Disinpacrion, movicol and picolax

[acquiescence]

My 3 year old is undergoing a disimpacrion regime, he is up to 7 sachets of Movicol and will have 2 more days at 8 before reducing. The initially GP advice was up to 6 sachets.

He had an enema yesterday in hospital as it wasn’t working and he was in pain. The hospital doctor prescribed sodium picosulphate in addition to the movicol. I’m wondering whether to give this or not as he is having a good and steady clear out with lots coming.

He has managed to go to Nursery today. I’m wondering if the additional movicol and extra laxative will make it liquid and mean he can’t do anything and if this is what we are looking for or whether to just stick with the movicol until all the lumps have passed?

He is fortunately still in nappies and we have had months of overflow so we are all used to frequent nappy changes.

Any experience or advice welcomed, thanks.

[acquiescence]

Disimpaction! Sorry for the typo.

[ShellsBells76]

DD was given Picolax too, this was many years ago however it gave her terrible tummy cramps.
If I remember rightly it's role is to contract the bowel to encourage them to poo, if the Movicol is working I would maybe ask again if the Picolax is necessary.
Disimpaction is no fun, hope it's all over with soon.

[Wanttomakemincepies]

Picolax is like industrial strength drain cleaner. It is effective but not pretty. If the movicol is working then carry on and maybe hold the pic. Hope LO is ok.

[nocoolnamesleft]

If it doesn't go to liquid, it doesn't count as disimpaction. Basically, you want to see vast amounts of cheap gravy come out.

[acquiescence]

Thanks for your replies. It is like a thick gravy now with hard bits in it, he has gone 4 times today. Should it go more liquid than this? We are due to have one more day at 6 sachets then increase to 8 for 2 days. I obviously want to make sure it is all out but don’t want to make him any more uncomfortable than necessary.
I can’t really ask the doctor who prescribed it as it was the A&E doctor. Am I right in thinking that if the liquid consistency continues and there are no bits then it is done? So hard to know if there are still some bits stuck.

It was a bad case, he hasn’t pooed properly in 3 weeks and had been having what I now know was overflow diarrhoea for months. I had been to the GP several times about it but they hadn’t recognised it as overflow unfortunately and were treating it as diarrhoea which obviously made the constipation and impacting worse.

I’m going to follow my instinct after the replies here and hold the picolax for a few days then reassess.

[ReverseTheFerret]

They work in different ways - the movicol makes it liquid and will gradually wear away at the impaction bit by bit, but the picolax makes the bowel contract to help force it out (and gives a bit of the "needing to poo" feeling).

For what it's worth - it takes a combination of laxido (just what they prescribe instead of movicol here) and a very low dose of senna (similar principle to the pico) to manage DD2's issues - just constantly moving up doses of laxido wasn't doing anything but the senna managed to give her the feeling of needing to go and some awareness of the muscles involved (I'm very very sure her issues are connected with her low muscle tone and dyspraxia) and now gradually we're reducing the senna down and have the laxido on a slightly variable dose which we can just bring up a little bit at the slightest sign of things slowing down.

For us the key thing we look at (easier now she's unbunged and we can see it clearly in "normal" state) is her tummy - if it's starting to look more than a "just had dinner" pot and looking at all "tight" - we raise the dose up and monitor things. Also we log down all... ahem... logs... which really helps nail down a pattern of when things naturally tend to happen and if stool type changes - again we can tweak accordingly. Taken a lot of fiddling and monitoring to get the times and doses of what we give to the point where I've reduced the spare pant collection in my bag down to just a couple of pairs.

Couple of FB groups that are really helpful - Movicol Mummies (the name's terrible but the advice is good) and Encopresis Support UK. One of the biggest things people tend to do "wrong" though is not disimpact enough.

[acquiescence]

ReversetheFerret this is very helpful, thank you for taking the time to reply.

I have requested to join movicol mummies but not been approved for some reason! Will check out the other group.

The doctor explained it may take a bit of tweaking with both meds. We need to get used to what his normal little tummy looks like as I think we have forgotten. I’m hoping we will be able to nappy train soon once we get on an even keel, he has been ready for a while but there was just no point before.

[Pythonesque]

Don't expect to rush to toilet training, frustrating though further delay may be. Once the impaction is properly cleared, you will need to maintain a significant dose of movicol to keep things soft to runny for several months. The point being that the lower bowel has been abnormally distended for a long time, and needs time to gradually return to normal dimensions and regain muscle tone, otherwise the problem will keep recurring.

Hope things keep going well and that in 6 months time you are well down the path towards normal function.

[acquiescence]

pythonesque thanks for your reply.
I had been told 6 months to stabilise things so hopefully after that we can get somewhere with potty training, I know it’s not all going to be instantly solved, I’m just glad I’m better informed so we won’t let it get to this stage again.
I’m feeling a little annoyed that the GP didn’t recognise it was overflow/constipation earlier on as it seems quite obvious to me now that I have the information.

[ReverseTheFerret]

GPs are generally, pardon the pun, shit on constipation. We had more advice from the continence part of the healthy family team around here (school nursing and health visitors are all combined in our area) but they lost the referral request three times before they bloody came out to us by which point we'd got things to where they'd want us to get to anyway.

I'd say it's taken us till now, and DD2's 5 1/2, to get onto a relatively even keel with it - but even then a tummy bug or anything can send things completely tits up again, and at the start of the holidays they went away to stay with MIL and she came back completely blocked up and incontinent (last time I fecking let MIL have them to stay). She still rarely, if ever, self initiates for a poo (but she has dyspraxia and is very very undersensitive to things like touch which adds to it all), but we do now get her to go to the loo and do one morning and evening - still bribed with a Haribo for doing it but fuck it if it keeps things moving she can have jelly fried eggs after a shit till she's 55 as far as I'm concerned!

[acquiescence]

Sounds like a tough journey Ferret. Glad you are in a better place with it now. These things they should tell us about children! I’m sure this could’ve been avoided for us if I had been a bit more informed about it. I am a nurse as well so generally I get physical health concerns!

We have had a gastro referral so hopefully we will get to see a continence/constipation specialist team at some point. Who knows though.

[SaltedToPerfection]

Have you spoken to anyone from ERIC? The specialist website. They are really helpful and it’s worth phoning them. They also say disimpaction has to be ‘rusty water’ by the end.