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Movicol - son still witholding(29 Posts)
My DS aged 4 has been on movicol for a year now.
He was prescribed it because he was holding onto his poo, sometimes for up to 3 weeks at a time. The GP did say the movicol was to be long term and that we would notice a regression when he would start school - which is in 7 weeks!
When prescribed we were told to try him with one sachet and gradually increase this until he started going again but not to give him more than 4 and if no luck, to go back to the GP. Luckily we reached 4 sachets and we had five days of explosions - several times a day, needing baths. It was THAT bad.
For the past year he has maintained his toilet trips to about 1 or 2 a week, which the GP said was fine, and taking just 1 sachet a day. His bowel movements are very wide and extremely long. Sorry for the description but so long that they reach half way up the toilet bowl. He is 4!
But for the past month he has regressed again. He is with-holding again. He is going more than a week sometimes 10 days without going and in between all this he is marking his underwear; not skid marks but more so. He keeps saying that it isn't telling him but I am telling him that it must be for poo to be on his underwear.
I am scared that he will be singled out for this at school and worried about how school will handle this. So far at nursery it isn't noticed (3 hours a day) and it usually happens in an afternoon when he is at home anyways.
I have my suspicions that this is the 'regress' my GP was talking about but not sure whether to leave him and see if the 'phase' will stop, increase his sachets or see the GP but I'm not sure what to say. I think he'll just tell me to increase the sachets but I am concerned about the size of his poo.
Anyone got any advice on this?
Sorry no advice other than it is so very common. My ds has periods of with holding but will not drink the movicol, so we manage it as best as we can. He is now 7 and have a trip to the gp planned to try the movicol again. The plus is that none of his peers are aware
If movicol on its own is not working you might want to investigate also using a stimulative laxative too - such as sodium pico sulphate or Senna. We've recently had a noticeable improvement with our dd who has been on Movicol for 2 years, by reducing the movicol to half a sachet a day and adding the Senna, 5ml a day. The sodium picosulphate we found too explosive and have her cramps but the Senna seems to be more gentle. While she's still having soiling accidents (though a lot less) she's now doing proper shaped/sized poos more frequently and is going nearly every day or every day. I made this change to the movicol dosage as I was advised that if the poo was getting too soft and not 'forming' in a sausage shape then there might be less of a sensation of 'wanting to go'. It's only been a couple of weeks but the transformation and improvement for my dd has been significant.
I have this problem with DD3, although much improved with 1 sachet of movicol a day she still stresses and pretends she doesn't need a poo until situation is critical! Poos are also v long! I found book Stool withholding: what to do when your child won't poo (Amazon) practical and reassuring.
He needs to be on the amount of movicol that has him pooing a soft poo every day, if he's going to grow out of it. (Basically, if he's pooing only one a week, his rectum will be all stretched up - when it's stretched it's great at collecting poo, but rubbish at pushing it out...if you can get them pooing well, then it will shrink back to normal).
And he almost certainly doesn't know when he needs a poo, because he's been so constipated for so long that he can't feel it any more. But his anus will have been so stretched out from the poo sat on it for so long (think like baby's head on a cervix) that bits can leak out and stain, without him knowing it.
He's undertreated. You may find it useful to read the eric website? www.eric.org.uk/Parents/information_constipation_parents
(Wanders off muttering about GPs undertreating constipation in kids)
Thank you all!
I am planning on increasing the number of sachets as it is the summer holidays and we are not under as much stress when it comes to accidents.
His poos are perfectly normal - sausage shape, firm but soft (IYKWIM) - but just VERY, VERY long.
Elongation of the colon? I was told about this not so long ago by someone else who is familiar with these problems.
nocoolnamesleft - the problem with that is the one sachet was enough for him for a long while. Does this mean that as he is getting older we need to increase it? The GP was quite clear that he does not need to poo every day; as long as he is having 2 bowel movements a week. 4 sachets gave him a good clear out but it was messy, he was distressed and he 'went' several times a day. We did bring this down and found 1 sachet was enough.
I'm confused as to what to do! I think I might try him on 2 sachets a day and see how that affects him.
Oh and 'bad' parent alert, I manage to hide the movicol in lemonade or cola which he has with his dinner.
I second the Eric website recommendation.
I don't think it sounds like he goes often enough either.
