Soiling caused by constipation in 6 yr old

[tigerbalm]

I am looking for advice and support from anyone who has experience of the above and of their child getting better. I havent been on here for years but I used to be on here alot when my kids were younger.

My dd has this problem and has had for 2-3 years. She is now on Movicol and also Sodium picosulfate. Under consultant paediatrician at hospital, and community nurse. Still soiling at least every other day and sometimes every day for several in a row. Has no feeling of needing or doing a poo. Got a toilet time routine in place twice a day, tried rewards for good days, nothing working. Now on a dairy free diet although the doctor says the NHS do not test for dairy intolerance, yet their website says there is a blood test ??

I am desperate to find out how we can stop her getting blocked up and the poo leaking out. Any pointers we havent yet thought of would be appreciated. Thanks

I personally wouldnt omit dairy unless you really think she has an allergy especially as she is veggie, it'll be an important protein and fat source. I'd want to know the doctors rationale for advising that.

I wouldn't say all kids have high carb diets, for example we don't eat pasta or only toast in the way of bread but we do eat some rice or potatoes at dinner. Could she have like scrambled egg for breakfast instead of porridge (do you have eggs as a veggie? Sorry for my ignorance!), maybe with veggie sausages and fried tomato/mushroom/beans. Or full fat yoghurt with fruit for brekkie.

It sounds like re-addressing the balance with the carb side of her diet would be a good place to start. Add more protein, whatever you use, tofu, quorn, cheese, beans. Give her plenty of fat, it'll lubricate her stomach.

You only have to think about you cook carbs, in a big pan of water usually or you add a jug of water to flour to make bread. It continues absorbing water in your stomach, like a sponge, that's why it's dehydrating.

Try upping her fluids with some soups, smoothies, homemade ice lollies, hot chocolate at bedtime, any sort of inventive way to make it interesting! Fruits and veggies are mostly water. You may already give her these things, it's just about balance.

Like for lunch, instead of sandwiches, give her 'kebabs', thread cubes of cheese with veggies onto skewers, hot ones with tofu, halloumi, veg or fruit salad ones - those would do well for lunch boxes too at school if cold. If she needs extra filler, add a small portion of rice salad.

Doctors know little more than you or I about nutrition as they just don't study it at med school.

I couldn't tell you why doctors don't suggest magnesium, maybe other more modern laxatives have taken over. But it's really safe, and magnesium is an essential mineral used by the body like calcium is. It's good for bone health, the brain, nerves - so some people use it as a health supplement too. Natural sources of magnesium are cocoa, beans, peanuts, any seeds like pumpkin, sesame or sunflowers, chickpeas, dark green veg - so eating any of these in abundance will help her go.

Just want to offer my support and sympathy. My dd (7) has been on movicol, for about a year now. Been struggling with constipation since she was a baby. We have some soiling when she's really backed up, and then I don't know whether to up the dose or not because I don't want her to have an accident outside the home. It's affected her schoolwork too because she often feels really lethargic and sore.

Interestingly, she is allergic to peanuts, and from reading this thread I've noticed some kids with the same constipation problem have a dairy intolerance. I might try cutting dairy out for a month to see if that helps at all. Also, someone mentioned magnesium. I've read about magnesium elsewhere too so I'm going to buy her a kiddie supplement. Especially if the main source of magnesium is nut/seeds which we have to avoid.

Good luck, I hope things improve soon. Keep us posted.

just checked back here after being away for the weekend and wanted to say thanks for the extra replies and suggestions

the only thing I am not sure about is cutting down on fibre and wholegrains as that goes totally against all the advice I have been given or found on the internet

also glad bevmummyto2 who has been able to find some info on this thread that may be of use - best of luck to you in battling with the same problem

Agree with butterfingerz, magnesium is a very effective laxative, it is a stool softener (pulls water into the stool) and promotes the urge to "go". Best to take/give it at night as then you get results the following morning. Even if you're completely blocked up, i.e. manual removal stage , the magnesium will soften it all up and clear it out. I have given it to my daughter (3) when she has been constipated, works like a charm, and take it myself.

My DD is 8 and has been suffering from constipation since the age of 3. We do go through good periods but we are currently on day 13 without a poo! She is on Movicol, we have tried supposatories and still no movement. We were under a poo doctor but were discharged several months ago whilst going through a good phase. My next move is to stay indoors for a few days and up the Movicol to completely liquify her and flush her out. You would need to speak to your Dr about this but it has got us back on track before. I am sorry not to have any helpful suggestions but after being housebound for the last 3 days due to excessive soiling, came on here to hunt for any different methods.

DD is 6 and has been like this for 3 years, although we have been under a community paediatrican for this time I have now managed to get a referral to a specialist. NOthing I can add but just to let you know you are not on your own, DD's diet is poor which I think contributes to this, I have also asked about intolerances and my GP seems to think it is unlikely, however when I spoke to a friend of mine who is a GP in Australia, the first thing she asked was has she been tested for any intolerances.

We got reffered to a specialist school nurse but the school, and all she wanted was to send us to parenting classes.

You have my deepest sympathies. My now almost 9 year old DD went through about 4 years of this, it was awful, it got to the point where she was wetting at night as well because her bowel was so impacted, what worked for us was not losing our temper (which was so difficult after the fourth or fifth pair of soiled knickers in a day). We were under a paediatrician at the hospital and they kept tweaking her medication until she could go normally, she was on Movicol, Lactulose and Sodium Docusate, Movicol x3 times per day.

The leaking was awful and the smell was horrendous, I felt like our house constantly smelt of crap and DD would never tell you when she had leaked, just relying on you to sniff it out. Of course by the time she got to school the teachers were quite obviously not as keen to sniff her out as we were and there were times when I sobbed for her coming home absolutely stinking.

