Disimpactions using Movicol - advice, please?

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Ds is doing his first disimpaction. Tomorrow he gets 12 sachets.

I have two questions:

1. How will I know that the disimpaction is successful, and can stop? He is currently passing a mixture of 4s, 5s and 7s (on the Bristol Stool Chart).

2. what about afterwards? He goes back to school on Monday. Can he go straight from 12 sachet dose to 4 sachet maintenance dose, or does the dose need to be reduced gradually?

It's been a while since we did this.

1. When he is passing very runny, watery poo without lumps it should have worked. Sorry it really is that gruesome.

1. Yes.

Sorry on iPhone and posted too quick.

1. Yes. Put him on his maintenance dose and make sure you stick with his toilet routine. Our DD1 does a poo nearly every morning after her breakfast. In the early weeks and months after the disimpaction she was encouraged to sit on the loo for 5 minutes with a book about 20 minutes after breakfast if she hadn't gone herself.

You'll know! We did this last week with DS. 2,4,6,8,12,12 then boom - it literally kept coming for 19 hours.

How old is DS? You will need towels, bed mats on bed, pull up if he'll wear one.

It'll come out waterey and yellowy when it's the last bit. It will also smell because it's been inside the body for a long time. Hot water bottle on stomach and rubbing stomach helps.

I had a bucket with warm water and washing powder in the bathroom for dirty underwear to go straight in.

My DS still didn't eat for 2 days after dis impacting. He takes Senna rather than movicol daily and so we waited 48 hours afterwards to start it. (So after a proper meal). So far he's been daily and seems to be maintaining movement.

You can continue the maintence dose of movicol straight away afterwards.

Good luck!

That's a little worrying. He needs to have control over his bowels by Monday. So even if he hasn't fully cleared out, I think I will have to end the disimpaction tomorrow, to give him a chance to be ready for school on Monday.

Clinic want me to disimpact him every school holiday. Seemed do-able. But how do you actually fit it into the holidays? Two weeks, fine, but two sets of grandparents to visit in different parts of the country, and two other dc with holiday activities and things they would like to do, to.

Youarekiddingme, why didn't your ds eat? Was the disimpaction distressing? So far it hasn't bothered ds much, and his appetite is probably even better than usual.

DS was so impacted - totally loaded colon - he was in agony and really felt ill. He just didn't eat. He did literally empty his bowels for 19 hours - there was A LOT in there.

I'm a little concerned that they suggest you dis impact every holiday. Your DS should be emptying his bowels completely on a daily basis if he's got impacion problems and should be on a maintence dose of laxatives for this.

When a colon/bowed gets impacted the muscles stretch and it takes 6/12 months to go to to normal. It's unhealthy to be impacted so often.

But PLEASE if he's impacted then DO NOT stop dis impaction. Your causing more damage to his bowel by doing this.

Are you under a gastroenterologist?

Ds was soiling most days, and pooing anything between twice a day to twice a week. On 3-4 sachets of Movicol daily his leakage is vastly reduced and he poos every day. His appetite has always been good, but before we started Movicol he had a lot of nausea and mild tummy aches.

He's been seen by a paed and is now under the care of the nurse-run constipation clinic.

Was your ds's constipation a one-off? It sounds really miserable, poor boy. My ds has been like this for years. We just thought it was attention-seeking! I thought constipation meant intense distress, hard, painful poos and a poor diet, not ds's healthy diet and generally soft poos. I had no idea you could get blocked higher up, with relatively mild symptoms.

DS has a very good diet too - but he has hypotonia (low muscle tone) which they think may be the cause.

The leaking is where they get hard stool, the bowel stretches and they a) lose feeling and control and/or b) have leakage past the hard stool.

DS has chronic constipation - hence the daily Senna. It is a myth that going everyday - even more than once - doesn't indicate constipation. That occurs when the bowel doesn't fully empty and some stool remains. That hardens and remains put. Eventually they can end up loaded (like DS was) and need lots of movicol (which draws water into the bowel) to get it moved.

What concerns me is that they think your DS is still retaining stools and needs a dis impaction every 6-8 weeks. He shouldn't be retaining any.
This is why if my DS doesn't open his bowels during a day he has 2 movicol as well as the Senna that night. Then increase each day until he empties. It's not unusual for him to be impacted - but this was the most severe he's ever been. The worst he's suffered before is a bit of discomfort bless him.

4 and 5 on BSC are acceptable. It doesn't always indicate though that the bowel is completely emptying.

7, to me, would indicate that there's no impaction. It's coming out watery and clear and therefore the bowel, colon is empty.

DS stools are softer than is normal - but that's the price we have to pay for knowing he's emptying out as much as possible. He seems to be a - nothing coming out or a 6 kinda guy!

I meant in all the big holidays, not counting half-terms, so 3 times a year.

We're back at the clinic this week.

I still think it's a lot of movicol fir someone who isn't impacted - eg they are just assuming he is

How do you confirm it?

You can usually tell by feeling the stomach - apparently! The GP always confirms it this way with DS.

I'm not saying the clinic are wrong with clear outs every 4 months - just its unusual to go from 4 to 12 sachets directly and the whole idea of the medication is to prevent impaction.

Yiur advice just seems opposite to mine.

We've also been told to do the 12 sachet clear outs every big school holiday. We went up to 12 and then came back down gradually by one sachet less each day. We had an xray afterwards to check if he was completely clear but it showed he wasn't, even though his poos had been coming out completely liquid after the Movicol. So we did the clear out again and we're now staying on 6 sachets a day so he does block up again. DS seems prone to constipation even though he has a healthy diet and drinks loads.

We were told that one of the reasons children continue with leakage is that the Movicol isn't taken in a large enough dose and for long enough.

I sympathise with you, DS has been soiling and wetting since potty training and he's 8 now. How old is your ds?

*doesn't block up again.

We have been advised to disimpact 3 year old DD every 3-4 months as well, so it's not unusual advice. The rationale from our consultant is that it's best to assume there's regular incidences of impaction, and to clear them out periodically. DD is on three sachets as a maintenance dose as well.

I must admit, we did it in October but haven't since. She still isn't toilet trained and I've been pregnant the entire time so it just hasn't been workable. Hope we don't get told off when we see the gastro in a couple of weeks

The difficult thing for me is never knowing when and how much her gut is backed up, because like youarekiddingme says, a bowel movement every day doesn't mean the gut is performing well and emptying fully each day.