We had a temporary issue with this with DS, it was really upsetting and disruptive. We resorted to bribery , which totally worked. And we hid the Movicol in cereal too (dissolve in water, mix with milk, put on cereal).
Lots of luck.
have you tried adjusting his diet as well?
Avoid bread, pasta, cereals and sugery foods and increase protein scrambled eggs/boiled eggs, fish and chicken.
vegetable sticks for snacks, red and yellow sweet peppers and carrot and cucumber sticks etc.
This worked hugely better for mine than Movicol alone.
I second the suggestion to up the movicol until he goes every day. I have had this problem with a DC also. We have a reward scheme where poos get stickers and clean pants at the end of the day get stickers, and certain numbers of stickers get prizes. Rewarding clean pants has helped a lot, as when we just rewarded poos previously DC would wait until there was some soiling and they absolutely couldn't hold it before going, and now we are back on track most of the time.
I don't think you're using enough.
Dd2 was compacted and what we had to do was
Day 1 6 sachets
Day 2 8 sachets
Day 3 10 sachets
Day 4 12 sachets
Continue on 12 sachets until it was totally pouring out (sorry)
Thankfully that happened on day 3.
She was then on 2 sachets a day for about 2 years before we reduced down-slowly, 2 sachets day 1, 1 on day 2 (repeat) for aged.
Yep, I usually advise building up through the disimpaction regime until you get 3 days of shed loads of gravy, then back off to the amount of movicol that gives daily pain-free scrambled egg consistency poo.
One of the problems is that if you partially treat, then fresh poo that hasn't had all the water sucked out of it yet can come past the rocks that haven't been cleared out, and catch you out - if I could have a fiver for every person that stopped/cut down the movicol just as it was starting to work, because no one had warned them about overflow diarrhoea, I'd be able to treat the whole department to a Michelin starred meal.
DD1 is 4 too and does this. It's really getting me down She knows when she needs to go as she will sit on all 4s and rock. Is it wrong that I find it embarrassing? She has been half days at nursery school and at the end of term we got a folder with photos of her and work that she had done. In some of the photos it was classic poo holding pose. I cried! Dr's and HV have been pretty useless. I truely feel lost. Reading your post I'm rnow eally worried about her regressing and getting worse when she starts ft school in September.
Moll, I think you're right to try to get a handle on this as soon as you can. Our GP didn't really know about it at first, but then did some reading before we saw her the next time - I remember her saying Oh, I did some reading about this, and apparently it's quite common! Can you ask to see a different GP who might know more about it, or be willing to learn about it? Is your DD on Movicol?
SpaceKablooie yes she's on movicol, has been for about 2/3 years so I'm worried she's built up a resistance to it. (Can that happen?????!!!!??!?!) my HV did try to help and did some reading, but nothing that I hadn't done myself, the same with ERIC, lots of great suggestions, but nothing that works for more than a day or 2. We've also seen a specialist at the hospital who just said continue with the Movicol. Personally I think it's psychological with her now. She's built it up so much in her head. x
We have been through similar although DD is still not keen on going - she will when told and occasionally goes on her own. She has to be told usually to sit on the toilet every evening to go.
When she was younger I literally had to make her sit on the toilet everyday until she went - she actually had constipation issues and was on movicol - she would either read a book or watch the tablet. I was so desperate she didn't get blocked again we had to do it.
It's not perfect now and we still get dirty pants from witholding but I find she can hold it less and has to go most days (doesn't have movicol anymore).
She still does eye watering whoppers occasionally! She used to regularly block the toilet!
My DS is also 4, we've had years if being on different things. We're going to start him on movicol again tomorrow as he's bee OK for ages, but the last few weeks he's been struggling again.
We found that we had to give 3 sachets a day, until he's going regularly for a while, then reduce it gradually, when we first started on it, like your son it was awful and sent him the other way. My DS was in nursery and went through 4 sets of clothes in one day. Not nice, but we'd explained to nursery so they were prepared and were really good with him.
Maybe use senna at night time and increase your sachets, it worked well for us, can you encourage your DS go to the toilet to 'try' more often?
I used to (and still do when he's bad) sit in the bathroom while my DS was on the toilet, take him a comic to read, read the stories and sing songs, sounds mad, but wanted to show him it's not a scary thing.