The medication worked over a period of about 3 years and she now no longer takes anything, although is not what I'd call regular with her bowel movements, however she goes when she needs to and forces herself to pass whatever is there.

As I say you have my sympathies. It's absolutely awful.

thanks for the Magnesium info

And thanks BenedictsCumberbitch :)

hi tigerbalm.... have experience of this. dd from age 4 to 7 now almost better.

1. fibre.

some posts on here reflect experience of fibre which is very contrary to what most people find. i would say either fibre is going to help, or it is not, which is the case for those posters. do you suspect that fibre is a problem? it wasn't for my dd. porridge every breakfast really helped.

1. restrictive diets.

the reason that the nhs do not offer sensitivity testing for food is because they calculate that the nutritional damage done by parents in restricting food groups which may cause a sensitivity (remember these tests are not 100 percent accurate) is more problematic than consumption of the suspected sensitivity causing foods. whether or not we agree with this policy, proceed with caution when restricting food groups. your dc already have a restricted diet, so this would not be my first priority.

1. dosage of movicol.

it is trial and error. you need to try different dosages until you are getting good results. do not expect the doctors to be terribly interested in advising you about dosage, because they don't know anything about it. a continence nurse might be better informed. if you feel she still has a blockage, do the dosage for faecal impaction. then reduce dosage until you are getting sensible results. movicol is a great treatment and it can really work, but only if you adjust the dose to suit your child's needs. if hydration is an issue for your dd, i would have thought movicol would be a really good treatment for her. my dd was having 6 sachets as a daily dose at one point, and the nurse said that for some dc a daily dose of 12 sachets was needed at times

1. behavioural.

once you child has lost feeling for needing a poo, they are suffering from a physiological problem because the nerves are not sending messages to the brain. this is not behavioural, and therefore any rewards for this aspect of the problem are inappropriate. there will be behavioural aspects to the problem that you can reward, but you need to work out what they are... sounds like drinking 6 drinks in a day will be a key one for your dd. for my dd it was taking self to toilet after each meal and having a good try. eventually once she was in control of her poos, i gave her knicker stickers for clean knickers, just to get her to focus on that final bit of improvement.

1. alternative treatments

at the risk of being flamed on here.... i gave my daughter homeopathic treatment by a qualified homeopath, and it really helped. i was never advised to stop using all the treatments the continence nurse was offering, so i carried on using both treatments together. the homepathy really helped especially with the more emotional aspects of constipation. when people are constipated, they can get very moody and grumpy. sound familiar? the homeopathic remedies have made so much difference to my dd's state of mind and attitude to the physical problem.

parents

when our children are not toilet trained it is embarrassing, inconvenient, stressful, frustrating and a myriad of other emotions. accept that it is a physical problem, there is no fault or blame or punishment needed. so many other people suffer too! and we are all too embarrassed to share and help one another.

i'm sorry this has been a ridiculously long post, but i really wanted anybody, especially op, to know that there are things you can do, and that at some point, those little nerves will start working properly again, and when they do, it's gonna be great and our dc will have learned a lot about overcoming difficult and embarrassing problems once its over.

good luck all

i second clockless, the movicol dosage is very important, my 5 year old dd has suffered on and off with this for last 2 years last summer being particularly bad and resulting in a 3 day hospital stay to be 'de-impacted'. this included very high doses (12 sachets) of movicol and an enema. we then gradually cut her down over the next 4-6 weeks to one a day and she was using the toilet with success. she occasionally gets blocked up sometimes, and i keep movicol on prescription, and now know how to treat the blockage by giving her a high dosage say 6 sachets and seems to do the trick. i also second lots of water, but have not made any changes to dd's diet as dietician was not concerned at all, in fact she told me that children with food intolerances often have diarrhoea and not constipation. and clockless, I have tried homeopathy a couple of times once with great success and second time with none. and you can use homeopathy alongside conventional medicine.

thanks clockless for your message it means a lot to me - and simplifies things

also thanks to Quip who recommended the book on constipation which I have now got and read and it is really helpful and readable

still no improvements here but we have abandoned the dairy free diet after a long discussion with our GP - he felt that if she was dairy intolerant then we would have noticed a significant difference when it was removed from her diet. he also pointed out that the symptoms of dairy intolerance are usually diarroeah (sp?) and failure to gain weight. He said the same as you clockless about the fear of having children on a really faddy diet and the damage this can do long term.

I am now concentrating on:

• routine (even more religiously than before and rewarding for compliance with toilet time)
• drinks (but need to talk to school because dd came home with full water bottle today )
• fruit and veg and liquidy / soft foods rather than particularly wholemeal type of fibre
• increasing movicol and sticking at doses rather than increasing and decreasing like we were on advice of constipation nurse

It helps me massively to know that others have solved this, and that it can be solved with huge patience

Just an update on our situation in case anyone in the same boat is still around to discuss with ....

Since early August, dd has been on Sodium Picosulphate to try to shift the blockage in her bowel. This is as well as the Movicol. We have been going to hospital regularly for the doctors to check her bowel ... they now seem to think the blockage has gone, and have stopped the Sodium Picosulphate and told us to just use Movicol.

She is still soiling daily, but she is resisting the regime of toilet time, drinks and medication much less than before. That has take so much hard work and talking talking talking to get her to accept what is necessary.

I went into school to explain the importance of her drinking extra fluids and they wrote it up formally as a medical condition with actions for school, child and parents. She still comes home with a full water bottle every other day though, as they said they can only encourage they cant supervise this, other than lunch time drinks, but even then I dont know what she has.

Emotionally she has been very aggressive and difficult, and now seems to be very clingly and demanding. Just ongoing I guess.

Fingers crossed that the soiling now starts to reduce and hope we are getting somewhere although I know it is going to be a long slog.