Just been to a&e with DD, constipation

[norksinmywaistband]

DD has had constipation for about a month now, last weekend she had me up all night crying in pain with some overflow as well, finally got her to go Monday morning.
Saw GP and was prescribed 5ml lactulose daily

Repeat performance this weekend, but tonight she was crying, screaming and doubled over in pain - got to a&e and on examination the Dr said he was not even sure if the suppository would work as she was too bunged up and was all ready to admit her.

Thankfully it did work, and she is now sleeping peacefullly in bed.

The dr in A&e has said she is to have 10mls 3x a day of the lactlose - that seems a very high dose compared to what the GP said, but not very aware of these things.

I feel so and with myself for letting her get into this state and not pushing for more help earlier.

Anyone experienced this dose of lactulose??

[Washersaurus]

I'd ditch the lactulose and ask for Movicol powder. It takes a while to get the dosage right but it really works.

Your poor DD, how old is she?

[norksinmywaistband]

She is 4, I hate that she has been in so much pain.

Is the lactulose no good then?

[Washersaurus]

DS1 was prescribed it when he was a baby and it didn't work. He went onto Movicol until he was 3yo. It really gets things moving but is difficult to control the dosage; the effect of this may be scary for a 4 year old though - I know there are others on MN with older DC's who use/have used Movicol who could offer you advice.

It is definitely worth investigating.

[wrongsideof40]

lactulose is a softener - helps retain water in the sools so are less sore to push out. We had a long term constipation problem with my DD and used lactulose for years, prob 2 x 10ml at about age 3, but in conjunction with Senna syrup. Can't say the regimen was particularly effective. I have heard that Movicol is very good but my GP never suggested it - with hindsight I could/should have been more proactive. I would take Washers advice and ask for Movicol.

[LargeGlassofRed]

poor little thing can sympathize, have had awful constipation this pregnancy. Didn't have any joy with lactulose or movicol. The only thing thats keeping it at bay is 2 senna tabs every night.

[3littlefrogs]

5ml daily (lactulose)is far too small a dose for the condition you describe. TBH, lactulose only works, for the severe condition your dd has, if it is combined with senna and docusate, for a period of weeks or months, with very close supervision by a doctor experienced in treating severe constipation/witholding.

I have heard that movicol is much better, particularly for children. But experienced medical supervision is very important to prevent this turning into a chronic problem. IMO.

[Washersaurus]

It is such a horrible thing for them - DS1 used to scream and break out in a sweat when pooing. He isn't on Movicol anymore but still has trouble now and then and I think this is the reason we are having problems with toilet training.

[KathG]

The thing that has my DD under control now so we don't end up in a constipated state is regular swimming lessons (often has to come out half way through to go to the loo)

[muggglewump]

I had this with DD a couple of years back when she was 5. She was on 10ml of both lactulose and Sennakot twice a day.
It was awful, she screamed in pain, pooed herself with the overflow, wet her bed because it was pressing on her bladder and hardly ate.
She's a good and adventurous eater but I was lucky to get her to eat half a fishfinger and two chips.
I kept her at home for a week and a half because she wanted to be with me.
I know others would have sent her to school but I just couldn't do it to her, she was so miserable and weak because she wouldn't eat. She needed Mum cuddles..

It did clear after about 8 weeks, and when it did, it cleared all at once, my whole upstairs was covered in poo!
I had a BF at the time and I remember joking that I was trying to be sexy and I failed badly when he had to help me clen up the poo as even I was covered in it!

Luckily he was a good guy and did help with the clean up.

DD has been fine ever since but I do make sure she goes often. Saying that, she did before and it really came from nowhere.

I hope your DD gets better soon, it really is awful to see them in pain.

[muggglewump]

And I should have said, don't blame yourself. I didn't see it with DD either, she ate plenty of fruit and veg and only drank milk or water, still does.
It really came from nowhere and it didn't occur to me to watch for it as DD is independent in the loo.

I ask her now if she's pooed, and do make sure she has if she's said she has which is gross I know, and it's not that I think DD will lie about poo, I just want to make sure as I don't want her, or me to go through that agin. It really was awful.

I called NHS direct one night and they could hear DD screaming in the background and just told me to give her orange juice.

[sandcastles]

Deff go for the movical! Nothing works as good as this!

Dd (5) was exactly the same recently! They even gave her an adominal xray to check that it was nothing else except constipation.

Nothing worked until she had a weeks worth of Movicol.

And it's not your fault! I didn't realise that dd had stopped being able to pass stools. New baby etc! Also until she was in alot of pain there were no other indicators! She continued to eat well & play etc!

I hope your dd is better soon!

[sandcastles]

Th dose we did (hosp directed) was

1/2 sachet when we got home (was almost 10pm)

1 full sachet next day

1 1/2 (in 2 doses, so 1 am 1 pm) on third day

2 a day for 4 days.

She is 5, so not much older than your dd.

[sandcastles]

muggglewump, we go in & 'check she has wiped her bottom properly' to check dds poo! She is independant too, but this way she will let us in & we can check. I am now on alert & if she hasn't been for a while, or they are pebbeled (was told that this means that the stools are harder & therefore harder to pass) we put Coloxyl in her water to help soften them.

Thankfully we hav ehad no major dramas since the movicol sorted it.

