HELP!! How will we get this poo out!?

[PurpleLostPrincess]

DD2 has lots of history - she was born with an imperforate anus, had a colostomy done at 3 days old and reversal at 6 months. Has struggled with constipation ever since. We were giving her movicol every day until May when the consultant said to give her a suppository every other day. She is almost 4 now.

We stopped doing the suppositories a few weeks ago as it was just too stressful for both Cerys and I. Also, it wasn't keeping her clean the remainder of the time which, from what I can gather, was the whole point of doing them.

I decided not to reintroduce the movicol because she continued to be rather loose and would explode every couple of days - almost like her bowels had been trained to do so...

Last week I noticed she did a couple of pebbles one afternoon and nothing else, so gave her a suppository the next morning as she clearly needed to be emptied out. She then continued to go every couple of days as before.

The day before yesterday she had a few pebbles and I made a decision in my head to do a suppository yesterday if she hadn't emptied. I'm such an awful mother, I didn't do it as we had lots going on, were moving her room around and coping with this cyst on my ovary etc. Last night she was straining and said it hurt, so I thought "right, first thing in the morning we will have to do one".

This morning DH got up with her and when I came down late morning, he said she'd been crying and asking for the 'sore thing' as her tummy hurt. I put a suppository in but nothing came out. I could feel there is lots in there and it's hard, but all she did was cry and strain. So after two hours of it, I put another one in. So far she has had two lumps come out, but she's on the settee telling me she doesn't feel well and every now and then she cries and strains. I'm rubbing her tummy and back and lifting up her knees, I'm getting extremely worried now - how on earth am I going to get this poo to come out!? The consultant always said she would have to go no longer than 48hrs between poos, it's gone over that technically. Do I ring the emergency gp? Bless her, I can't bear to see her go through this especially knowing I could have prevented it if I gave her the suppository yesterday .

Please help! I'm going to copy this into childrens health too...

Do you have a direct number to ring your children's ward? I was given one when ds2 had bowel problems so we could call for advice/treatment at any time.

I'm afraid I have no other advice other than maybe put another suppository in and/or try her in a warm bath.

Please don't feel this is your fault though. My ds2 has bowel problem and can become constipated in a matter of hours, which means quite often we get no warning until he is struggling to do a poo and by then it is too late.

Call a GP or someone, or even take her to A&E as they will be able to do a manual extration there.

Hope she can get some relief soon.

I forgot to say my ds2 used to have to have his bowel washed out which sounds unpleasent, but he never minded. In fact he was quite happy lieing there having it done as I think it made he so much more comfortable. In fact a couple of times he fell asleep. The nurses told me it was quite common for them to have to do this even on normal children who just had a one of case of severe constipation.

I think you should seek medical advice too.

Thank you all, I'm not the type to panic usually but this had gone on far too long!

Literally as I posted that, she had another episode of crying/cramps and straining and a very smelly parcel as a result. I'm not convinced it's all out but she seems to be feeling much better and insists it's all out now.

Provided she is happy I'll hold off for now. DH and I have had a chat and decided she's best off going back on the suppositories every other day. It was unbearable, but not as awful as what we've just experienced, poor little thing!

Thank you all again though - I LOVE mn so much!!!

Bless her, she's sleeping on the sofa, she never sleeps on the sofa, she must be exhausted!!!

I think you need to speak to the GP about different options rather than making decisions with your husband. I'm not medical, but I've had years of working with adults who use a combination of enemas, suppositories, movicol, lactulose etc, so know more than the average person about bowel movements.

Does your daughter take lactulose? Movicol + lactulose can work fantastically for some people, and they're less invasive than suppositories. It can be trial and error though. Some people take movicol daily, others don't take it unless they haven't been for X days, and then can take up to 3 per day to clear them out. It's finding out what combination works best for your daughter.

As you say the body does seem to become reliant on suppositories and enemas, the muscles don't need to work so hard, so if it was my daughter I'd be looking at movicol and lactulose which encourage a more natural bowel movement.

Also do you know about the Bristol Stool Chart? It's a good way of spotting if people are becoming constipated before it actually happens.

I think your dd is suffering with compaction with overflow. Which means the actual poo isn't coming out and then gives backed up and up till some gets though and she makes a movement. Although the compaction hasn't been cleared

The best thing is a wash out, with it being done regularly. Movlicol and lactulose together.

And also a belly massage every night to get the gut working.
Lie her face up on the bed and starting just under her ribs press your hand flat down in a wave like motion working in a s shape over her tummy, you need to press firmly but not to hurt her. About 10 mins once a day.

Hope she feels better soon

Thanks biblio. I can totally see what you're saying and have checked the diary and we're seeing her consultant on August 8th. The thing is, she wasn't born with those particular muscles, they reconstructed her bottom and the big mystery is whether or not she will be faecally incontinent for the rest of her life. If she is, we've talked with the consultant about having daily irrigation or possibly the MACE button. These are options but not until she is 6 or 7, as children younger than that tend not to manage them too well.

