prolonged use of Senna in DS 5yrs

[proctortwin]

My DS (5 yrs) had poo accidents for 2 years before it was diagnoised as overflow from constipation. Consultant thinks it's withholding although I'd argue my DS never had a period of consciously retaining the poo, he's just always been crap at it (excuse the pun!).

For a year we were on 5ml of Senna but he still had a blockage high up so he's been on 15ml for 6 months.

We are down from 8 accidents a day to 3 accidents but I feel we are just managing when the poo just happens to explode out of his body propelled by laxatives. The school are brilliant but the consultant claims 20% of 5 year boys come homes from school dirty. Maybe, but they don't have to go in with 5 changes of clothes KNOWING they'll have accidents.

The consultant now wants to increase the dose to 30mls and I think its such a high dose for such a prolonged period know. I've lost faith that this will cure him & can't get a clear picture about whether this timescale is normal. I feel like I'm pushing an elephant up a hill but its also me that's got to find the path.

My despair is worse because he's on the cusp of bullying starting as his classmate are begining to notice.

Anyone can shed light on how long their DC took Senna to get over this?

[chocoluvva]

I'm surprised he's been prescribed senna. It's very rough.

Ask about a stool softener. Sorry if you do this already, but make sure he has plenty of fluids, but nothing containing caffeine.

Try not to let him eat too much wheat as it is very sticky in the gut.

[BobbiFleckmann]

hello! I've been there... The good part - Senna was a miracle worker for us and cleared up the mess (literal and figurative) left by movicol.
We were really reluctant but we went up to 20ml with our small 3 yr old (in terms of bodyweight, that's probably similar to your DS and 30ml?). It taught her to poo in maybe 3 months after which we reduced it very gradually (1ml at a time, using very finely calibrated syringes to dose). All in all, she probably took it for 8 months. It was then nervewracking to stop it altogether but she's been regular as clockwork ever since - she learned the signal to go and how to do it. If he's still blocked however, maybe he needs a serious clear out first? we had a picolax clear out before starting the senna. PM me if you want any more info, very happy to help.

[UrbanSpaceMum]

yes the timescale is normal. You understand the bowel is damaged and has to repair itself. With two years of damage think maybe two or three years of repair, and then a lifetime of maintenance.

What else are you doing? My child was on some kind of sugar syrup (galactose?) that softened the stool. We had to stop the senna as the cramps it caused my child were too awful, so we only had the sugar syrup, that took 18 months to get something like normal. (For dignity I gave the senna after dinner. Instant agonising result, then safe for 24 hrs. Does that help you at all or do you get a delayed result with senna?)

Long term we have to be strict with our child, ourselves and anyone who looks after her about what she eats and drinks. Clearly every constipated child is different so what works for one is literal poison for another, and I sometimes have to fight off well-meaning relatives with their strong opinions on "healthy" food. We had a constipation nurse help us find what was right for our child.

[proctortwin]

Ladies,
My reply to thank you for all your help didnt post - so I'll thank you again. It's really claming to hear that you've used high dosages and that the timescales are not abnormal.
They haven't suggested a stool softener because he's never had a "hard" one - albeit we could only be seeing the seepage. I'll ask when I see the consultant. I'm interested in your picolax clear out.
It's odd because I want to say my son has a brilliant diet - perhaps a bit too much milk (about a 1.5 pts a day). I'll keep a food diary but it is jolly difficult to work out the effect it has on poo given you're also giving medicines etc at the same time.

[mummy2benji]

Hi, I'm a GP and have a special interest in kid's bowels (not a phrase I thought I'd use!) as my ds, now 4yo, has always suffered with constipation as a result of reflux / dairy allergy / feeding phobia as a baby. 30ml is a lot but ds was on avery hefty dose plus lactulose when he was only 3 months old and it wasn't enough - he got up to adult dosages and ended up switching to sodium picosulphate (dulcolax) which worked much better and in smaller amounts. He has been on dulcolax and lactulose once daily each for a couple of years now and over time we have gradually been able to reduce the doses. He used to get impacted from time to time but this hasn't happened for over a year. His diet is still terrible. I'm a little surprised too that your ds is on senna. If he is having blockages you don't really want him on a stimulant that is likely to give him tummy ache and then propel out an 'explosion'. Obviously I haven't seen him or talked to you in depth like your consultant has, but to me movicol would be a much better option as it works higher up in the bowel and would stop the impactions happening in the first place as well as softening the stool and making it easier for him to go more normally more regularly. But to answer your question, yes that is a high dose to be used on its own, but if he has been on it for some time it is likely his body has got a bit used to it. Hopefully over time you'll get to wean down his laxatives so I don't think you need to worry excessively that it will cause him long term problems, but focus on treating the here and now. Ds's constipation is certainly improving slowly over time, although we are nowhere near coming off the meds. When you see your consultant, ask him about movicol - maybe he has a reason for preferring senna or maybe he just doesn't want to upset ds's system by changing the drug, but personally I think it would work better for him.

[chocoluvva]

It would be a nuisance - but it might be worth eliminating dairy foods from his diet for a week to see if that has any effect. Intolerance to lactose and to milk proteins are surprisingly common.