Faecally impacted 5yo

[ElphabaTheGreen]

Turn away now if you do not want a poo-related discussion!

DS1 (5yo), having never been constipated before in his life, passed a golf ball sized poo with great effort and me lifting his knees up on Thursday. Same again Friday. On Saturday, he was absolutely screaming with pain and passing nothing. I had a look and a gentle feel and he appeared to have the Rock of Gibraltar lodged in his rectum, so I took him to A&E, where they gave me a large box of Paediatric Movicol as they don't give suppositories or enemas to children. I basically have to give this to him in ever increasing amounts, to a maximum of 12 sachets a day until the dam bursts. Six sachets today was a bloody battle - not looking forwards to eight tomorrow. He'll only take it dissolved in apple juice but even that's becoming a challenge. I'm also pushing fluids on him like a fiend, trying to get him to eat fruit and veg (an utterly impossible task at the best of times), along with other high-fibre foods, encouraging warm baths and he even let me give him a gentle abdominal massage tonight. He's getting a bit uncomfortable and his tummy's starting to look a bit bloated, but he is passing wind OK and he seems generally alright in himself

How much longer have I got of this?? I'll have to go to the GP with him on Wednesday to get more Movicol anyway and I'm half hoping she'll quietly ignore the NICE guidelines and BNF and give him a suppository. I really have no idea how the brick wall in his bum is going to be dislodged without a huge amount of pain for him.

Reassurance/advice gratefully received...

Is he getting plenty of exercise? Make sure you go for a really long walk. It should work.

He's a very frenetic little thing, and we never sit down when I'm looking after him, but he has been with MIL and FIL yesterday and today while I'm working, and they have a frustrating tendency to park him in front of the telly 🙄 I've asked them to make sure they run him ragged today.

If the impaction is right down in the rectum, it'll take longer for the movicol to dissolve it. Check in with the GP about suppository/enema, though; we were using enemas regularly at that age due to ongoing hideous bowel probs, but that was under specialist gastro consultant care, I guess. The movicol should work, but may just take longer to do so. And it should dissolve stuff enough that the first bowel movement out isn't too hideous. Make sure you keep going until you're getting soup type texture before cutting the dose down.... really important not to do only partial disimpaction.

The reason for pushing movicol rather than suppositories/enemas is that in the vast majority of kids the movicol works way better. I remember doing constipation clinics before movicol was invented - sheer hell. We were regularly admitting kids for several days of a NG tube down the nose to give them bowel prep, as we just couldn't clear them otherwise.

Okay: trying to get them to take movicol. Bear in mind that it's not just the taste (bit salty/metallic), but also a slightly gritty flavour. So sometimes have more success with drinks that are naturally a bit gritty/bitty/thick, as the mouthfeel is less weird then. Failing that, make it up a bit in advance, as whilst sitting a bit it dissolves a bit more thoroughly. Taste buds work most effectively at room-to-body temp, so best to avoid that. Either fridge cold, or even in a hot (non boiling!!!) drink. If using cold drinks, straw helps bypass some of the tongue. Something nice tasting for immediately afterwards. Don't worry too much about healthy eating at the minute - get him disimpacted at the minute, rewarding with yummy foods, then start building up on healthy foods once he's cleared out, in the hope of gradually getting him back off the movicol. Whilst he's this bunged up, the fibre in the food can't get into the impacted rocks.

Oh, and 1000 times agree with above about not reducing so fast. He needs a good 3 days of copious amounts of gravy stool, with no lumps left, before reducing. Don't suddenly stop. You then want to be at scrambled egg consistency whilst his rectum recovers, or much higher chance of getting back to square one.

If you need more movicol it might be worth trying a couple of doses of chocolate flavour. My DD has that - it is still vile and gritty but she much prefers it to the normal flavour.

I had vile amounts of radio and chemo for tonsil cancer, it has left me with lazy bowels.... I make them work by blitzing a banana, two kiwis and some almonds every morning. Every so often, they come to a crashing stop, I mix four or five movicols with all of the above and blitz it with almond milk. Twelve to twenty four hours later, BINGO.

Can you get your hands on a blender ?

Funny old place MN, I would never have predicted sharing my bowel movements on here.

I'm surprised they wouldn't prescribe suppositories.

I mean, yes, Movicol is brilliant but it takes a while to work its way along the digestive tract, softening the impaction as it goes. IMO there's no harm in using a suppository to soften the worst of the blockage at the bottom end. After that, the rest will come out like a tsunami (seriously, don't leave the house )

If I were you I'd consider buying some adult suppositories and cutting them into quarters lengthways. But see how tomorrow goes, I guess.