When I speak with any GP's, I have to explain to them what she was born with etc, and they all back off and say that I'm better off speaking with the expert (her consultant) as they wouldn't want to muddy the waters, or recommend something that wouldn't be right. Our family GP is fantastic but again, he holds his hands up and claims that he's not familiar with this particular aspect of medical expertise.

Yes she did have the lactulose for the first year or so, but we were having to give it 4 times a day in order for it to have any effect, and it made her sick which put her off her food and we got in a rather difficult spiral/viscious circle with it. The movicol each night was working (with it's own set of problems), but when we saw the consultant in May, he talked about 'top end' and 'bottom end' medication and wanted to try the suppositories as an experiment to see if it would train her bowels being as they don't seem to have the necessary muscles (it's only with the suppositories that she seems to be aware of anything going on down there). We were sceptical about this to start with, especially over the first 2 weeks when we had to do them every day which was hell to say the least! I'm concerned about the impact it is having on her psychologically too as she calls it 'the sore thing' and asks if I'm doing it each and every time I change her nappy/pull up.

Please don't think I'm being confrontational, in fact it has done some good for me to have to explain it all and think it all through in more detail, that's why I love mn!

So, we're now faced with the decision of whether or not to go back to the movicol each night (which made her explode each day a few times), or the suppositories every other day. The thing is with movicol, every other day wasn't enough, but every day was a bit too much. The consultant is fantastic and has often said that as parents managing this day in day out, we are the experts . That's great and I agree to a degree, but need his input now. Saying that, this wouldn't have happened if I'd given her the suppository yesterday, so better management on my part is needed.

Mucky, thank you, that's exactly how I've been rubbing her tummy all morning! You've explained exactly what is happening so well (better than I did!). That's how I've been massaging her tummy all morning, glad to hear I've been doing something right!

The irrigation thing is another way of doing a wash out, but they won't do that till she's older...

Don't worry I didn't think you were being confrontational at all, if fact I was worried you'd read my message that way. :)

I agree with Mucky that there is a chance of compaction and what your DD has passed is the overflow, that's why it's so smelly. So you need to be working hard over the next few days, or until you see the consultant to get the compaction cleared. Your GP should be able to tell you if she is compacted by feeling her stomach.

Everyone I've worked with has had lactulose, in combination with something else. It doesn't make you go, it just softens the stool so that it's easier. It will only work on it's own with relatively mild cases of constipation.

I'd be asking the consultant if a small amount of lactulose (once or twice a day, 4 times a day is loads) plus movicol either alternate days, or 1 day with, 1 day without, 2 days with, 1 day without would work. Doing it like that is difficult to keep track of, but I've had to do something similar with one of my clients before. Make yourself a handy tick chart to go in the movicol box.

It must be really difficult for your daughter and you, you just have to keep positive about it with her and keep explaining why you need to give the suppositories if that's the route you decide on. Now that she's had such a bad day I'd probably use it as a reference to explain the suppositories will stop her having pain like this again.

Thanks bilblio, so glad to speak with somebody who has some experience of this!

I was thinking of either giving her some movicol this evening, or just going for another suppository first thing in the morning. She seems absolutely fine now, but I agree she has got rid of the overflow rather than emptied her bowels.

Yes I agree about having a plan in place, the only thing that made it difficult before was managing the movicol/lactulose against what she had been eating. For example, she loves pasta, but if she eats it, it bungs her up, so we stuck with movicol every night for a few days. Whereas if she'd eaten lots of fruit (which she often does), we'd cut it down a bit. Bit of a juggling act but it has to be done! She's a little pickle - she absolutely loves bananas with a passion, but if she eats more than one she gets bunged up. She's often been known to steal them and hide them, even though she knows she's only allowed one per day lol!

You can can get latose in tablet form if it helps.
Or if you do it try it again have same grapes to hand, and giving them both at the same time makes it taste a lot better

Oooo, I didn't know that mucky! She loves grapes with a passion so that's a good idea, will mention it to the consultant. Thankfully she loves most fruits and we keep her topped up with them and lots of fluids too.

I'm thinking it may be worth me ringing the doctor tomorrow and getting an enema? She really needs to be cleared out and the suppositories just don't seem to be doing it - would that be too extreme?

No, I think a trip to the doctors would be a good idea. They may be able to tell you is she is compacted, and if she is you really need to go overkill to get it cleared or it's likely to just get worse. An enema is less invasive in some ways than a suppository, and it's much more effective.

I'd keep hassling the doctor anyway. I know it's not his speciality, and you have a consultant, but he's the one you can easily see... if nothing else he should be hassling the consultant for better/more regular advice.... And he's your GP, I'd like to think if I was a GP and had a patient with a particular problem I'd make an effort to brush up on that area a bit.
(Apologies to any GP's, I know how hard you work, and you obviously can't know everything, but it sounds like this GP should at least be liaising with the consultant a bit more.)

A lot of it is trial and error on your part, you're the one who's administering the medicines so you can see what's working, but you need the backing of your GP and consultant to know what combinations may work without doing any harm to your daughter.

In some ways you're lucky. At work we weren't allowed to make any changes to medications or frequency of them without asking the GP first, which was immensely frustrating when you can see something is causing problems.... but on the other hand I wanted the GP's advice to reassure me I was doing the right thing... they're the ones who are trained after all.

