He won't drink movical and the senna has not worked...what now?

[HumphreyCobblers]

4 year old DS (possible asd, severe receptive and expressive speech delay) has had ongoing constipation issues, not completely bunged up but constantly moving small amounts through. It has meant he has had to go back into nappies as I can't ask nursery staff to deal with this otherwise, it is really stinky and sticky. He doesn't seem to have the urge to go to the loo and do it any more.

We tried lactulose, then movical. He will not drink the movical. The doctor prescribed senna but two nights running it has not made any difference.

His diet is most likely to blame but we are powerless to change this any time soon.

Does anyone here have any ideas? Sorry for the way TMI here! I am on my fourth nappy of the day and the house reeks. Poor DS, it can't be comfortable for him.

I was told last week apple juice is good for disguising the taste of movicol - not tried it though as it isn’t a drink on ds “approved” list

Milk of magnesia is the most effective laxative I have ever found.

Does he like smoothies? You get the happy monkey ones and the innocent smoothies. They are good for getting things moving.

The Ella’s kitchen fruit pouches although for babies are generally very good.

Those things are good for maintenance.

Offer a juice or water bottle everywhere. I offer ice cubes to make it more appealing.

The movicol put in nesquick strawberry milkshake. Give a twirly straw with this and distract throughout.

I also agree with others who say disguise in cereal or anything you can.

The alternative will be a trip to hospital as a blockage can be quite dangerous

Oh and one more thing - houmus - it’s beige and he may well take it with his breadsticks

Would he drink a smoothie or milk shake? - cram in as much fruit as possible and a shot of movicol.
Does he like ice pops? - you could make a mixture with the movicol and put in the popsicles and freeze (also good for doing with deorilyte if treating dehydration).

Does he like running or cycling? The movement might help the stomach to move things along. Warm drinks would help soften the stool and gently massaging his tummy. I know his diet is limited but all the bread/carbs will make the constipation worse. If you have a little step, elevate his legs on it when on the toilet so he's not straining when trying to poo.

Sounds like my ds a couple of years ago, infact I had to double check this wasn't a zombie thread under an old name!
Are there any treats/desserts he will eat?ice cream with sauce that the movicol can be hidden in? Put a little movicol in absolutely everything you can, he'll hopefully get taste blind to it and then you can add 1/2 or full dose to just one thing-juice cereal yoghurt.
Will he eat any tinned food stuffs-i know not nutritionally great but thing like tinned spag bol, ravioli (pasta parcels) and things like that have a sweet sauce which can hide movicol ect. We used to sit on toilet with DS in front, his feet up either on our knees or on seat and do row row row the bastarding boat, while rocking. We'd have to do this two or three times a day but eventually it lead to him sitting and rocking, and proper belly laughs seemed to relax him enough for gravity to do it's work.could try even with nappy on.
Ignore the diet worries, DS went for MONTHS only eating porridge, beans, chips nuggets and toast. He's still not the best eater ever but he will eat some fruit and veg and will try new things now. He still won't spontaneously go for a pooh but most days we tell him to go super fast before bath and he does. Hope something there helps!

Give the lactulose and the Senna together as they work with each other.

Movicol is the best if u can get it into him otherwise it will be a suppository which probably won’t be pleasant take but will do the job

Stop giving him rice cakes it makes it worse

Thank you so much for all the replies. I didn't know you could have more than one sachet of movicol, I will try again later.

My ds was on 8/10 sachets a day at one point, that was fun!

The consultant also asked me to avoid fruit juice, smoothies etc as he said it would constipate him more.

What's the reasoning behind juice and smoothies making constipation worse? I've never heard that before and can't understand how that could possibly be the case?

My daughter has been on movicol (this is month 2 now). 1st month nothing much reqlly happened so upped her dose and the floodgates opened so to speak. She wouldn’t drink it in water but added a bit of summer fruits squash to it and she drinks it no problems now.

Forgot to add, she’s got the plain one so
Guess you could add it to any drink

Ask the gp to prescribe you some plain one

Does he eat jelly? I make some up - leave it cool and then add the movicol (already dissolved) and leave to set. In a normal pack of cubed jelly I can disguise 3 sachets of the normal movicol. Dd won't take it in jelly if I use the sugar free jelly though.

Also does he like homemade ice lollies? We do ours with not from concentrate orange juice and she loves them.

Also any cereal you can get him to take easily disguises it!

If you are having issues getting it in him, might be worth making up a sachet and then leaving it in the fridge (keeps for 24 hours) then just adding a splodge here and there to whatever you can.

Also what is his water intake like? Try and up it if you can. Get some fancy cups and straws and have a few challenges like "let's see who can drink this the quickest?"

Another thing is that movicol is best disguised in warm or cold drinks - room temperature isn't so good for disguising. So if he still has a glass of milk before bedtime warm it up then add a splodge of the movicol!

www.thepoonurses.uk/

Watch the video on this website as well - you will learn more watching this than a 100 visits to your gp.

That is a great video, thank you so much

I am so grateful for all the replies, I managed to get more movicol into him by just keeping at it today. Also bought lots of different squash and juices and managed to up his fluids. Have a doctor app on thursday and will ask for plain movicol and see if he thinks there is impaction.

I have a plan!

My daughter had this problem for many years, the GP just kept prescribing movicol and senna but nothing changed. Saw a locum one day and she referred us to paediatric gastroenterology. They told me that senna will do nothing for severe impaction and prescribed sodium picosulphate instead. This has worked wonders and although we still have the occasional accident or bad few days, she is so much more in control of everything than before.

If the impaction is severe, then I would seriously try and get a referral to paediatrics. We were going round in circles with the GP, you need to see someone who specialises in that field. Good luck, OP, I really feel your pain.

Has he had a stool specimen tested at all?
Offensive and sticky stools - I'm sure there's a bowel condition that may present with this. Can't remember what, I'm trying to dredge up something from paediatric nursing 35 years ago!

It was the surgeon that said not to give the fruit juices etc, that it could be making things worse. Ds was so sick at the time I didn’t question it, we just went with their advice. He does have them now. I’ll ask him next time we have an op appointment.

If you are on Facebook search for a group called movicol mummies - lots of help on there.

Thank you so much for all your help.

I really concentrated on getting movicol into him, using all the advice given above and succeeded in getting two sachets into him on two consecutive days, I also upped his fluids hugely (I ended up syringing lots of water/juice into his mouth as he seemed to find that entertaining). The doctor said that he didn't think he was impacted but to keep upping the movicol along with the senna l until I saw a result, which we did about ten minutes after coming out of the doctor's. It was an enormous relief, both to him and me!

I gave him two sachets again today. Fingers crossed this will do the job.

Great news, hope things continue to improve.