poo trauma

[drivingmisscrazy]

Hi - not sure if this is the right place for this, but worth a try. DD is nearly 15 mo, and withholds her poo, and then produces it eventually with much pain and crying and upset. She was fine until weaned, and since then (I think) has been slightly constipated (except when on antibiotics). She associates the urge to poo with pain and tries to resist it, making it all worse. She poos every couple of days, mostly. She eats a good(ish) diet - likes veg and fruit, and drinks water - but possibly not quite enough. She's having about 330ml formula each day. We're trying her with lactulose (5ml, 2 x a day) but it doesn't seem to be doing much (slight improvement but hard to get her to take it regularly).

Has anyone else had this, and what did you do? I'm keen to get her to break the association between poo and pain before it's totally ingrained - any ideas, beyond more veg, fruit and liquid? All the threads I can find on here relate to older children - many of whom have problems until school . Any ideas or experiences much appreciated

My DD has had chronic constipation since the age of two when I potty trained her. She was always very forward for her age and we think, she witheld poo as a power thing.
I would check out the ERIC website - it has lots of info and useful tips.

Lactulose actually stimulates the bowel, whereas something like Movicol Paediatric simply adds water to the stool and is therefore less agressive o nthe bowel. I would ask your GP about Movicol and see what they say. It's very easy for little ones to associate the pain and carry on withholding so you're right in wanting to get it sorted out.
If possible, ask your GP to refer you to a constipation clinic if he thinks it necessary: that way, you'll have informative up-to-date info on how to encourage your DD not to withhold.
Have you tried changing her formula? Can they have cow's milk at a year still? Formulka is very bulky and not easily digested. As long as she's getting enough calcium, it doesn't have to be from milk and could be from greens/cheese/yogs etc.

that's helpful; I don't live in the UK, and I suspect GP would just give me a don't be ridiculous look, but it is an issue, it does cause her distress and I'm struggling to find a resolution. What I'd read suggested that lactulose was gentle on the bowel and could be used long-term, but you seem to be saying the opposite? do you think I should go to the GP and try movicol (I don't think you can buy it over the counter)?

I think that the idea of a constipation clinic here in Ireland is, well, hilarious...they don't even check weight and development beyond a year as far as I can see

The paed docs suggested that movicol simply added water to the poo to make it softer and therefore doesn't hurt when it comes out.
I have actually just looked at lactulose and it seems it is a similar thing - working by osmosis of water into bowel so maybe stick with it but I guess you could ask the GP about movicol. I definitely remmeber them saying it was the best stool softener. Will try to remember why!
Definitely have a look at the ERIC site I said though - there's a forum on there and there are loads of people who've all had similar things.

Have you tried giving her a cup of diluted prune juice? natural but works a treat without side effects.

We had this with DD and found that a few things helped.

Lots of fluids, and a glass of apple juice - it needs to be really good apple juice though - once a day really got things moving.

She is now the opposite, cannot drink apple juice at all.

Try tummy massages too, after a warm bath and a warm drink - this often helps.

My ds1 has had problems with poo (well both my kids have but for different reasons) he has been constipated since weaning despite having a very good diet. He is now 4 and still has some problems, but things are much better than they were. The worse time we had was when he was 3.2 and he wouldn't poo because I kept trying to put him on the potty (he would only poo in his pants for 14 months after potty training for wees) then he got so constipated he couldn't go at all. He didn't go for 14 days, we were about to be sent to hospital when he finally managed to go.

Anyway we have found movicol to be much better than lactulose. Tbh lactulose doesn't seem to do anything for him no matter how much he takes whereas the movicol works pretty quickly. Ds1 has sachets which you dissolve in water (I put a small amount of squash in aswell), he actually likes drinking it.

We have finally been referred to a poo clinic! So hopefully they will have some more advice, but I would definately ask your GP for the movicol.

Ask your GP to show you the Bristol Stool Chart as well - you can get it in leaflet form - it shows you what a 'good poo' looks like and a number 4 is great.

Hiya, My 2 yr old has been going through a similar scenario for quite some time. He can withhold for up to 15 days if he decides he's going to, and the amount of stress and tears that have been shed over what should be a normal act, you wouldn't believe.

We have tried everything possible to get him to poo, bribery, praise anything we could think of and finally we think we may be getting somewhere!

Apparantly children suffer from anal "tears" if they have become constipated, then every time they poo it hurts like hell! Very quickly you have the catch 22 situation where they hold it because they don't want to go, but because they held it it then is harder and hurts more!

The key according to our gp is to use movicol to clear them out, lactulose to keep the poo moving until the elasticity of the bowel has come back and treats and positive praise to encourage them to go!

The idea is that you need to retrain the child that poo is not painful!

Ds is getting there, however we realised recently that he was not improving much with the positive praise and so we have spent the last 2 weeks "normalising" his poos! We are being totally calm about it and reciting a list of all the people we know who poo!

