Enema and movicol, how do I know they have worked?

[thomas2596]

Hi I am looking for some advise as I can’t seem to get any sense of my GP, my 8 year old DD has been suffering with constipation on and of for around 2 years and normally the movicol does it job well, but this time my dd has been constipated for around 3 weeks maybe more and the movicol didn’t seem to work as well but she was having huge amounts of overflow, I took her to A&E to hopefully get her some help as it was getting really difficult for her as she has missed school all week and been isolating her self due to the over flow being so bad, the paediatric Dr gave her an enema to flush it out but the only result of that was lots of liquid, she had the enema on Tuesday and it’s now Thursday but I’m not sure it’s worked, she has also been having movicol, 4 yesterday and only 2 today, over the last 2 days she has passed 3 small hard stools but the rest has been thick liquid pouring out of her, she can’t control it and there was so much this morning, what I really want to know is is that the hard stool coming out but now soft or is it just overflow still, we are really struggling at the moment. Any advise would be greatly appreiceiated thank you

I feel your pain...
My DD has had fecal impaction a few times.
Get the nappies ready take tomorrow off school. When my Dd was 5 the dosage of Movicol was as high as 8-10 per day for the 1st 2 days, then down 6, 4, 2 doses per day. It could take a week to fully clear. When you think it has cleared get an ultrasound or x-ray to show that it has fully cleared and then they will probably need a maintenance dose of movicol.

My DD has a maintenance dose of 2 x 1/2 movicol + 1 enema a day. Her bowel was stretched due to constipation for 3 years. The consultant said it will take the same amount of time to get it normal and this is only if there is no impaction.

Even with high doses of movicol impactions would regularly occur. The only thing that seemed to work was attacking it at both ends. So Movicol to soften from the top, then enema at the bottom to get it shift. The enema will still not work that well without the stool being sufficiently soft and you have found out.

Whilst yuou can't really tell over the internet, I suspect that you need to go for a full disimpaction regime of the movicol.

www.eric.org.uk/pdf-a-parents-guide-to-disimpaction

In order to know that it has worked, you want the lumps to come out, then to clear, and the poo to go like thin gravy. Lots and lots of thin gravy, lots of times per day. For a good 3 days. For which they usually need to be off school. And then reduce to the amount of movicol that has them pooing once a day with squidgy soft poo. That way their rectum can start to recover.

Have a good look round the eric website, it's pretty helpful.

Hi thank you both for the advice, we just feel like we are fighting a losing battle at the moment, it’s mentally and physically braking us both now, the amount of thick over flow coming through is unreal and stilll no lumps which leads me to believe she is still completely back up, we have a drs app this morning to see what they think and to ask for an X-ray, with out that I will never know if she is still constipated, she is having 6 movicol today but I’m worried I’m just making it worse. Xx

Should I reduce the dosage now? It’s thick liquid and been like that for around 4 days now. She had an enema on Tuesday and loads of moviolas since, I don’t want her to have constant diarriah, how do I know when to reduce the dose and if her bowels are clear, its litterlt ringing out of her none stop.

I would only stop the Movicol when it's like brown water. She will needs nappies, there's no other way. Even feeling the abdomen is soft is no guarantee that she will be free of constipation. The only way to know is with an X-ray or ultrasound. Actually, I think an ultrasound is better because they can take measurements. For my DD with a soft abdomen she had a megarectum at 5year old. I think measurement was 4cm in diameter when it should have been

Thank you for the advice, it’s such a stressful time for a little one when they go through this!!

Should the watery liquid be poring our all the time or only at times, at the moment there is no gap and just pours out continuously, the gp had a feel of her tummy today and said she isn’t blocked at all anymore and that what is pouring out is the movicol just softening everything she eats but the peeds dr told me on the phone today that she is still blocked and to up the doors, just don’t know what to do!!

OP
my DD is now a teen and suffered from severe constipation since she was a baby. She was under various NHS hospital consultants for most of her life and suffered from daily faecal soiling and megarectum as a result. We tried absolutely everything they suggested....high fibre diets, prune juice, pears, increased fluid intake, loo breaks 20 mins after eating, bowel transit time tests, lactulose, senokot and Movicol. For 4-5 years my DD was on 4 Movicol sachets and 25 ml of senokot daily just to keep things moving.

Today 2 years on, DD takes no Movicol and her bowel is totally normal.

I never thought I’d see this day - the stress of ongoing faecal incontinance is hideous for all involved not least the DC - and I just want to tell you about my experience in case it could help. Obvs not all children are the same but if it can help even one family, it’s worth it.

On a friend’s advice we saw a nutritionist and got my DD tested for food intolerances. I'd always been a bit suspicious / cynical about these intolerance blood tests, but after years of absolutely no change under conventional medicine (and a DD about to enter her teens where the potential social consequences of faecal soiling are just devastating), I decided we had to try another approach and took her to see a nutritionist/ naturopath 2 years ago.

We discovered she is intolerant to cow's milk and wheat. We cut those out of her diet and she started taking various probiotics and digestive enzymes. 2-3 months after cutting them out and reducing the Movicol dose very carefully, she had stopped soiling totally, after 8 months she was down to half a Movicol sachet a day, (we stopped senna straight away) and NHS ultrasounds show her bowel had returned to normal size. 2 years on she takes no Movicol and all is still normal.

It has been such a long and difficult road, but I cannot describe the difference it has made to her life.

Your DC may be in a totally different situation, but I wish to God I'd thought about checking intolerances out sooner and feel so cross with myself for blindly trusting conventional medicine for so many years even though I could see her condition was not improving. I think the NHS is amazing, but sadly, I think the doctors just aim to treat the constipation, rather than looking for the underlying reason behind it. In any event, it might be worth a punt. Severe constipation in children seems to be incredibly prevalent in the UK but notoriously difficult to 'treat', but in a few short months, my DD's life totally changed. If sharing this can help anyone else avoid the years of anguish we've been through, then hurrah for that!

Hi , came across this discussion board while looking for a solution for my daughters constipation issue going on for years :( . Just wondering did you take your daughter to see a nutritionist through NHS or privately.
my daughters case started with tummy ache complains and it took us a while before we got hold of an appointment with Gastroenterologist . But we never had follow up with an X-ray after following the plan. Initially she had the scan with plastic markers to swallow and from that they said seems like constipation. She had been given movicol and sena and advised a high fibre diet. But nothing really worked and we never had a follow up with an X-ray to make sure things are going in right direction. During covid time she only had one telephone appointment and after that was discharged with instructions of using movicol. At one point she was tested for celiac and it came negative.
she’s nearly 12 now and the problem has increased to the level that she has fissures all the time . Itichy and painful and now blood coming from stools. When ever I go back to the gp they advise to continue with movicol but it doesn’t seem to make any difference. Really feel devastated when I see her struggling and crying after she passes the stool and hurtful terrible fissures ( using steroid cream given by gp ) but it’s like a vicious circle.
Im thinking now to ask for Gastroentology referral again.