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Movicol questions - sorry very long(16 Posts)
Hello, I can see that there's a lot of experience with Movicol on here, so I'm hoping someone might be able to answer some questions - the GPs at my surgery are sympathetic but don't seem to be specialised in this and leave it to me to decide on doses etc.
My DS, 5.5, has been on paed Movicol since last July. Before that he had got into a habit of holding in his poo and going about every 3 days for very large BM (8-10inches), after a day or so of soiling. Gradually the time between poos got longer, more like 5 days, then suddenly he went 8 days so that's when I went to GP. She prescribed Movicol and after 2 days (1 sachet first day, 2 sachets second) he had another large BM. Soon poos were very runny (not liquid but running down his legs) so reduced to one sachet and in the next couple of weeks things got very loose again so reduced to half. Gradually we've reduced further, and now he's on about 1/4 per day, adjusting a bit depending on BMs.
From then until now he has been soiling every day several times, for a while he had no large poos at all but such a lot seemed to be happening in his pants that I assumed he was getting rid of it all. Now he has a large BM every few days (up to a week) with lots of soiling in between, but generally only if he's in the shower and I catch him crossing his legs and get him onto the loo in time. The poos are not as big as they used to be, which may be because a lot is coming out in between, and may be (I'm hoping) that the bowel is less stretched.
What I'm wondering is whether the constant soiling is because his muscles are weak, and he's tending to be a bit bunged up, but that when he does a "biggie" it is all cleared out each time- or whether there could be an impaction that has never got cleared. The GP was happy when she felt his tummy the second time we went, but he hasn't seen her since - they renewed the prescription over the phone. I will make sure they see him next time. He always (except once) says he has no tummy ache - just that sometimes doing the poo hurts. In fact, the time he had tummy ache it was followed by diarrhoea - he'd had a large BM the night before immediately after having about half a sachet (because I had a feeling he needed to go and hadn't been getting rid of enough through soiling the last few days I'd given him more) so I put it down to the Movicol acting on an empty bowel. The diarrhoea cleared up quickly and tummy ache went.
I imagine he'd have pain if impacted? Do children soil just because their muscles need retraining / time to recover?
Also, the large poos he does seem v big for a little person and a good consistency (sorry for detail!) and I can't imagine more being in there!
I had expected it to gradually improve but the only sign I can see is that he seemed to have lost the "feeling" to go altogether and now he seems to be getting it again - even though he still resists it. Mostly however, he soils without realising - it just seems to come without any control.
I don't mind the soiling if it's getting rid of what has to be got rid of(!) rather than causing a backlog, but just concerned it could be sign that things aren't clear.
I think it's mainly a behaviour thing, he never seemed to have really hard poos, but reading the high doses that some children have had to have to get rid of impaction, I just wonder if we have reduced the dose too quickly (although Dr seemed to be suggesting that we should.) When I up his dose very much his poos get very sloppy, and if I reduce too much the soiling reduces but then he does seem to get bunged up.
Any advice gratefully received!
He sounds still constipated and he didn't clear out. The soiling you describe sounds like overflow, basically the liquid poo working its way round the harder poo. You probably need to increase the movicol again and keep him at a higher dose for much longer so that he's completely cleared out before moving down to a maintanence dose. To give you an idea my ds is on 2 - 3 sachets per day just as maintenance. He is 6.
Thanks Mumgoingmad. The soiling is still quite solid - normal poo consistency really. Is overflow mostly liquid or can it be solid like this too?
Oh and another question... can someone still pass large (normal consistency) poos when they have an impaction, so even though a large amount has come out there is still a large amount of hard stuff left?
Our DD did daily poos which looked pretty normal but was still impacted. She has had no pain or sore poos. We had to do an impaction regime with the Movicol to completely clear her out over a week or so last summer. I had to do it again in December and am about to embark on yet another session as she is getting bunged up due to the side effects of medication for an irritable bladder and even 3 sachets a day aren't doing the trick. The impaction regime will result in almost liquid poo.
My DS passed normal poos whilst extremely impacted (as eventually diagnosed by xray) and also had liquid oeverflow.
I would ask for referral to a specialist. In my experience GPs and paediatricians were useless. We are under a gastroenterolgist and it is so much better to have an expert. Just cant imagine where we would be without but doubt DS would be attending school.
It may be that he is impacted or it may be that he has lost sensation in the rectum. My DS has been on a mix or movicol and sodium picosulphate to try to help regain sensation in the rectum but still several years on it is not recovered but improving.
Sorry but it sounds like you reduced the dose far too rapidly and he never really cleared the backlog.
Ds2 has just been given a 3 month prescription for 2 sachets a day and we've been told he'll remain on it after this.... That's the sort of time frame you're looking at. A bit of runny poo doesn't mean you reduce the dose, it means its starting to kick in. Ds2 has been having lots of loose poos for a week now, it's just starting to ease down now.
I agree with above and think he is still impacted. I found this stage really hard because it was really runny but had to keep giving it. I put ds in nappies and did it in half term.