You must get the lactulose into her tho because it will ensure she has soft poo, which should be less painful. Good luck :O)

With lactulose though, they have to drink lots of liquid through the day - movicol is drank with water/juice and you don't need to consume as much liquid because of it (although making sure your little has lots to drink is very important).

luciemule, I have never been told that you need to drink lots with lactulose, in fact it is given to dialysis patients who are on severly restricted fluid intake (200-300 mls per day). Lactulose increases the softness of the poo but doesn't actually give an "urge" or stimulus to go. Movicol speeds up the through put of the stool and gives a very intense urge to go! If a child has had an impaction then movicol is routinely used in conjunction with lactulose, they can work very well alone or in conjunction with each other, but they work very differently.

I am a little by your last post.... Yes making sure you LO has plenty to drink is right and I think I can see what you are trying to say but I am afraid I don't agree with the rest of your post as it stands.

Please have a chat with your gp if you need to clarify how the different meds work the paed seems to have given you some incorrect info, movicol does not increase liquid to the stool, it just makes you poo, lactulose does enabling a softer poo to come through, movicol can produce poo like rock if that is what is in there when its given.......

Kickarse queen - I read that you need to drink lots of liquid with lactulose on another forum so perhaps that's not completely correct however, there does seem to be lots of different info and from different GPs.
With reference to Movicol though......

"Osmotic laxatives (such as lactulose) that increase the amount of water in the stools by drawing water in from the bowel lining."
From the Netdoctor website.

"Macrogols (polyethylene glycols). These are administered along with extra fluids, so they don't draw more water into the bowel from the body. Examples are Idrolax and Movicol. Macrogols may be of long-term benefit to patients with persistent constipation and faecal impaction"
From netdoctor website.

luciemule, thankyou, I do accept your sources, my gp told me that Movicol does not increase the poo fluid volume (never thought i'd type that sentence!) and I accepted his word on that, considering the solidity of some of ds's poo after he had been given Movicol it seemed accurate!

The LO still needs to have the same amount of fluid intake either way.

All the sources that I can find only reccomend Moviciol for a 3 day spell, I know my GP prescribed it for my ds for longer and I know of some children who need to take it every day, the preference is usually for children to be given lactulose which is safe to be used for decades and is generally classed as the gentler of the 2.

I totally agree that the op should speak with the gp about the possibility of a course of movicol to get things moving, but she likely to then end up on lactulose to soften things and get the lo used to the idea that it doesn't hurt....

Good luck everybody I hope you all have poo to clean up tommorrow! :O)

Thing is though, my DD has been on Movicol from the age of 4 until 8 with a gap of about 9 months break, as have many other children. Having been under 3 different health authorities during that time, all the consultant paeds (one of whom is a specialist bowel and constipation guy) (including the JR, Oxford) have all said that the movicol is the best course of action and can be taken for years (1 sachet a day) until the rectum has returned to it's normal size. Yes - it really can take that long. perhaps GPs aren't as geared up as the hospitals in the ongoing treatment of chronic constipation.
I'm not implying you're wrong but all evidence I've heard from the paeds and that I've read suggests macrogels (like movicol) are the best bet for treatment of faecal impaction and constipation.
Although my dd has just been represcribed Movicol due to withholding again (!), she hasn't soiled for over a year thanks to the meds - hooray - was so fed up washing poo out of pants!

thanks all - didn't realise that there was so much potential for disagreement!

took DD to GP today - who was very helpful. She suggested that we keep on with the lactulose for now, and that as DD eats a good diet , that we drop her formula and take her down to one bottle of cow's milk before bed and offer her water ALL THE TIME. Now that she can drink out of a cup herself, she will drink it, but only a little at a time.

So I hope that the formula will turn out to be the culprit and am glad that for now we aren't doing anything very aggressive. We're to go back in a month if things haven't improved and then we'll be referred on. But there's no impaction or obvious problem, and (as someone here suggested, I think) some kids just don't get on that well with formula, bowel-wise.

But thanks for all your comments and support - really helpful

If the formula has lots of iron in it, that can cause constipation.

OK, here we are a week later, having dropped her formula completely by Sunday (not sure how long it takes to get out of her system ) - but things are really quite a lot better - she is pooing every day now (sometimes big, sometimes not, TMI ) and with minimal distress - just a bit red-faced and grunty. DP and I are trying to get used to the fact that we have to check her nappy, as we aren't always sure whether she has had a poo or not...before we were in no doubt!

Just an update and a suggestion to anyone with this problem, in a baby over a year, (not sure of my ground here) that they try dropping the formula. I kind of feel terrible now that she has been going through this for months and the solution was so simple (apparently, fingers still crossed)

Hi

Glad u are getting sorted. I have found processed sliced cheese gives my 3 yr old problens too. No so bad with regular cheddar but the sliced stuff is def a no no.