My DS' poos are massive too, I wonder where its all come from!! Sorry if its TMI.
We also kept a food diary and worked out he has 'triggers' which cause him to bung up, we've mentioned this to nursery and they've helped monitor his intake of certain foods.
We have several children at our school who are on Movicol (or Laxido, which is the new brand I think). They have all been through the regime witchend describes but most of them are also under the specialist nurse at the hospital who runs a "soiling clinic". She is simply amazing and is of the view that a massive clear-out is the best way forward, not 1 sachet a day.
I have sat in appointments with parents and have picked up lots of useful information about poo along the way! I don't actually think twice a week is enough. The bowel needs to go back to its normal size and learn how to process poo properly. Leaving poo to build up for 3-4 days won't encourage the bowel to contract back down to its normal size. It will remain stretched and the poo will just build up there and not budge.
But to reassure you OP, a good school will be used to managing toiletting problems. There's nothing they won't have encountered before - just go in and talk to them and explain what works and suggest ways they can help.
Morning. I've decided to up her on the movicol today, I've also made a worry doll and a worry box that we are going to decorate later. Do you just buy the Senna at the pharmacist? Is it a powder like the movicol? I even considered feeding her undercooked chicken to get things going! (Joke)
Lol yes to the massive poos!!
OP, I really wouldn't do any of this without speaking to your GP. If you feel the advice you've been given there is insufficient or that the treatment isn't working for your DD, ask for a referral to a specialist.
Please don't medicate your child - even with a product like Senna which is marketed as "natural" - without getting proper medical advice first.
I would never use senna until the poo is softer than average (scrambled egg consistency). Senna is a pushing agent, so if the poo isn't soft yet, then the increased waves of pushing through the gut hitting hard poo can really hurt.
Senna can sometimes be useful if you've got the poo consistently soft, but they're still struggling to pass it through, or if you're trying to encourage a pattern in when they poo.
I have two threads about this!!!
Today he had a MASSIVE poo. It was so long (as long if not longer) than my forearm and, sorry for the TMI, curved at the top end which I am suspecting where it has curved round the top of his colon.
It was a relief for us both - poo (and wee) in his pants everyday but because of the successful toilet trip we have had no wet pants which I suspect is related to him holding his poo and causing pressure on his bladder. (A theory I have!)
Under no circumstances would I ever suggest he would take SENNA. (Did I ever suggest it or was it because someone else did?)
The GP did give me 'permission' to increase and decrease his sachets as and when required because it was mentioned that there would be 'good days and bad days'. Fortunately (or is it?) he had a good eight months of no issues hence why we had the maintenance dose of 1 sachet.
After today's poo, I am doubtful that going to 4 sachets is needed. And last year we gradually increased every three days.
So that is what I am going to do. I am going to increase from 1 'maintenance' sachet a day to 2 sachets. He's slightly older, growing etc so maybe he does need more.
Also we have enforced more fluid intake today. By 3pm we were becoming frustrated because the only fluid he had had at this point was a mouthful of water DESPITE him given 2 drinks in the morning and a drink at lunchtime with offers of juice during the afternoon which he refused until we pulled a 'well if you don't drink this then this won't happen' scenario.
DS has a similar issue and yes the pressure in his bowel can cause wee accidents. And warm weather without a suitable fluid intake causes trouble.
His first year at school has gone fairly well. We've had a couple of days when he's been on the toilet and we've been half an hour late for school. And recently we had to crank up his Movicol to clear him out and it was a bit tricky. Fortunately I can go in to clean up.
I would try and dose him up to get him to move his bowels at least every other day. Extra dose on the days he doesn't.
We are trying to stop ds's Movicol but every time we do (without telling him) he gets constipated. So here's on about half a sachet a day given in orange juice as a preventative dose.
Can I suggest something called 'oxytech' by dulwich health? PleAse have a read. It's an amazing product!
One sachet as a maintenance dose is really very conservative. My DD (also 4) takes three!
By increasing the dose you'll soften the poo to the extent that he won't be able to hold it in so easily. So, personally, I would experiment by giving three sachets daily, even if that makes his poo runny and explosive, just to get him back in the habit of going every day. Then reduce to two and wait and see how his bowel habit changes after that.
Sorry, OP, it was another poster who came on this thread and asked for advice and another poster suggested senna to them.
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