3 year old struggling with constipation issues- Any help massively appreciated!

[mrsm22]

Hi

I think I have possibly posted before about this but right at the start when I first noticed a problem. We are a bit further in and still having problems and it's causing me a lot of worry as there is nothing worse than when your little one's aren't well. My DS who is nearly 4 years old has been struggling with constipation for a few months, I noticed he would be stood in a corner of the room going red in the face and crossing his legs in an attempt to try and stop himself from having a poo. He would say it hurt and stopped going to the toilet for a poo altogether (which is where we are now).
I think because he thinks it will be painful he tries to avoid going so it has got to the stage where he will try hold it in and will 'mess' himself throughout the day a few times so we are changing pants a lot and if its a really bad day, I sometimes put him in a pull-up for ease.
I noticed that he would leak bits of liquid and from what I have read and heard, this is because he is so constipated with hard poo that he becomes impacted. Anyone feel free to correct me if I have got this wrong. We tried Syrup of figs which did actually work the first couple of times in making him have a big poo, but the problem has continued so I took my DS to the doctors 6 weeks ago. The doctor was very nice and understanding and suggested we try Lactulose. She said to try 5ml morning and night for a few weeks and then try decreasing it to 2.5ml. So we tried this and for the first two weeks it seemed to be working wonderfully and my DS was producing two big poo's each day, correct consistency etc. The problem is that when I changed him to 2.5ml morning and night my DS is really struggling to poo again and back to being comstipated, so presumably it is not enough for him. And when on 2.5ml he is getting leakage again if just small amounts of liquid in his pants. I quickly put him back to 5ml and on Tuesday this week he had 5ml in the nirning but in the afternoon had bad runs about 3 times. He said he had tummyache too so I thought it best that he didn't have anymore Lactulose Tuesday evening and just gave him 2.5ml on Weds morning but he didn't do anything all day in terms of having a poo, just tiny amounts of liquid leakage I call it. So I gave him 2.5ml again this morning and took him back to the same doctor who insists that she thinks Lactulose will sort the problem out and will regulate DS but that its a case of finding the right dosage and pattern of Lactulose that suits DS. She has suggested we try 5ml tomorrow night and every night for ten days, so just once a day and see how it goes. She said if he still has the runs on this dosage to try 5ml every other night. She actually wanted me to start the 5ml once a day tonight, even though I had given him 2.5ml this nirning before we saw the doctor. The problem is that this afternoon he has had the runs twice or two pull-ups of liquid poo so I was scared to give him any Lactulose tonight and thought that all being well, I will try to start the 5ml tomorrow night and try do that every night for ten says as the doctor instructed, provided that DS doesn't have any runs tomorrow.
Sorry that this post is long and probably repetitive but I would be so grateful if anyone who has experienced this with any of their children could offer and helpful advice or tips. Or if anyone has tried Lactulose? Will DS settle on this or would he be better on something else? I keep seeing Movicol crop up all over the place but the doctor didn't seem keen when I mentioned it today. My DS isn't the best eater as he's never been overly bothered about food but he does get a varied diet and all fresh home-cooked meals every day and I try my best to get him to eat the right foods and drink water. He has never liked cereal and will not try any so has toast for breakfast but fruit as well and he likes fruit so eats kiwi, banana, strawberries and apples most days. He also likes brocoli and carrots and he eats chicken and meat and fish, he drinks a lot of pure fruit juice and I am trying to get him to have sips of water every half hour as he's not keen on water. He is very active and full of energy and a happy little boy. I just wish he could poo properly.

Many thanks in advance for any help, tips, advice or shared experiences.

My experience is well out of date, as DD is now 25. But I remember the worry of it all. DD was about the same age as yours or a little older perhaps. My GP put her on an adult medication (he rang a paediatrician to doublte check) and we spend a day sitting on the floor together playing beggar-my-neighbour, with DD taking a swig of her orange medicine after each trick had been played. Thankfully it worked, and DD increased her veg intake slightly, and was not troubled in that way again.

I felt it was All My Fault, but it wasn't. I can't remember what med it was, but doubtless treatment will have moved on slightly since then. But just wanted to send solidarity from an oldie who's been there.

He is still having overflow by the sounds of it. I would ask GP for some glycerin suppositories to help get the impacted poo out. You need to keep up the lactulose every day, it sounds like he will need 5 ml daily. Also try a probiotic powder mixed into yoghurt or sprinkled on cereal. Movicol tastes horrible and they need to take quite a large volume to get things moving, he probably wouldn't drink it anyway.

DD had dreadful problems with constipation round the same age. Movicol was the only thing that worked and at its worst she was on 8 packets a day ( only for a very short time, but still). This followed a hospital visit because she was in so much pain one night on holiday. We were also advised to reduce her intake of milk as this can exacerbate the problem ( may have been all dairy products - I forget as it was a few years ago). Obviously liquids are vital so keep the water or whatever he will drink up.

