Toddler constipation / lactulose

[Coffeemonster1]

Dd 2.3 struggles badly with constipation which she holds in and has previously made her bleed. But the stools she passes aren't typical dark, little pebbles, sorry for TMI they are the size of tennis balls, so no wonder she holds it in :(. She has had movocol since a few months old but it doesn't do much, so have now been given lactulose. How does this work, are there any side effects or problems using it etc? Is it better than movocol or is there anything better if this doesn't work? We have tried the obvious diet changes, increased water intake, fibre etc, less dairy and even trialled soya for a while but with no change :(

get 'philosophy of health' a. ciesielska, from amazon. in this book you will find the reasons why your dd is constipated and what to do to get rid of it.
100% works!

Had same issues with DC1 when small. We were wary of giving too much lactulose but the pharmacist or doctor told us that it is not absorbed into the gut so you can't overdose on it. He said it needed to be the texture of toothpaste when it came out. DC had a tear which was causing pain and so started holding which exacerbated the problem. We encourage lots and lots of water ever since (11 years later!!!) as it seemed such a trauma at the time.

BTW the lactulose sorted the problem at the time and we stepped up fibre and water from then on.

It draws water into the gut to soften the poo. Works very well, makes it nice and soft - also it becomes impossible to hold in, so beware!

Almost 4 weeks with the lactulose now and nothing has changed :( still in discomfort and complains of "tummy hurt", very swollen belly, still 4/5 days of all this before something large, solid and painful is produced. I do think a Gp visit is on the cards next week.
Is there anything else they can prescribe or is there a reason why these meds might not be working?

There are number of things for the GP left to try or add on to the existing treatment.
Here is the NHS guidance www.nice.org.uk/guidance/cg99/evidence/cg99-constipation-in-children-and-young-people-full-guidance3

I assume you are giving her plenty of fruit and fluids a well as the other dietary measure you mentioned.

Hope you get it resolved soon.

Thankyou I'll have a read. Yeah she eats loads of fruit and veg, only drinks water and plenty of it.

I used to work as a nursery nurse so have seen how varied children's diets can be and my DD's is extremely healthy. The amount of fruit and veg she eats, any other child would suffer from diarrhoea from, yet she is still constipated :(

How much Movicol are you giving her? My dd had to go up to 8 sachets! before it cleared the constipation. Once it cleared we reduced sachets down to a maintenance dose of 2 sachets a night.

This has kept her soft and regular for a couple of years now.
Talk to your gp about increasing the dose.

We gave up on movicol in the end and switched to lactulose as the pharmacist said it was. Enter. But we were giving her about 4/5sachets at 18 months old. Will make a Gp appointment.

Lactulose is a plant sugar that the body can't digest, so it just passes through, drawing water with it and that's how it helps constipation.

DS1 was on it for a while (couldn't get him to take movicol, think it tastes a bit grim). His paediatrician told me he had prescribe up to 30ml doses for some kids, so it may be the dose needs increasing. He also recommended giving him some fresh orange juice in a bit of water with his breakfast (he was only 10mo at the time, and fresh orange alone not recommended). His constipation cleared up fairly quickly. DS2 occasionally gets constipated but not to the point of needing medication - just prunes and raisins and it clears sharpish!

Have you tried Glycerine Suppositories? When she starts to strain you shove a suppository up her bum, sorry for phraseology but you will have to push it up and hold her bum cheeks together to keep it up there. The suppositroy breaks down the poo so she isn't trying to push a tennis ball out. I have been exactly where you are and it is horrible. My middle child would be screaming in pain everytime she had to go. Make sure you're giving her the right fruit and veg as well, some of them actually make constipation worse, banana's are a big one for this. Where as Apricots even dried ones can make you go!