GP reluctant to prescribe more Movicol

[doublehelpings]

My 3.3 yr old has been on movicol for about 4 months. Initially on 1 sachet but reduced to half a sachet a day.

She's always had rock poos or bunches of grapes. We then had issues with potty training which I realised was actually due to constipation. After a GP visit we were prescribed movicol and then once on the movicol we worked on the behavioural reason for soiling and after 3 months she was all fine. Her poos are really normal
looking now.

That was 2 months ago. I've since been back to the GP for more movicol. This time I saw a different doctor. Thought it would be all routine to get some more but she gave me a bit of a lecture. I explained she's always been constipated and her diet is excellent though she could drink more. Reluctantly she prescribed more movicol and told me to get her to drink more possibly juice would help as she only ever has water.

In the meantime since seeing that GP I have skipped days to see if the problem still exists but it does. We went away for the weekend and allowed her to have loads of juice and forgot the movicol. Problem still there. She's drinking more at home anyway but the problem still there.

I thought movicol was really common and a gentle medicine too. Obviously it's better if she doesn't need it but if she does is it so bad? I hate her straining when she's missed a dose.

[Witchend]

With movicol you're meant to reduce down slowly (very slowly, took us about 2 years to go down from 2 a day to none.
You can buy at least the adult variant (which I think is twice as strong so half the dose) over the counter.

I think probably your gp feels that it's time to reduce further, so perhaps try going to 1/2 every other day.

[ipsofatto234]

Bit left field but see what you think: try removing wheat from your daughter's diet - that's what worked for my DS. He was on three different types of constipation medication and each worked for a while before we would be back to constipated and then soiling, then ok for a bit, then back to constipated/soiling. The consultant we saw explained that the constipation/digestive problems were a delayed-onset reaction to wheat and/or dairy. Six weeks after removing both we had no further need for the meds and have since been able to reintroduce dairy. Our GP went on and on about liquid also. Consultant said unless your child drinks no water, eats no fruit/veg and plays outside all day in the sunshine while sweating buckets, it's very unlikely she is dehydrated. We saw a paediatric consultant that specialised in digestive issues, btw. Would recommend if you can get a referral. We found it v helpful.

[doublehelpings]

Thanks for the comments.

Sounds completely stupid but I didn't consider giving the dose every other day and stepping down, definitely something to try.

Really interesting what you say about water ipsofatto234. I just don't think water is the cause here. I've ensured she's getting enough soluble fibre and all bread at home is wholemeal and lots of fruit and veg each day so I don't think it's diet. I've cut down her milk which she's loves as well as I know that can bind.

Interesting what you say about wheat. I think if the GP says anything next visit I'll ask for a referral. Again, something I didn't consider given the low dose she's on.

I gave up wheat myself for a 7 year stretch but it was because I'm addicted to it. How do you manage wheat (and before then wheat and dairy) free diet with a 3 year old? Did your DS like the gluten free bread etc from the shops or did you serve up complete alternatives?

[InSpaceNooneCanHearYouScream]

I agree if the GP argues again then ask for a referral. My daughter is under 2 consultants who BOTH say it's fine to stay on movicol for a long time, as long as they need. It is a long term treatment and the child should be staying on it for at least a year and then reduce slowly, only reducing if not getting constipated anymore. GP sounds like an idiot.

[nocoolnamesleft]

Oh god this drives me nuts. The NICE guidance on childhood constipation specifically states not to just use dietary measures alone.

pathways.nice.org.uk/pathways/constipation#path=view%3A/pathways/constipation/clinical-management-of-idiopathic-constipation-in-children-and-young-people.xml&content=view-node%3Anodes-maintenance-therapy

"Continue medication at maintenance dose for several weeks after regular bowel habit is established – this may take several months. Children who are toilet training should remain on laxatives until toilet training is well established. Do not stop medication abruptly: gradually reduce the dose over a period of months in response to stool consistency and frequency. Some children and young people may require laxative therapy for several years. A minority may require ongoing laxative therapy."

