Poo problems

[familygirl]

My DS, 8, has just been prescribed Movicol for faecal impaction. We had been seeing a paediatrician as he wets most days, soils occasionally when not very near a toilet as he always needs to go urgently. He appears to not feel it coming and I don't think his poo has ever really been formed properly (mushy, 5 or 6 on the Bristol stool chart!). We had reduced his fibre intake (no weetabix or brown bread but still eating fruit & veg) as I thought it was too much fibre (he was eating 2 weetabix & 2 slices of wholemeal bread a day). He was tested for coeliac and dairy inolterance and then they did an xray which showed a very full bowel, hence the movicol. SO I am confused as he has never had a hard poo come out (as far as I am aware) although he has more recently described the feeling that he needs to strain on the toilet. Today-2nd day of movicol so 4 sachets, he has done a formed poo, light colour but formed. We were told to keep increasing the dose til he had liquid poo then reduce. Has anyone else had experience with this and would you expect a normal 'sausage' poo before the liquid clearout? Is it really likely to be constipation/faecal impaction? Sorry for the long post-I am totally baffled and could really do with some advice!

Maybe this is tmi for a Friday night!

One more try during the X factor break... Would REALLY appreciate advice/ experience please...

Can't help at all but really feel for you. DD1 is 8 and we're having lots of problems with her passing long hard stools (and subsequently causing anal fissures and everything that goes with that) and having stomach aches etc. It's a minefield out there and even though we've seen a doctor, and spoken to her several times since the start of term, I'm not sure that her casual 'it's very common for children this age' approach is working for us. Anyway, nothing to do with what is wrong with your DS but wanted to wish you the best of luck and really hope you manage to sort it out for him soon.

My DS has poo problems but he was eventually diag. coeliac but still isnt right and takes 2-3 immodium a day depending how bad he is.

My brother/Mum both have horrific constipation and always have. Having a actimal/yakult sort of drink every day means my mums goes once every 7-8 days instead of 2 weeks

Also my DS wets a lot and was told this is linked to the bowel, it irrtates it (He just 8 btw)

Thanks so much for the replies-sorry to hear your children suffer too. I will keep on with the movicol and hope it helps. Still unsure of whether he has other underlying issue, or whether blood tests for dairy & coeliac can be wrong? Or what else could cause him the problems, for it to be so mushy and it be so urgent? (sorry for tmi!!)

Did they just do a blood test for coeliac ? In kids it can give a false reading. IIRC the only way to rule it out is a biospy. Most coeliacs are lactose intolerant at diag. - this normally settles down after a few weeks on Gluten free.

Thanks - I think after this week on trying movicol etc. if there's no change I will try to get them to rule it out with a biopsy. I just think the older he gets the worse it is, having accidents if he doesn't happen to be right near a toilet. He copes very well but it can't be nice. One mystifying factor, which has only meant I have had to really pursue getting someone to see him, is that he has not had a problem with weight gain.

My son was/(is) tall, thin and looks/ed healthy - he eats very very well and normally has about "10" a day so the doctors kept fobbing me off - telling me it was a bug and giving me really strong anti-B's - this went on for nearly 2 years. he himself wasn't bothered but it was an issue at school with staff (kids where fine) but now when he has "accidents" he is trying to cover it up/hide it.

Hope you get some answers

I have a DS very similar to yours but 5. 6-8 mushy ones a day - and soiled frequently as he doesn't feel the build up and know when it's coming.
1st paed said it was behavioural . 2nd paed sent him to gastric paed. He has the endoscopy and colonoscopy and said mildly lactase intolerant. After being dairy free - there was virtually no change. He has noticeably lost weight - and has a more pronounced belly and no weight held anywhere else.
gastro are treating him for faecal impaction diarrhoea - although i have my suspicions - as does a friend who is a paediatrician and has known his history since birth.
He was treated with movicol during the summer hols - and was liquid for nearly 5 weeks and didn't even firm up enough to get to mush. With gp's knowledge we stopped as his weight was going down.
When we saw Paed in Sept. He started him on senakot and fybogel. Similar pattern to the movicol. he was soiled 6 times in school in 1 day! After 10 days i phoned the gastro sec. she passed the message on but he has refused to speak to me (or won't - the sec has confirmed he has received my message and she has left his notes).
Consequently i have done some re-adjustments myself. I have given up the senakot completely. I give him the fybogel every couple of days and it firms him up enough to pass reasonably formed stools - enough to get a build up feeling.
Sorry for long post, but i think there are very many parents out there that have similar difficulties and that are just put on the same 'order' of medication - sorted by price - and not by efficacy. There are other meds out there that may control the situation. Ultimately, finding the cause would be my greatest wish!

