To not believe this is constipation and be worried?

[bctnop]

DS (3) has been having soiling issues since not long after potty training, which have been steadily getting more frequent. It’s never a full poo, but small patches of loose poo or, confusingly and more frequently, completely clear liquid. GP felt it was overflow caused by constipation and put him on ½ sachet of laxido a day which initially seemed to resolve it, but it quickly came back, and did not improve even with 1 x laxido a day. Have been in touch with the continence charity ERIC who also felt it was overflow from constipation, and I have been following their advice and recently completed a 'mini' then a full ‘disimpaction’ regime (poor kid is sick of laxido!) to completely clear out DS as ERIC thought there may be an impaction. But it hasn’t helped, and they are now saying to give him senna daily on top of the laxido.

But…he has not had any other symptoms of constipation, he poos at least twice a day, no straining and number 4’s on the Bristol Stool Chart (which I am now extremely familiar with😞). The ‘accidents’ are more like leaks and happen at the same time roughly most afternoons which seems very odd, and more often than not is the clear liquid, which I keep raising with ERIC/GP but no one has been able to explain what it is. That doesn’t seem like it could be overflow to me?! I have tried to get a referral to gastro via my GP but am getting nowhere, and am worried that something else is going on with DS’ guts that is being missed. Anyone experienced anything similar and worked out what was causing it?

It does sound like over flow tbh I have a child with chronic constipation, have they done an abdo scan he could be impacted further up.

This forum won’t help you with referral pathways @bctnop - I would keep going with the health service and get that referral asap. Hope your child feels well very soon.

@x2boys thanks - no scan has been done, no examination even. Is interesting it sounds like overflow to you - even the clear liquid? I don't understand what this is, do you know?

@SavoirFlair I am trying with the referral but the GP says they won't accept it without a series of weigh ins which we are currently doing, and I think if he's not seen to be losing weight (he isn't) they won't take him. Am considering trying to get a private consultation for a second opinion, but I can't really afford private treatment.

Bumping in hope someone might have some advice...

Is there a nurse-led community constipation clinic or bladder/bowel clinic near you? Try googling it. Neither my GP nor health visitor knew about it. I found it, asked GO and he referred us there.

1/2 to 1 laxido a day wont clear impaction. If you did a full disimpaction ( like 8-12 sachets a day ) you then need to stay on a maintenance dose for ages otherwise the stretched bowel just fills up again. We were on it for years and years

My daughter had problems with 'accidents'. Poo stained underwear and leakage. We thought she was just leaving it too late to go or not wiping properly at first but as it got worse the GP suggested allergy testing since I'm coeliac, turns out she's lactose intolerant. Not a single accident since removing lactose from her diet.

@elaeocarpus thanks - yes there is but only for 4 years and up, and even then it has to be alongside wetting, they won't accept referrals just for soiling.

I did the full disimpaction up to 8 sachets a day (which was the max for his age), then slowly reduced until DS was doing number 4/5 type poos, which he now is on 1 x laxido a day. No sign of constipation (there never was other than the soiling) but still getting the leaking.

The leaks mostly being clear fluid, rather than poo, is worrying me and making me think it's not constipation, especially as there are no other signs of it.

@maltesersarethedevil that's really interesting thank you, I have been wondering if it might be some kind of intolerance. I could ask my GP about testing, did you have to wait long and was it very invasive?

It was just blood tests so quick and easy, had them done in the childrens ward at local hospital as they were better with children than the practice nurse. She didn't even realise it had been done.

I was going to suggest dietary intolerance too, could you look into private allergy testing? I think coeliac or dairy can both cause some weird ibs type symptoms.

I'd push for a referral to general Paediatrics with a view to getting on top of the constipation rather than gastro. I think they would be more likely to accept the referral, and you've been struggling with this for some time so it's a reasonable request. General paeds normally deal with constipation, and can refer to gastro if they have concerns when you have explained about the clear liquid etc. It could be overflow, but does sound a but less usual.

The other thing could be that it's not constipation and that he is having loose stools because of e.g. intolerance. Has the gp ecer felt had poo when examining him? Have you tried keeping a food and stool chart to see if there are any patterns? Definitely seems reasonable to ask for further investigation if the gp doesn't have a plan for moving things on.

OP has repeatedly mentioned "clear fluid" as being concerning (which it should be) but all the replies here seem to frustratingly ignore that point and just talk about their own experiences with disimpaction.

