toileting issues

[mitch67]

Can anyone advise: I have a 7 year old grandson, his parents are at their wits end, he is not using the toilet properly, he has poop in his pants and over his bottom up to 5 times a day.
He had constipation and takes movicol and goes fairly regularly now, however he can go to the toilet and pass stool normally and 10 minutes later is covered in poop, it is every day, we have tried everything and don't know what else to do.

1)He's almost certainly still got a back up
2)When did he last have a proper disimpaction regime? By which I mean increasing the movicol/laxido dose in steps all the way up to 12, and staying there until 3 days of vast quantities of gravy like poo, with all lumps cleared. Sounds like he could have done with it during the holidays.
3)Maintenance therapy CANNOT just be movicol enough to go "fairly regularly" - his rectum will have been stretched up by how long he's been properly constipated. So there's a great big baggy reservoir that's great at filling with poo, and crap at pushing it out, or knowing when to. Once cleared out, the only way the rectum can heal up, shrink down, and get function back is to be pooing every day with soft squidgy poo. Fairly regular doesn't cut it. Also worth toilet sitting (5 mins, timed to be about 20 mins after a meal), foot rest to get knees above hips on loo etc. And once daily painless squidgy poo, have to continue at that dose for usually months, only then bringing down v v slowly.
4) www.eric.org.uk

Agree and came to say everything already posted. He’s still constipated. The holidays would have been a great time to sort it but you’ll have to get cracking now anyway. Good luck.

Thank you for the link to ERIC, very helpful