Ds has had probelms with this for years. Unfortunately, once they have constipation/impaction/soiling it can take a very long time for the bowel to return tonormal and give the signals to the body that they need to poo.

As the impaction builds, this stretches the bowel and so when a normal poo passes, it does not give the signals that you and I have.

The soiling occurs when softer poo slips past the impaction and then slips out with the child completely unaware due to the lack of sensation.

First step for us was to talk about it not being ds' fault> They obviously have no cntrol over the soiling. The only thing we asked was to tell us when he needed clean underwear/help with washing himself. This hlped his confidence immensely.

We managed to clear the impaction using lactulose but, I think, Movicol is very good. I don't know anything about doses but the advice to keeping going until soft poo starts does make sense.

You may need im to be on movicol for some time, tweaking the does for him to do a daily soft poo.

He will also need to sit on the loo regularly to get his bowel into a routine. My ds used to sit on the loo 20mins after breakfast and 20mins after his tea.

Water is very important and has been the key for ds to keep his bowels openning regualarly and much more improtant than diet for him. He has to drink LOADS of water, much more than many adults and if he does not drink enough, he starts to get bunged up again.

Have you seen the Eric website? They have useful information, leaflets and a good helpline.

Sorry for long post, I'm sure I have missed loads out though!

If you search encopresis, soiling, pooing on here, you will find lots of other useful posts.

Unfortunately, constipation and soiling is quite common and can take some time to improve. Gla dyou sound as though you have a supportive medical bod to help!

Familygirl - Our 7 yr old dd is exactly the same. She has never had a hard poo to our knowledge, passes a BSS type 5 on the vast majority of days but also soils. She has been seeing a (private) peadiatric gastroenterologist for 18 months (after countless GPs told us she was 'just being naughty') and has had an x ray which showed megacolon. She appears to have little or no sensation that she needs the toilet.
The gastro has been treating her for a bowel blockage initially by sodium picasulfate and movicol and then by movicol alone. She spent a good few months on a daily dose of 4 sachets of movicol (with regular check ups with the consultant) until he was sure that her bowel had been empty for some time...then we took her off movicol and we are back where we started with no obvious signs that a blockage was building up ie. no hard poo, no days without poo. Gastro have now asked for a colo-rectal surgeon consult :( which is due in a couple of weeks.

I find so much of the info on the web is for children who have obvious constipation - therefore you 'dose' til you see a daily soft poo. There is little or nothing for those who have the daily soft poo but still soil. In fact at our last gastro clinic (this was NHS as the consultant wanted her back on the NHS books to be able to access the surgeon) we saw a different doctor and he pronounced that it was impossible to be caused by constipation when she is having a daily soft poo and that it was psychological. He then had a strip torn off him by the Consultant who is very sure that it is a physical problem.
There don't seem to be any easy answers - I really don't want dd to end up with a colostomy (which seems to be the surgical answer to everything) but as she gets older her soiling is getting more and more socially unacceptable.

With the first lot of movicol our gastro consultant said that the commonest mistake is stopping the movicol when they have the first bout of liquid diarrhoea. This liquid poo is likely to be the poo behind any blockage and therefore the block will still be there (the fresher poo liquifies and goes round it)..so he recommended that we kept going for some time after the liquid poo starts until it goes firmer again (which hopefully is the impacted poo finally shifting).

My dd2 kept getting so impacted that she ended up having weekly enemas .

We had tried the movicol (as a regular and as an impaction dose), lactulose, sodium picosulfate, docusol...

The saga continues!

Hope yours gets sorted out - unfortunately it seems too me to be a very inexact science.

From our experience, getting rid of the impaction was the easy part.

It is the on-going routine/diet/drinking water that is the relentless bit. Luckily, we manage to keep thngs 'going' without needing movicol, etc but many require it for years.