FWIW DD(3) had typical constipation with soiling and the symptoms you described don't sound like that at all, so YANBU to be worried at doctors expecting you to follow a fairly harsh treatment. If he's doing 2 normal poos a day with regular consistency then how can he be so impacted that overflow is completely clear?

My totally laymen's theory would be the fluid might actually be excess Laxido because he's drinking so much of it, it's just flowing right through. Since the water+macrogel doesn't get filtered out as pee, the liquid might passing through the colon unchanged. Which might also explain the timing of it if he drinks Laxido at a certain time.

Could it be possible that he's not constipated and initially had soiling as a result of IBS/stomach bug/intolerance and the rebound soiling was actually caused by Laxido? Macrogel draws liquid out of the surroundings to keep poo soft so if his bowels are actually empty enough, it might come out as excess water. Laxido poos have an easily identifiable smell (quite chemical) so you might be able to tell from that.

If he's not bloated, uncomfortable and clearly withholding poo for days then seems excessive to make a child go through a disimpaction regime without any proof like abdominal scans. Of course, this is NOT medical advice but if my own child had those symptoms I would probably take her off the Laxido just for a few days just to see if it makes a difference. Since there are normal poos every day (assuming both in size and consistency) then it can't do a huge amount of harm as there is stuff moving through the bowels.

Ah just misread that the clear liquid was happening before he started Laxido so that won't be the sole cause! Hope you find some answers. And definitely push for an examination...even just be pressing on the tummy a doctor should be able to tell if there's significant constipation.

My son had the exact problem with clear fluid, really concerning at the time and I never got an answer from any medical professional. Always happened late afternoon. As well as leaking clear fluid he'd also have complete bowel movements of clear fluid sometimes.

It stopped after I stopped giving him laxido. Also turns out he was intolerant to dairy and soya. I had no problems getting a paeds referral and then onto paediatric gastro, so I'd keep pushing. My son was older though, 6 or 7

@PlayDohDots thank you, I did think that as well and tried coming off the laxido for a couple of weeks but it didn't make a difference, so have stayed on it in case it IS constipation, I don't want to make it worse!

@ProbAmU that's exactly like my DS - it always starts in the afternoon, around 3/4pm! How strange.

Maybe I should try a break from laxido again...so difficult to know what to do for the best.

Just though I'd update incase it was useful for anyone else having the same issue - I stopped the laxido...and the problem stopped! Been a few weeks now and all seems fine. Now I wonder if DS ever was constipated, and I've just been spooning laxido down him and 'disimpacting' the poor kid for no reason. Or perhaps there was an impaction and that cleared, and the laxido wasn't actually needed after. Either way, his bum appears to be watertight again, so that's good.

That's fab news, and I felt the same after stopping the laxido, wondering if he ever actually needed it. I felt quite cross that I'd potentially distressed my poor child further.

Glad your DS is ok!

I spoke too soon - DS was fine for about a month, no bum leakage, then had a couple of accidents, then was ok for a couple of weeks, but now we are back to nearly every day again. Always about the same time, late afternoon/evening. Normal poos rest of time, but quite explosive farts in the evening with small amounts of loose poo. It's starting to upset him now too, poor kid, he's desperately trying to hold in his farts, giving himself a tummy ache, as he doesn't want to have an accident,.

Gastro won't accept a referral, I don't know why, think might be able to see dieticians but I don't know if they are really the right people, have tried health visitors but they can't help. I don't know what else to do to help him 😞

Does this sound like a food intolerance?

Its not clear liquid now, its more pooey, had some mucus in it too a couple of times, so I guess the clear liquid before was the laxido.

Hello. Just wondered if you ever figured out what the clear liquid was? Sounds so similar to my son - don’t know if he is constipated or not!

Is he witholding? Because of the constipation they withold poo as they are scared a poo will hurt them and what comes out is overflow/soiling when they can't really hold it for much longer.

He needs a maintenance dose of lactulose and picosulfate if so.

Thanks for replying. No I don’t think he’s withholding and this is just completely clear and odourless liquid, since I started on the laxido again.

@Hwhtrio sorry for late reply, not on here often. Nope, never found out, despite eventually being seen by a paediatrician. He still has some issues now but not as bad. I still don't think he was/is constipated.