I would do that, wash outs made the world of difference to Ds2 initially.

Just wanted to add my experience with ds2. He's is younger than your daughter and I don't have any experience of your dd's health problems, but when my ds2 was born the muscles in his bowel and intestines weren't working, also his anus was too small. After several tests (and manual stretching of his anus) no conclusive diagnosis could be made, so he was deemed to have an immature bowel. Once he was a few months old we were given suppositories for him so we could treat him at home rather than having to go to hospital several times a week. I felt uncomfortable doing this as we were told that ds2's bowel muscles needed to learn to work and I felt that giving him suppositories everyday would stop that as they would never need to learn to work IYSWIM.

Any way as ds2 has grown his bowel muscles have developed and overtime we were able to stop using the suppositiories and have tried a couple of different medications. He is now on movicol and I have finally felt less bad about him needing to have a regular medication (also I can now see that having it isn't stopping his bowel muscles from developing). It is trial and error with dose levels, but we have had the importance of keeping ds2 regular stressed to us. (If he were to be constipated for more than 2 days we need to seek furthur help as they don't want his bowel stretching as that will make the problem worse).

The best thing Ds2's consultant told me was not to compare ds2 with other children as there is no normal. He told us some people only poo once a week and that is ok and normal for them. He feels my ds2 needs to poo 2-3 times a day to be happy and healthy and that is normal for him.

As I say you have had longer dealing with your dd's bowel problems and her condition is different to my ds2's, but at your next appointment really share your concerns with your consultant - sometimes there are different things that can be tried which haven't be suggested before and they can make the world of difference.

Try an enema, you can do this at home using a turkey baster or similar, or can order specially designed products online. Just be careful not to force it.

I've rung the out of hours doctor and we have an appointment at 12.30 so they can check her tummy and hopefully give us a prescription for an enema. There's no sign of any poo this morning but I'm reluctant to give her a suppository when she's so happy!

We're then going on to my parents and I'm cooking them a full on roast so we won't be home until bedtime this evening. If I can pop on beforehand I will, but if not I'll update tonight

Well, that was an adventure to say the least!

I honestly thought I could speak with the out of hours doctor, let them examine her to confirm she was backed up, get a prescription for an enema and go home and do it - boy was I wrong!! Looking back though, it was probably a good thing...

Turned up at the out of hours doctors (situated on the ground floor of the local hospital), explained to the duty doctor who examined her. He was a bit vague, but put a call through to the paediatrician upstairs and asked us to wait outside. He then came out with an envelope and asked us to go up to the childrens day ward upstairs. They were a little busy but Cerys was happy playing with all the toys. She had complained of a sore tummy earlier in the day and had done a couple more small hard pebbles in her pull up. It took a while to explain it all to the nurse and we had some forms to fill in etc. Eventually the paediatrian came over and listened with interest to Cerys's history. She asked to examine her, but clearly hadn't understood the extent of the reconstruction I had told her about, as she was shocked at how red her bottom looked (inside). I had to explain again that it was her bowel - they had pulled her bowel down when they reconstructed her bottom grrrrr....

So, after much more explaining, she realised how much Cerys needed to be cleared out - she could feel it all built up in her tummy and agreed that 10 sachets of movicol just weren't going to do the job in the timescale we needed it to. She explained that they usually do the enemas in the hospital and it suddenly crossed my mind that I've never actually done one and I wouldn't have a clue what to do! So I was relieved to have a nurse administer it. Cerys may have to have daily wash-outs when she's older, so I'm going to have to learn one day, but at this stage, she needed an expert.

So they did it, and Cerys was soooooo brave!!! It produced the desired results (maybe desired is the wrong word here though!), and she immediately said that her tummy felt better - phew!!

We will never let it get to this stage again, this was a big lesson learnt! We're giving her movicol for the time being as she seems quite sore at the moment and we're seeing her consultant on August 8th, at which point we will put a plan in place.

Thank you all for being there and helping me through this awful situation - again, this is why mn is so fantastic ime!!!

So pleased it all worked out well and you got the help you needed. And well done Cerys for being brave.
Enema's aren't that difficult to do, especially as you've been giving suppositories anyway. The micro enemas are even easier. So don't worry about them when/if the time comes.

Make sure when you go in to see the consultant you have a big list of all the things you've been doing, what's worked, and what hasn't, to help you get a plan together.

Seeing the consultant this afternoon so will be giving him a blow by blow account of how things have been since May, including this situation - will upate later

Didn't see Mr Griffiths himself, but his associate (I'm assuming registrar) from the last appointment was there, so he was well aware of everything. Told him we'd had a nightmare 3 months and told him everything! Poor bloke didn't know what had hit him lol!

Anyway, he examined Cerys as well which is pretty standard these days. He said that we need to continue to try and train her bowels but wants to include the movicol into the plan. So, we are to give her movicol each day as before but in addition we are to give her the suppositories every other day. To be honest I've had to give her a few the past week or so as she had got rather solid, and now that we have the aquagel it has got slightly easier.

Seeing them again in 3 months, going to keep a more detailed diary this time!