Ds was first diagnosed with an impaction 3yrs ago and we still have to make sure he sits on the loo daily (even if he does not feel 'the urge') and watch his water intake. He still has very little warning that he needs to go and so still can have soiling when he can't get to the loo on time.

He is definitely getting better but there is still a way to go, I think.

Had a really interesting lunch with a friend who is a pharmacist. He even brought his books with him as he probably knew the talk would work its way round to poo!

We have the same problem as EColi and feel the same that there is little or nothing about children that have 'constipation' that have never struggled to do a daily (sometimes 6-8) poo and still leak.

The pharmacists book showed the pages of anti diarrhoea drugs and laxatives. There is some crossover with bulk formers such as fybogel ( isphagula). it says that if the dose is too high of some laxatives - it can give the reverse effect - diarrhoea.

I think most of us are in it for the long haul - a 'saga' like melted says. Anyone else feel like they are given so many different ideas to try that in the end they hope that your DC grows out of it - digestive process matures - and they don't have to put their thinking caps on to work out 'why'?

Hah! If only they did all grow out of it!

Unfortunately dd2 will not grow out of her problems - she has physical disabilities, is tube fed, incontinent and not very mobile, so bowel problems come as part of the package, I'm afraid.

I think she sees some pretty competent medical experts yet I still get the feeling none of them really truly understand how to manage constipation, so consequently cannot really explain to me what to do!

Good luck all of you, I'm glad we're not in it alone... My son (5) withholds poos and was prescribed movicol a few weeks ago to help with his constipation. It seemed to help and certainly softened his poos up, but now he has no control and though I cut down the movicol to 1 sachet every 2-3 days and now have not given him any for 6 days, he is soiling his pants constantly, several times an hour. When will it stop?! I'm sure it works great for some kids, but I'm going back to lactulose and at the moment would be happy if he went back to being constipated and only going once a week! Evil mum?

nasu why do you think i'm called auntevil!!!

melted i know you have other difficulties with your DD - read you on other pages [hsmile]. i still think that some gastro paediatricians work on a ABC list. I don't think they stop and reassess the situation and think - hey lets try something really radical and off the ABC for gastros list.

I had bowel, swallowing and dietary issues as a child - to which i only remember some of the impact. I still have issues - but you can self manage as an adult (although i could never have a job where i didn't have easy access to a toilet!). I can't begin to imagine how your DD feels melted to feel physically uncomfortable with incontinence and not being able to self manage. She must feel truly miserable at times. [hsad]

I don't think she really cares, tbh, except when there is an actual elephant-sized poo trying to exit her back passage!!! - or unless she has diarreah-ed all over her clothes/wheelchair/bedding/me!

Mind you, she's getting used to the enemas!

LOL [hgrin]
Must admit, i still laugh if my DH goes into the toilet after DS and you hear 'OMG'. I don't think he knows how such a little body can physically produce that amount.

Absolutely! Before the movicol my son blocked the toilet every time! He was actually proud because we were all so relieved when he did a 'big poo' that he got the impression that the bigger the better...

By the way my son's problems began when he was a baby and it really helped that I gave up wheat and dairy while BFing. He has been having wheat and dairy since he was about 18m but I'm now trying to reduce dairy again to help with his constipation. Don't really know how to cut out dairy from a 5 yr old's diet, but GP said he wouldn't refer me to a dietician because there aren't enough of them. Anyway I think it's worth a try.

Please don't cut down the movicol too quickly.
Your son has classic impaction.. and soft poos are most common because it's all that can get round the blockage.

My DS2 has had bowel problems for years, several hospitalisations because of it. Movicol works but in the early stages it has to break down the impaction.. hence the liquid poo. You WANT him to have a good few days of liquid poo because that means the blockage is being cleared. Then you can gradually reduce the movicol. However, realistically, as he's impacted he will need long term movicol (prob 6 months on a lower dose) to allow his colon to shrink from being all baggy and stretched. And LOTS of fluid. First sign of any problems.. up the movicol again.

We have been at this for nearly 13 years , sigh, and it does take careful management, but it can be sorted! (My ds2 has other problems hence not ever quite resolving the problem!)

kidsncats is right....if poo is impacted,all that gets round the blockage is the loose liquid poo so you need to persist with the movicol to get rid of the obstruction