Constipation/with holding

[sazza040]

Daughter is 2yr old 3 months , been suffering with constipation for a while now. To cut a long story short , found out she has been with holding and have put her on daily doses of Movicol and Lactulose. Now the witholding is obviously worse than ever. Its been going on for a week like this now, I feel like I am losing my little girl. Its affecting everything. It has been to the point today where she wouldnt even leave her bed as she was trying to hold it in, she was trying to get me to leave her alone so she could hold it in peace. I cant bear her doing this to herself. Im trying to ignore it and its breaking my heart. Any one who's had experience to this how did their little ones cope when put on the medication- J seems worse than when she wasnt (but then shed eventually pass agonising bm which was also heart breaking).

You have to make it up with water but you can then dilute it with squash or juice. ERIC suggests you avoid milk if possible but go for it if it really is the only way your DC will take it.

www.eric.org.uk/Parents/viewThread/2743?PHPSESSID=72c4a8e73a9b316716799450528f5943

You need enough Movicol every day to get a poo everyday - even if at the beginning it's in pants make it clear how delighted you are and give a reward. Sticker charts are great if your DC respond to them. When you know you are going to get a poo every day start having regular sitting on the toilet sessions, initially rewards for just sitting on it and then rewards for poo in the toilet. Don't even consider stopping the Movicol until toilet training is completely finished.

It's a really long term thing to fix but you are getting there.

Thanks for the link, I know it's early days so hopefully a bit of perseverance and praise will do the trick!

The consultant I see with my DD told me you're looking for a poo consistency like mushy peas That's what you need to aim for!

Just keep tweaking the dose until you figure out how much your DD needs.

clare8allthepies I have always given my ds his movicol in milk for a year and a half now. The hospital know and I think they suggested it initially actually, and never had any problems.

This may be completely irrelevant, but my 2yr old was recently diagnosed with the dientamoeba parasite, having had very painful poo, causing her to withhold, and alternating constipation and diarrhea. When she had fresh blood in the stool GP immediately tested for this - I've read that it's often missed. Is it worth asking for same or similar tests?

Thanks. Im giving 3 movicols a day atm, today ill probably up it, havnt done the clear out yet. DD went to nursery yestserday, It was her first day and she got on great- but still holding even there in the middle of playing would throw herself on to the floor :( We got home and she was still holding till she could no longer- tried to be so happy with her but she just gets upset and cries and wants it cleaned off her asap just seems to want me to get on with it- she seems disgusted with it but as soon as its clean she sais byebye. A long while ago when I was at the doctors with her when she was a baby she had gone all stiff with her hands by her side and I remember asking the dr what she was doing and the dr didnt know and just said it was probably behavioural and she would grow out of it. Im now thinking this could of been something that started at a really young age (baby :( ) and im scared she maybe cant even help holding it in and doesn't know what to do any more.

She'll get there. It will take a long time to break the habit but eventually she'll lose the association between bowel movements and pain.

You should probably chase up that gastro referral as well, because it would be helpful to rule out any physical cause of the constipation and/or pain.

Thank you for the re assurance. I will be ringing the drs in the morning, 3 movicols yesterday -4 today, nothing today and again straining all day and finding it difficult to get her to eat much. I'm very concerned about it all. I could cope with an hour or two of it but when its literally from when she gets up to bed its hard to bear.

Wow, I'm amazed she's taking that much Movicol and nothing's happening. Definitely get her checked out and make sure that referral is in the system.

Yeah its crazy- just have no idea how much movicol its gonna take to get her to go daily! She is just so determined to keep it in not sure if she can really even help doing it. I have tried talking to them but they dont see witholding cases 'urgent' it seems we could still have another 18 weeks of this. :/

My ds used to have 4 sachets a day as maintenence dose so think that's ok if that's what she needs. One thing we've learnt from my ds paediatrician is that movicol only softens the poo, but if you need to stimulate the bowel to make the poo come out you need a prescription for senna or sodium picosulphate. Maybe try asking your gp to add one of those in whilst you wait for the referral appt?

Thanks, Phoned HV - they dont seem to know much about the whole situation nor do drs - the drs will not give me any Senna they will only give me the Movicol too and they do not know the guidelines on dis impaction. 6am in the morning I checked ds and she had been she was still sleeping crossed legged :/. Again this morning she had been, the whole business is very upsetting for her she was hysterical at me changing her. She had 4 movicols yesterday, 3 the day before. Should I just continue with 4 now and see what happens?

forgot to say, the past few times she has been its been mushy- like nutella (Sorry tmi!!!!)

Is what is coming out ok looking and volume? The darker the poo the older it is. How does her belly look? If her belly looks larger and firmer than usual then she could be impacted. It can be hard for a doctor to diagnose that as they don't know what your childs tummy normally looks like and not many doctors, even at the hospital, we've discovered, know how to feel the tummy properly for faecal impaction.
I would continue with the 4 movicols, lots of fluid and fruit intake, and if you think she's bunged up and in pain then I would ask the gp's for a referral to the local paediatric ward to go same day to be checked over. If this has gone on nearly 2 weeks now, it's time for someone who does know what they are doing to look at her, especially if she's in pain. If she's not getting everything out, and it's gone on for 2 weeks, then there could be a build up in there, depending on how her tummy looks.
I have had to be that pushy mother in the past, arguing with the gp and taking my ds to hospital myself to a&e but I've learnt you know your child best.