And

"Do not use dietary interventions alone as first-line treatment."

Yes, optimising diet/fluids etc helps to eventually get them off the movicol....but you've got much better odds of eventually getting them to grow out of their constipation if you treat them properly, for long enough, from the start.

Will you excuse me? I need to go find a brick wall to bang my head against....

[RomComPhooey]

My son has been u der the care of a paediatric gastroenterologist for sever constipation since he was 3 - he's now 10. He's tried all sorts of combinations and is on a megadose of picosulphate daily, has been for several years. His gastro has always emphasised how important it is to actively manage his constipation and reduce his bowel loading so he can 'grow into' his distended bowel before his teens, to prevent problems in adulthood.

Why the rush to taper your child's meds down if there is still active constipation? If the GP keeps pushing for it, ask for a referral

[doublehelpings]

Thanks nocoolnamesleft

That's it. I'll go to next review armed with the NICE guidelines and just ask for a referral if they push back.

Movicol is still new to us, why didn't they explain that it's better to keep them on it and taper meds down. So annoying but thank you all.

[RomComPhooey]

Its really important to keep things moving, double. Don't be in too much of a hurry to drop the meds.

[ipsofatto234]

My son eats all the gluten and dairy free stuff from the supermarkets - we switched when he was 2. He still drinks Koko (coconut milk) and Oatly (oat milk) as a cows' milk alternative (both are available fortified with calcium) and you can get pretty good vegan cheeses and yogurts etc. now. Lots of kids in his class at school have allergies/intolerances and school caters really well for them, so we're lucky. We just went cold turkey straight away after the consultant appointment and removed all wheat and dairy immediately. I literally drove to the supermarket from the hospital. Consultant said dairy intolerances tend to cause grief "upstairs" (eczema, rashes on face, repeated ear/throat/tonsil issues) and wheat intolerance causes issues "downstairs", which I had never heard before. I'd always thought an allergy to something would have much more obvious signs and neither DH nor I had any issues, so I was sceptical TBH at the beginning.

The results after 6 weeks were hard to deny though and not to be too dramatic, but getting this resolved has literally changed his (and therefore our!) life. He used to get so upset when he had accidents and was starting to get anxious about it at school too, which affected his learning and socialising. Touch wood, he's had no problems with soiling/constipation at all since. Good luck and hope things improve for your DD soon

[doublehelpings]

Thanks. She had reflux as as a baby. I do wonder sometimes if she's a bit dairy intolerant but she loves her milk. And she has ecemza.

[Sleepingtom]

I was permanently confused as to the how/why/when of movicol which my DD was on for several years due to v similar issues.

Someone eventually suggested cutting down wheat to see if it helped and it did. We were advised not to cut out completely and to gradually reduce movicol. At almost six she appears to be now fine apart from the odd lapse (usually when on holiday), despite eating a fair amount of wheat now and not being on movicol.

We are more conscious about wheat though (eg we get brown rice pasta and buy her sourdough), which we might never have thought about it we had just relied on movicol. A combination of the two was what (eventually!) helped us.

I know someone who managed their child's symptoms entirely by cutting out wheat. Unless my child was gluten free I would find this personally v difficult as it is not just the food you give them but every time they are offered a biscuit etc (she is very organised though)

[Sleepingtom]

sorry, unless my child was coeliac and I had to I mean.

[doublehelpings]

Ok. Might well be worth cutting down on wheat and seeing if it helps when I taper down the meds.

We've already switched a lot of snacky type things and Cheerios to oat versions already as read a book which said you need to make sure child is getting enough soluable fibre. Other than wholemeal toast in the morning the only wheat they have is pasta a few times a week and perhaps a sandwich for lunch a couple of times as well. I think it would be easy to switch pasta to wholemeal if that helps her.