Constipation? 4 year old constant soiling

[veneeroftheweek]

My 4 year old is constantly soiling his pants. At its worst it's been 10 times a day, a small amount, possibly not even enough that he knows he's doing it. He'll do a large poo every 4 days or so, always in his pants. I can't remember the last time he did a proper poo in the toilet.

The doctor said it was constipation - the soiling was overflow and prescribed lactulose. This didn't really seem to have much effect and, if anything made it worse. He was on 5 ml 3 times a day for about 7 months. Doc took us off lactulose for a while but nothing changed. I've just gone back and doc is referring us to a paediatrician but it will be a bit of a wait. Meanwhile we're supposed to start lactulose again. DS starts school in September which I'm really concerned about as, because of this problem, he's never been securely toilet trained. Also, the sheer volume of dirty pants is really driving me mad.

Doctor also thinks it's possibly behavioural (not sure how it can be both - she was a bit vague. Possibly she thinks he's withholding) so I'd really like to deal with this side of things. No matter how we dress things up with treats and prizes I think he feels that sitting on the toilet is a bit of a punishment. The constant pant-checking and sitting him on the toilet has now become a real issue. Any advice?

Anyone?

Sorry, not much of an expert on this but hopefully by my bumping it someone more useful might come along!

My understanding is that faecal impaction doesn't resolve itself without a proper clear out - a friend's child was prescribed high dose movicol for this, I don't think lactulose works in the same way.

I hope you can get it sorted asap. for you - I find it trying enough when DS (also 4) hasn't wiped properly and I have to clean poo out of his pants, but you're coping with that on a much greater scale.

Thank you for replying! That's interesting. I asked the GP about getting something stronger but she was very reluctant. What I don't understand is that his poo when it comes is very soft and not hard which is what I would expect from being constipated.

How long was your friend's child on movicol for?

I agree with nellwilson

Ds has had major issues with impaction previously and I found that I was only scratching the surface with his treatment until we saw a consultant.

Ds had a weeks worth of movicol building to the maximum dose, this cleared him out and every poo he had was runny, basically water. We then reduced the movicol by a sachet a day until we reached an 'ideal poo'.

This along with a medicine called sodium pico sulphate changed things massively. The website Eric has lots of information on.

Ds relapses sometimes- I've found he just wasn't drinking enough since starting school so have switched him to a zero sugar flavored water. He thinks this is a treat and is drinking a 500ml bottle during school which has kept him regular for a few months now.

I would be pushing for movicol and doing the 'evacuation'(building up to maximum dose) and then increasing liquids as much as possible.

Our consultant was brilliant, spent lots of time with me discussing the ins and outs of ds issues- which tbf I think did start with withholding during potty training. He was even at the end of the phone during the evacuation week for advice.

It's definitely not a quick fix, but worthwhile pushing for different meds now rather than later x

Thank you numberseventeen. We've got the hospital appointment booked for the end of July so hopefully they will be able to sort him out. The GP won't do anything else in the meantime. I'm curious though if it's likely to be impaction if his poo is really soft. I imagined that it would be hard.

Will check out the Eric website too.

I think it's that very soft poo gets around the impacted hard poo (overflow diarrhoea?)

Ah ok. He did have a massive clear out on Saturday which filled trousers etc and was really soft and sticky. I can't understand how there can be more in there but I think I don't have a clear understanding of the workings of the bowel!

It is surprising how much poo is in there!

Our consultant drew me a picture to help me understand. It does get better I promise- ds has at least 1 poo a day now and most days 2.