Tummy doesn't look too bad and its not that dark, I don't think she's overly bungee up but it's been coming out in little bits now where she is holding on and loosing control. Have spent all day cleaning up little amounts.

oh poor girl. Is there another gp you can see? it makes all the difference if you get a sympathetic gp. My gp has no experience of constipation issues but my ds is under a couple of paediatricians who can help. I found the health visitors also don't have any experience. If you get really concerned I would insist she is referred same day to be checked over on the children's assessment ward at hospital. I've done this a couple of times and my ds has then had the care he needed, and admitted twice, as the gp failed to diagnose him.

I am waiting to see what the HV come up with (they said they would get back to me within 24 hrs..) Worse still I chased the referral and although the Drs said it was sent on the 3rd the hospital have not received it. Still small bits here and there. Did your DS do any of this? The Drs told me before they cant do urgent referrals for this type of problem...how did you manage to get referred same day? I will probably have to really make a nuisance of myself to get anything done.

If small bits are coming out and they are all Nutella consistency (with no hard bits mixed in) you may finally be getting there.

I'd stick with the 4 Movicol a day and see what your HV says. Can you ask her if she thinks it is worth you doing the disimpaction regime or whether you have now more or less done that, if another GP at your practice has more experience with paediatrics and whether you should be adding some senna or picosulphate?

I took my ds to doctor three times over a few days as he wasn't pooing at all and insisted gp did something. She reluctantly did and he was checked at hospital and admitted. long story and not entirely relevant as we later discovered he has a congenital defect with his intestine which we hope to have surgery for this year. This causes severe constipation so he lives with this every day and takes a lot of medicine. But I did find out just how pushy you have to be which served me well when he got bacterial pneumonia later on and gp failed to spot it until I insisted he was checked at hospital!
If you know something isn't right and she's in pain I would just keep pushing. Maybe the hv can visit you and see first hand how much pain your dd is in and they might be able to help push the doctor?

Wow, yes go's to show mothers instinct is such a valuable thing at least you have an answer now hopefully be better after surgery?? I am also keen to rule out medical issues as she has suffered with general constipation since a baby she was a breech baby too If that makes a difference I am not sure. Well another load tonight and its pretty liquidy now so must be cleared out now?? She is desperate not to do it but she just cant help it but go now its so loose. Im not sure what I should do re dosage as they say that I need to give enough dosage for her to have one formed poo a day but how on earth can I achieve that when the only way she cant hold her number two is if it is like liquid?? Confused.

I was told to keep going until she is going every day (even if that means very runny) they said that if that is kept up for a good few weeks then not only should the bowel regain proper function but that she should lose the fear of pooing. If she is going for weeks but still tries to withhold then my doctor said next step is a referral to the specialist psychologist.

Thanks Clare that helps, I was starting to wonder as they had kept going on about formed poo's which is impossible for us to achieve at the moment i think!!

Oh god OP I really feel for you, my DD just turned 2 at Christmas and from the start of October until after Christmas we had the same issues as your poor DD.Its a horrible situation and so hard to watch.

My DD started off badly constipated, not going for 2, 3 days, then when she did go the stools were very hard and large, and painful for her to pass. We were prescribed lactulose but like you were given very little direction on how often or how much to give.

The situation escalated until she was only going every 5 days but at this stage she was with holdind due to the pain she had experienced at the beginning of all this.

When she did start to feel the urge to go, it was horrendous, high pitched screaming, bright red face, sweating, and this could go on several times throughout the day as she wouldn't let 'go' - and I can't blame her - it was awful to watch.

Eventually she would go, one of us would have to hold her close and you could feel her little tummy muscles in spasm, as if they could no longer hold and were just overcome with the need to go!

She was also prescribed Movicol during this process but I had no success with getting her to drink it no matter what I mixed it with, so we concentrated on diet, lots of water, and lots of Lactulose! We gave 10ml 3 or 4 times a day.

I was dreading the thought of beginning to use suppositories but thankfully our doc agreed that it would be too traumatic for DD as she was already afraid of pain in that area!

Time is your biggest friend I'm afraid, our doc did say it could take months to get back anywhere near normal but thankfully we are making some headway now.

Now DD will go every other day at least and there doesnt seem to be any pain for her now, she will sometimes panic when she feels the urge to go and run to us but then it's over before she realises.

I was also afraid of this causing issues with potty training but I'm just going to hold off on this until the summer and she's already excited about getting a Minnie Mouse toilet and big girl pants so I'm hoping there will be no long lasting issues.
I really hope you see some changes in your little one soon, its just awful to watch and you feel so helpless!

Sorry this is so long winded but it was awful and I really sympathsise with you.

You could reduce her down to 2 or 3 sachets a day but I would keep it at 4 a day for a few more days first and then gradually reduce. You could do 4 one day and 3 the next then back up to 4 and see how she goes. My ds has never done a formed poo and he's 2.2 yrs now but i know it's down to his meds and not sure he ever will as even if he has surgery he will probably have Movicol still just maybe not as much.

My dd withheld because she hated pooing in a nappy, once I started potty training her it was really improved (and she was obviously practised at holding it as she never had a poo accident ever)