[jabberwocky]

Sadly I have much experience in this area. Definitely follow the excellent advice here and be pro-active. With ds1 we initially had to do an enema to get things really sorted. Do a search under my name and impaction - there are several threads on this.

[muggglewump]

I do the same Sandcastles and it's been two years!
I just don't want it to ever happen again though as it was awful.

I picked her up from school one day and she had a poo in her pants. She was too embarrassed to say anything.
That's when I kept her at home for a week and a half, we got it cleared in that time though.

She lost a lot of weight and just wasn't herself at all, very withdrawn and rarely smiled.
It broke my heart to see her like that.

[sandcastles]

muggglewump, I gave dd a week off school & sent her back because our trip to the dr convinced me that we cleared it. She advised just one sachet of movicol & as soon as she passed something, we thought we were OK! A few days later she was crying & I asked her to come to me & she couldn't straighten up! She had to bend as it hurt so much.

She was holding it in at school, as she was 'too busy' and 'worried that I couldn't wipe my bottom properly'.

I am hoping we never get a reacourrance. It was hard for all of us.

[beanpip]

DS (4.5) is just the same. I agree with the others here - Movicol is the way to go. It can sometimes take a few days - then you may get a total bum explosion! We had to take him to hospital too - they thought it was appendicitis until they did a scan then everyone in the room (surgeons, doctors, nurses etc!) breathed a collective sigh of relief and said "its just poo"!

We have made some dietary changes and that, combined with very small amounts of movicol every second day is doing the job (pardon the pun).

Take care
K xx

[UndertheBoredwalk]

DD is 8 and due to another condition has suffered with constipation since she was tiny. We were started off with lactulose, and 5ml daily is tiny dose, we had dd at about 2yrs on 40+ mls daily, were told pretty much to pour it down her until it worked, lactulose is not a medicine as such it doesnt enter the body, so you cant overdose on it
Then we moved to lactulose + senna daily, this didnt work either. Movicol does work, but can be a bit of a shock to the system! lol
DD now on a 'flush out' system as her constipation is not a temp problem and we need something long term and movicol wasnt good for 3x weekly!
But wholeheartedly reccomend it for those who need immediate fix

[mad4myboys]

ds2 is 5 months and movicol had himin even vmore pain. he is currently on docusol 5ml 3 x a day. the only thing to make him poo and it is still marbles

[aGalChangedHerName]

My ds1 has had problems too and still does on occasion. He is now 17.6 so better at keeping his fluid intake up if he feels he's not going as often as he should.

One doctor did tell us to make sure he drank loads of water and lay off the milk. At his worst he used to drink pints every day. When he cut down we did see an improvement. Not sure if your dd drinks a lot of milk but might be worth a try.

Oh ds1 had movicol and it worked brilliantly for him. Hope dd is feeling better soon.

[bigdonna]

my ds is on movicol he takes 2 sachets a day,he has been on this for8 months,if he misses a day he gets constipated again at the begining he was on 12 sachets.would recommend it lactulose only worked when he was little hes now 11.

[norksinmywaistband]

Thanks for all the replies.

Glad to know that you cannot OD on the lactulose.

I am thinking we will press on with the high dose lactulose and bring in the dietry change, for a week and if we are not starting to get some "movement", go back to the GP and suggest the movicol.

She does drink milk but not to excess, however she has never been a big drinker iyswim

Interestingly at 4yo she took in everything the DR said last night and requested healthy breakfast and fruit for snack, as she doesn't want to have to go back to hospital

Despite the constipation, she does seem to be a poo holder as well, which I think has compounded things.

Do you think there is any link with this sort of problem and emotional stress?? Dh and I have been separated for 3 months, but are beginning to work things out. DD's problem looking back started around the same time, coincidence?

[jabberwocky]

I think there can very well be an emotional component. Ds1's problems started right after ds2 was born and the doctor said that was common. He was 3 1/2 at the time.

[cestlavie]

DD1 (3.5) had/has really bad constipation for about the last year - only poo once every 3 or 4 days and a couple of times went 9 days without pooing (ended up in A&E both times with a very serious looking paedeatrician with was a mite scary). If it was possible to overdose on Lactulose I think she would have - even at the age of 2.5 she was on 3x 10ml a day.

Anyways, ended up going to see a paed gastroenterologist because it was just getting ridiculous and no amount of dietary improvements and water drinking was helping. Interestingly, she said where a child is still growing (height and weight) normally, constipation is almost always related to food intolerances, usually dairy and eggs.

DD1 didn't have loads of dairy, but she certainly had a glass of milk at night, plus various things containing butter and eggs (like sandwiches, cakes etc.). We cut it out completely about 4 months ago and now she's a different child - took about 2 months for it to have an effect but now she is completely regular.

I think the poo holding may have a psychological component - but it may be as much related to the fact that it hurts to poo as much as anything else (certainly was in DD's case...)

Hope this helps.

[mrsmeadweed]

My ds1 started with constipation last September, aged 16mths and only finished taking lactulose about a month ago (dosage was 10ml twice a day)

For a while we got into a cycle of having runny poos with the lactulose, stopping the dosage and then the constipation would start again. GP told us to only reduce the dosage after ds had a poo every day for a week.

Even then it took several months to sort it out - dr was happy to give us

Apparently it can take a few months for the muscles of the rectum to recover after impaction of the stools.

One tip GP gave to me was to avoid Weetabix, as it absorbs too much fluid and makes constipation worse.