Maybe try to get your doc to refer you to someone who specialises in this area? We ended up worrying it wad something more serious but once we were sire it wasn't we relaxed and eventually it just went away as a problem.

I know how worrying it is though so I hope you get some joy soon.

Lactose was useless for DD btw. Movicol is horrid but we mixed it into squash I think

We have this problem constantly but due to his complex needs our son is still in nappies.
It really is about finding the right dose for your child. Ignore the Dr's basic figures .. Maybe 5ml in the pm and 2.5 in the am will suit better ????

We also used sodium pico sulphate when DS refused movicol ... That works well. DS has a gastrostomy now so movicol goes in without a worry.

You need to a) sort out the medicine b) adjust Ds's diet.

If he only eats toast, what bread is he eating & what are you putting on it ?

Only use white bread, anything that's brown or wholemeal takes a lot of water to absorb, which means it's blocking him up.
Make sure he has some fruit with it every morning, so the kiwis, mango, pineapple are good. Dilute all his juice, full strength is actually quite filling, better to eat the fruit. With lunch, if he's having bread, then try a different carb, crumpets, jacket potatoes, baked beans, serve with slices of cucumber, butter, carrots sticks, tomatoes. Have a satsuma, Apple, grapes too.

My dd suffered in exactly the same way & unfortunately it does mainly stem from high fibre rather than soluble fibre foods.
We had similar problems with lactulose, I ended up, when she was about 2yrs, requesting sodium docusate which makes the poo absorb water so becomes softer & easier ( & therefore not unpleasant) to pass.

Try to get your son to eat porridge, even choc ready brek with a mix of porridge would be better than the toast.

I wouldn't use suppositories, there's enough bum trauma, so try to get the lactulose, sodium docusate & diet sorted.

Thanks to everyone who has responded so far. I have decided to lay off the Lactulose as DS has been very loose all day. When this stops and he becomes constipated again I have decided to give prune juice a try but if this fails, the doctor has offered a prescription for Movicol Paediatric to try. I have been trying to find out on the Internet what would be the right starting dosage for DS who is 4 in a few weeks as I asked the Dr but she said to read the instructions (ever helpful). I have read that one sachet needs to go in approx 60ml of water, so about quarter of a glass and that one sachet per day is what you start with for his age but is it meant to be just one drink in one day. Is a full sachet meant to go in so little water or are the sachets only small?

Lactulose is a pretty poor laxative - Movicol is far far better so glad you have got some.

How much you need is really by experimentation but what you are looking to achieve at first is runny poo (a sort of gravy consistency) that your poor DS will not be able to withhold and won't hurt him when he goes.

It's isn't just a case of him having a good clear out but also him forgetting that poos hurt so he doesn't just go straight into a pattern of withholding and constipation again. He also has probably been constipated for weeks or months and his bowel has got distended - it will take a long time for it to return to normal and for your DS to fully understand the signals that tell him when to do a poo so treatment goes on for a long time.

So start with one sachet Movicol a day for a few days, then if no progress or not enough progress (DS can still withhold, not pooing very very soft poo everyday) then go up to 2 and so on. 8 sachets is the disimpaction regime if everything inside has been there so long it has managed to set like concrete. Don't miss a day as the longer poo stays in the body the more it dries out making it harder to go.

Then once you have got him going and it isn't sore anymore you can very very slowly cut down so he is doing a soft poo everyday. And then keep with the Movicol for ages to let his bowel recover.

Bananas can be bad for constipation - they have to be properly ripe.

Wolpertinger - thank you. So I will wait for him to become constipated again before trying one sachet of Movicol per day. Should it just be the one drink or do you half the sachet so that its in two drinks? I expect it is just the one drink and that he can either drink in one go or have sips throughout the day?
Interesting that you say 'like gravy' as since Tuesday all that is coming out of him is gravy-like poo. I hope it firms up to something 'normal'.

I'm not sure that what he is doing now isn't overflow diarrhoea - but please don't take advice over the internet, get him seen in real life.

When you have been constipated a long time and basically the poo in your rectum has set solid, the only way anything can get out is by dissolving and slipping out as liquid around the lump. This is called overflow diarrhoea and you are still very very constipated but of course it's commonly mistaken for being too loose.

Of course it could be that the lactulose really has dissolved everything and now it's just runny which is what you wanted - its impossible to tell over the internet!

It's is v confusing! If the lactulose has had the desired effect then stopping it completely is the wrong thing to do as you just get in a repeated cycly of getting constipated again.

It's hard work but you have only just started and you are on the right track really.

Please don't wait for him UK be constipated, it's horrible for me.

The sodium docusate works much better as a starting point but none of this will work if you don't address his diet. Do you give him wholemeal bread etc ? Please don't, it's the worse food for little kids as their bodies can't deal with it.

The sodium docusate works by drawing water into the poo, which softens it.

Yes the bowel does stretch & that's why you need to address it now & not wait for him to become constipated again.