There is a really good book by a paediatrician named Anthony Cohn called something like constipation and withholding.
It doesn't take long to read and gives you some really good advice about poo withholding etc which my daughter does.
My daughter is on a movicol am and pm and this keeps her going!
She to did a lot of what your son does and the soiled pants does sound like overflow,when this happens you think you need to decrease movicol but in fact you need to up it!
we went through this, and the marvellous specialist we finally ended up with got rid of the movicol straight away. He prescibed picolax for a major clear out and then trained the muscles to get used to the sensation of pooing by relatively long term use of Senna. Movicol is for constipation (dry /hard poo as opposed to not wanting to go) , not withholding. It draws moisture to the colon which is what liquefies the poo, it is never going to train muscles / teach a child how to push / do a poo. With us, the experience was horrible and the leaking / accidents wtih movicol made the mental problem far worse. The reason Movicol gets prescribed so much is because it's new, tested and has a very active army of drug company reps hustling it, which very traditional / old remedies like senna do not.
By the way - if stopping, you have to titrate downwards and also (simultaneously) titrate upwards on the senna until you get to a dose at which you're getting daily action. We gave the senna in the morning and it would work by 4pm - it's normally given at bedtime but for our child that would have meant middle of the night waking to go. She's right as rain now and goes every day - it was very much a withholding / mental issue. Ignore me if yours is proper constipation with dry / hard poo
Bobbi I've just read your post with interest, because DS1 has just be prescribed Movicol for withholding.
He goes every 2-3 days, and in the run up to going we get a bit of smudging with the occasional small lump. When he then goes it is huge, maybe 10 inches long and very large.
It is purely a mental thing, I am fairly sure.
I will see how we get on with the Movicol but I will discuss senna with the GP when we go back in 3 weeks.
he might need movicol for a serious clear out first if he's impaced (how long has he been withholding?) 2 - 3 days doesn't sound too desperate so it sounds like you're dealing with it early. FYI, the specialist always advised me not to tell the pharmacist that the giant (GIANT) bottles of senna were for a child because they'd disapprove ;-) We started on 5ml senna and increased daily until ended up on 15ml / day for a couple of months, then reduced slowly (1ml at a time but maintaining daily "action") - getting fine syringes to measure how much you're dosing very precisely is important. Also have a look at the ERIC charity website, it might help.
My dd2 (3) has been on movicol since she was 6 months old. She started on half a sachet at 6m and now has 1.5-2 sachets a day depending on how much is needed.
She has days where she constantly poos, she is still in nappies and we go through loads.
I am not sure if there is such a thing as the perfect dose with movicol, but if we go below 1.5 sachets a day she gets constipated again very quickly.
Just found the replies - thanks. Does sound like he should have stayed on a higher dose for longer. As it happens, we went to GP last week and he has referred us to a paediatrician, appointment in a month, so that's good. He felt DS tummy and said he didn't feel "loaded" despite not having gone very much at all in the previous 5 days (only a recent thing because I'd reduced Movicol too much a couple of weeks ago, up until then he'd been soiling a lot so getting rid of a lot that way).
I gave him 2 sachets on Sat and Sun, then on Sunday evening he finally did a big poo. I did reduce back down to 1 sachet on Mon and Tue, but maybe I shouldn't have. Today he's doing wet poos in his pants - maybe I need to allow this to carry on...
I hope they do a scan at the hospital and then they'll presumably be able to see any impaction.
Bobbi - glad your DD is sorted now - how old is she and how long did it take? Yes, definitely a holding issue here, DS only had a couple of hard poos when very small but I think that may have caused it all - now they are always soft and he admits that he just doesn't like the feeling of going - it "disturbs" him - and he said the other day he prefers to do it in his pants so he doesn't have to sit on toilet
alibaba - I meant to add that what your DS is doing now is exactly how my DS started, so I'm sure you've done the right thing getting help now. My DS went up from 2-3 days between (then huge poos as you said!) up to 5 then finally 8 days between. I didn't go to docs earlier as I was trying syrup of figs etc. but none of the things I tried helped. Think the bowel is probably stretched as a result, so hopefully a scan will show what's what.
Also meant to ask opinions on lactulose. This time the GP prescribed us that as well as Movicol, and suggested I could try it either instead or as well. I was thinking of using it alongside, after I have cleared this current back-up, but any advice on that would be appreciated.
What you describe, is exactly what we had with Dd 5, who is still on Movicol 3 years down the line. She just doesn't like going, (nothing medically wrong) and can hold on for days (8/9 was the longest) poos the length of her leg sometimes! Doctors don't think her bowel it stretched, and she will eventually grow out of it. We have weeks of pooing every day, then a relapse. Things are slightly better now she is at school. She prefers to go to at bedtime (soiling is usually from her holding in) Our consultant said Movicol should be reduced very slowly, and her bowel should be fine. But be prepared for the long haul. There is no quick fix. We have a reward system in place(paper coins she get one for going and loses one if she has an accident or doesn't go, then gets to buy something at the ed of the month)
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