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Withholding / disimpaction / chronic constipation

(79 Posts)
Mercier1 Fri 05-Apr-19 19:25:18

I really hope someone can help us.

My son is 3 since feb. Over the winter we have moved house had a new baby and had a lot of stress at home. During this period my son woke up one day and said I want to wear pants so we followed his lead. He did really great with wee’s. He did one monster poo (like a tennis ball) that I can recall around this time and since the last four months I don’t recall a normal poo.

He is chronically constipated. 4 x GP visits. I’ve been trying a lot of things. 4 x Movicol, adding lactuose/senna and now something else as and when.

He does overflow liquid poos in his pants or nappy. (We’ve been going back and forth and following his lead on him wanting pants but he’s back in nappies this week) in the last ten days things have escalated and now he only poos in his sleep which I feel is the most depressing thing ever. The only time my child is relaxed enough to poo is asleep :-(

We have tried the apps, reward chart etc. Etc. We are now following the advise of Eric and disempacting him with 8 x doses a day. Except he’s still not going. I’ve done this for 2 days and tonight I have 10ML senna and nothing.

Does anyone have any experience like this. Is there light at the end of the tunnel? I feel this is having a huge impact on every family member now. Any advise or experience is great. Thanks

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JeanMichelBisquiat Fri 05-Apr-19 19:43:34

He'll be massively impacted if it's been going that long - it may well take more than 2 days for the movicol to even start softening it. Don't give up - keep going at the same dose of 8 sachets for a few days until you're achieving watery brown liquid, then gradually dial back to the maintenance dose.

Presume you've seen this?

If it's still not had an effect after a few days, I'd ask the GP about enemas...but he sounds to be very impacted, so you might need phosphate enema rather than mini Microlax variety.

Your GP doesn't sound great, btw - they should have known to give you the disimpaction dosage for movicol, but it's sadly a v common mistake! And 4 visits...your poor son, he must have been feeling lousy.

Even if you get DS fully disimpacted, his colon and rectum may well have stretched a bit from the long-term impaction, which means both that his gut's likely to fill up more before he needs a poo, and also that he may have slightly reduced sensation of when he needs a poo. I'd really, really recommend seeing if you can get a referral to gastro paeds just so that you can have a specialist to turn to if you need further advice on meds etc.

Hope it works soon - I will be very happy to hear any gory detail questions...spent years of my life developing this as an expertise, unfortunately, due to other health issues in DC, but am now past that stage smile

JeanMichelBisquiat Fri 05-Apr-19 19:46:34

Ps and pleeeeease drop the reward chart - he can't do a poo cos it's totally impacted, and the soiling is just run-around. He has no control over it.

Once he's totally disimpacted, you need toileting time twice a day, actually on a potty so his knees are raised and he's in the proper squat position for pooing. And he can watch telly or read or whatever, but make it a nice, non-stressful time for him to be able to tune back into the feeling of needing a poo.

Hope all this helps!

JeanMichelBisquiat Fri 05-Apr-19 19:49:21

Sorry, PPS - absolutely do not use senna before you've softened the poo - he'll be in agony, as his gut will be stimulated to expel it but it'll be too big and hard for him to do it. Movicol or enema, maybe with some senna added in once you start seeing some proper results, to keep the disimpaction moving along.

Mercier1 Fri 05-Apr-19 19:55:06

Hey thank you for your help. So appreciate it. We have been on the Movicol for months now it’s not new. We brought him to the doc as soon as we felt he was constipated. 2 in Am and PM were prescribed though we didn’t achieve this daily due to his complete refusal to drink it and some other issues I can’t be bothered getting into.

We only started the reward chart today as a reward for sitting only, not for outcome. As we are trying to get him into a sitting routein but failing. Again refusing... even for chocolate bribes. We also bought massive steps from Ikea for that squat position, again he’s refusing.

Gorey details are he’s now not soiling much (odd stain) but poos as soon as he falls asleep a decent amount of gravy. I am trying to achieve brown water with brown bits (ref ERIC) does that sound right? How much poo should I expect on disimpaction OR maybe he’s not impacted and I’m barking up the wrong tree.

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Mercier1 Fri 05-Apr-19 20:28:25

Love the username btw

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endofthelinefinally Fri 05-Apr-19 20:36:30

ERIC has a helpline.
You can talk to them. It is going to take a long time to sort this out so you have to be prepared for the long haul
Also, google The Poo Nurses and watch the whole video.

With holding is a family problem. It needs the whole family to be on board and consistent with the management.

It takes at least twice as long to solve the problem as it has existed.
So if a child has been soiling and constipated for a year, it will take at least 2 years to retrain the bowel. If they have had the problem for 2 years, it will take at least 4 years. It takes patience, consistency and understanding..
Giving up too soon will take you back to square one, but it can be done.


