Encopresis brick wall. GP/school nurse unhelpful

[Poohelp]

My 5 year old has been toilet trained since 2.5. However he is still having daily poo accidents. Sometimes just a mark, sometimes a full poo. There is no fear around the toilet etc, and I suspect he sometimes doesn't want to stop playing to go. However this isn't always. He quite often will deny that there is poo in his pants and then be genuinely surprised that there is. He eats a lot of fruit and a good diet all round. He poos regularly at least once a day. He still wears a nappy to bed and it's quite common for there to be a full poo in the morning (done after he wakes).

I'm finding the support from school nurse and GP to be seriously lacking. For one they keep passing us back and forth and say there is no encopresis clinic in our area. I have been asked to be referred out of area but told this isn't possible (he was referred out of area aged 2 for lactose intolerance, so I'm thinking this may not be right). School nurse asked for a stool test to be done by GP, all clear. We've done everything suggested on the ERIC website and all suggestions school nurse can give me is he is constipated. I struggle to understand how a child that is pooing regularly (and of a normal consistency) can by constipated.

I am now doing a poo and food diary at her request and will continue this until September.

Last Christmas we tried a sachet of movicol a day which increased the accidents from 1/2 times a day to 12 to 15. It was awful but we completed the course. She now has told me that 1 sachet is not enough (despite giving him completely liquid poos and multiple accidents) and says he will need to have more like 12 sachets a day! This seems like absolute madness to me. Nevermind the fact I will never be able to get that down him in a day.

Has anyone got any advice as to how we can move forwards with this? My gut is telling me that there is no way in hell 12 sachets a day is a good idea, and that he is not constipated. I'm at a complete loss. I believe it's an issue with the rectal muscles allowing poo through when he passes wind etc but no one will listen or offer any alternative to movicol. But I'm no doctor. Is there anything they can do? Can then US scan him to see if he is constipated? That way we know for sure without having to put him through what seems like absolute hell for a week.

In addition to this he is under referral for ASD which possibly makes the situation a little more complex. Any advice would be much appreciated.

If he's had lactose intolerance could it be possible that it's actually the Cow's Milk Protein?

It's not uncommon for someone with ASD to have CMPA. Is he completely dairy free?

I've got CMPA and pooed very often until I figured out it was the dairy causing issues and cut it out.

Do you know how long the waiting list is for his ASD referral? If it's long, have a look at Caudwell Children's Autism Assessment Service. You usually get assessment within 12 weeks and if he does have ASD, you get 12 months support.

I've been through all this with my now 8 y.o who was constipated since he was a baby. Been on laxatives for years off g.p including movicol. Was at 2 points on 16 a day. All this did was give him diarrhea basically water poo. I couldn't take him to school cause it was constant accidents

After researching myself I came across Peppa pig pro biotics and he's been having them for up to 2 years and he is fine. Has had maybe 3 accidents since having it and having proper bowel movements. The probiotics actually move the food in your digestive system. Laxatives soften stools. I don't know why professionals don't tell you this. They've been a godsend.