I can recommend using a wide straw and getting him to hold his nose while drinking. Also, making a game of how many gulps can he get down without taking a breath?!

The dam has burst and soupy poo has ensued, no suppositories needed! 💩💩💩

How much Movicol should I give for the next few days then? He had seven sachets today (it would have been eight if he hadn't had the late-afternoon mega-evacuation). The instructions in the box say discontinue once faecal impaction has cleared, but I take your point nocool about making sure he's soupy for a while so we're not back to square one. He isn't a chronic constipation type, though. He's never had this before so do I still need to keep battling with giving him the Movicol?

Trouble I thought bananas were constipating...? I've had them on the banned foods list since this started. If he'd even deign to try your concoction, he'd have a minute sip, then make like he was killed.

Fussy little sod. It's how he ended up like this. Bowels can't function on the odd ham sandwich, the occasional ice-cream and deep breaths of fresh air.

I think the standard advice for the disimpaction regime is to reduce by two sachets per day until you find their ideal maintenance dose.

I'd usually not start reducing until you've had 3 days of lots of pure gravy, but you may well be able to get away with not increasing further, as long as the world really starts falling out of his bottom.

What comes through to start with is poo from higher up, above the hard rocks. Because that wasn't as hard, it liquefies first. The act of the higher stuff coming through then really starts the process of working away at the edges of hard rocks, getting them ready to move. It you start reducing too soon, the danger is that the rocks haven't actually shifted yet, just the higher up poo, so that as soon as you reduce/stop, then the poor kid can be straight back to straining to pass rocks.

The reason for not really using suppositories/enemas much is a combination of they only tend to move the bottom bit of the rocks, but lull people into such a false sense of security that they don't give enough top end meds, and that many/most young kids with constipation issues end up with a psychological (trying to poo hurts, so try not to poo) element, and giving meds up the bum can make this worse.

Not being rude but Google it, too tired to try and recall........something to do with the ripeness of the bananas. Green tinge not great etc.,

Going forward, freshly popped pop corn, (you will get the kernels on the world food aisle) with lashings of butter and salt.

I'll confess now to not have RTFT (it's late!) but just popping by to say I had years of this with my now 5yo.

From 2 onwards he withheld going and it got worse and worse until he became incontinent (poo juice leaking out from around impacted stools) and one day ripped himself inside. GPs wouldn't listen, kept saying it was normal and he'd grow out of it. Movicol was more trouble than it was worth - disgusting stuff and the amounts he needed meant the whole day was a constant battle to get him to drink causing even more problems!!

The only thing that fixed this was a permanent maintenance dose of Lactulose. You can get it over the counter but we have on prescription. My DS has been on this for about a year now and regularly goes every day at the same time. He has 12.5ml twice a day although when he has been compacted he's had up to 30mls to try and dislodge what's there.

The problem with toilet problems can very quickly become psychological problems which obviously are much harder to cure. My little boy is OK now but his Lactulose prescription is very much a long term situation. If his routine or diet is altered he can become constipated again if I'm not very careful.

It's not just the Lactulose that helps him either, we spent months and months working hard to make sure he had a comfortable toilet routine. So now, every evening he sits on the toilet with a book for about 15 mins and will usually go. If he's drinking enough water and eating enough fruit sometimes he'll go in the morning too.

There is a brilliant Facebook group called movicol mummies - go find it. Full of excellent advice.

Agree with making sure you will properly watery poo to make sure you don't end up back at square one and then reduce slowly. Don't just stop.

Be aware that Gp's aren't always the best at giving good advice in regards to children's constipation, so you need to do some research if this doesn't resolve itself quickly. The Facebook group is brilliant for that purpose.

Agree with just letting him eat what he fancies - avoid eggs and bananas though. And replace ice cream with ice lollies!

As for hiding it - jelly and homemade orange ice lollies work in my house. And if you don't tell him it's hidden in them you might have more luck!

Also warm milk hides it great - hence my 3yr old still has milk morning and night!

And you can also hide it in things like pasta sauces etc, porridge, weetabix..... pretty much loads of stuff! Heard of success of hiding it in fruit shoots as well (not done it myself as I hate them, but if it's a short term solution to the problem then there is no harm!)

We make up the days dose in the morning (it keeps in the fridge for 23 hours) and then add a splodge here and there.

Hope that helps and good luck! Oh and baby wipes kept in the fridge might help with cleaning up and also maybe put some nappy rash cream on his bum (like bepanthen - better than sudocrem) to stop him getting sore. Prevention better than cure!