Mercier1 Fri 05-Apr-19 21:34:56

I called ERIC this week but I couldn’t get through and left a message, my husband also went to and ERIC workshop this week so he’s really on board now. We are doing our best under difficult circumstances atm.

Can you give me any advise on how to get volume of Movicol into him to disempact?

After disimpaction Eric advises a maintainance dose and I know we need to instil regular sitting on the loo/potty but does anyone have advise of how to make my kid 1. Consume enough Movicol (I’m giving it in squash/yogurts) and 2. Sit on the loo/potty 2/3 times a day?

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Mercier1 Fri 05-Apr-19 21:42:27

Also we are not having soiling, we only have poos when he sleeps and they are runny because of Movicol. I’m so confused... could it be that he’s not actually impacted?

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endofthelinefinally Fri 05-Apr-19 22:38:26

Have you watched the Poo Nurse video?
That will answer all your questions.

dottyp0104 Fri 05-Apr-19 22:45:45

My dayghter was in this boat. The movicol only needs to be mixed with small amount of water with diluting juice. Thats how i got it into her, we ended up getting to 12 sachets. It does take a few days, i recomment some pull up pants to contain the mess as it will become liquid. Once its passed, you willl know, then do nlt just stop the movicol. Made the mjstake once and ended up back at square one few months later. We now just titrate the movicol to how her bowels are -rather than 1daily.
It is really hard. But you have some good advice above.

dottyp0104 Fri 05-Apr-19 22:48:24

The poo when sleeping is because they are relaxing. I was disbelieving about impaction as we still had 'poo'. Until I sawthe xray. But you will know the movicol is working when it is literally brown water passing from them. Honestly i am a nirse and i missed it.

Stickmangate Fri 05-Apr-19 22:49:07

Sorry can’t offer much advice other than I know it’s hard. My Ds was and still is sometimes with holding. He never seemed to be impacted but I know the gps were useless.

As another poster said it does affect the whole family. I spent months and months where all I seemed to do was wash dirty pants and smell poo!

I did find that when dh and I eased off and were less stressed about (easier said than done) things did get better. Ds started school September and I was so worried as he was still soiling.

Just keep at it

Mercier1 Fri 05-Apr-19 22:49:18

Yes I watched it all and it’s helpful but we can’t figure out if we are dealing with overflow and there is a blockage or if we have just softened his still by giving the Movicol and should go to maintainance now

OP’s posts: |
Mercier1 Fri 05-Apr-19 22:52:22

Thanks dotty. Sorry to be gross but should we see water with brown bits in (this is what Eric says) as we currently have sludge/gravy and I can’t tell if we should continue disempaction protocol? This is what’s confussing us. For the last 10 days the only poos are during sleep or naps and we don’t have soiling outside this time.

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dottyp0104 Fri 05-Apr-19 22:53:21

I was told by hospital to keep going until passing liquid in the toilet ++ it is a good 4 days before it works. You will get some passing earlier but You really need to keep going for good few days. If you have a look at the disimpaction guides it gives timescale of how long it should go

Mercier1 Fri 05-Apr-19 22:54:10

Ok Dotty. My husband thinks it’s liquid but I don’t. He won’t sit on toilet or potty so we are in pull ups...

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Mercier1 Fri 05-Apr-19 22:54:43

We’ve nothing to loose by continuing so will do....

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endofthelinefinally Fri 05-Apr-19 23:02:32

Study the stool chart.
What has he passed in the last few weeks?
Any solid at all?
Sticky, smelly overflow is different from watery, fresh movicol induced stool.

Mercier1 Fri 05-Apr-19 23:04:10

He has passed only sevens in the last weeks or months even... they are gritty but not sticky

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endofthelinefinally Fri 05-Apr-19 23:04:28

The only way to tell is by doing a plain abdominal xray. But it is very, very difficult to persuade anyone to do it.

N0Time Fri 05-Apr-19 23:07:26

My DN needed disimpation doses for 2.5 weeks until he passed literally water with brown flecks in it. He had been constipated for years though. His parents thought he was cleared out a week earlier but were told to keep going until he passed water with brown bits in, not just liquid poo.
Might it help to add a different flavour juice to the Movicol to what he’s used to, and not tell him there’s medicine in it? Just an idea.

endofthelinefinally Fri 05-Apr-19 23:07:37

Re- reading your op, I think you need to press on with disimpaction.
2 days is nothing if this has gone on for 4 months.

endofthelinefinally Fri 05-Apr-19 23:10:59

You and dh must be on the same page. This is a psychological issue and you have to be really calm, patient and consistent.
All positive, no negative.

dottyp0104 Fri 05-Apr-19 23:14:12

I always worried that I didnt want her becoming reliant on the movicol, or that i was'overdosing'. Neither of this happens so just keep going with it.
It really is a long slog but dont stop too early

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