:16

I have tried giving 6 sachets of movacol a day but all that happens is that a small amount of poo dribbles out. The suppository is the only thing that makes her go. When she does go, afterwards she'll say 'I feel better now' and the poo looks normal (ie not hard or difficult to pass).

seaweed74 Fri 04-Jan-13 21:50:22

Wow OP. I have clearly been very lucky with our care and help or you're really unlucky! Second trying to see another gp. I got dd1 referred to community paediatrician at 22 months by gp for no standing at that point. Amazingly got appt at 23 months and diagnosis of hypermobility at that point. As already in system and full developmental check done at this point, delays in other areas were also noted at this point.

By chance when dd1 was 2.7 years we were about to start a new session of speech therapy so I noted down her vocab - was so proud of her 17 words at the time! Anyway that's why I realised that only a few months later we were down to 5 words. It was a conversation between dd1's physio and speech therapist following chats separately with me that got us a referral to the communication clinic for diagnosis of ASD. Following diagnosis we realise how many red flags we'd not noticed or ignored blush. I'd done the mchat when dd1 was 18-20 months too and that had indicated ASD.

Can/would HV refer your dd to paediatrician especially with your other dd's diagnosis? Different gp? Does your current gp know of your other concerns as well as the constipation? If not a referral to a paediatrician, would gp refer to a specialist nurse re bowel problem?

Sorry for firing off questions.

Also, have you read "constipation, withholding and your child"? I found it really helpful and made a big difference to us. DD has come the rest of her way by herself by nighttraining - not wearing nappies at all seems to have cleared it all in her head.

Movicol not modicom, stupid autocorrect.

I have a DD who had similar issues (same age too!) She was prescribed lactulose instead of modicom as the GP I saw felt it was better at forcing dc to Poo than movicol. I think you definitely need a different GP and a referral.

Really have no idea about the AS/HFA possibility because I have the same concerns but am waiting until she is older to see if her social skills improve.

Hi op. I had this exact problem at this age (my mum loves to remind me!) I did get over it. The pooing-phobia developed after very bad constipation which hurt so I was then scared to poo.

What you're doing it good re reassuring etc but because of the other issues I would see another gp and push for a referral

perceptionreality Fri 04-Jan-13 21:35:53

seaweed - I have an older child with classic autism so she is totally different. But I remember reading George & Sam by Charlotte Moore - she didn't realise Sam had ASD at first because he was so different from George. But my feeling is that something may be going on here. I don't think I am going to be able to get a referral easily here. I had to pay for my older dd's diagnosis report and as I said she is severe and had no language at all.

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