Movicol for 5 year old

[NeonQT]

Hi, just had a quick question and will be asking doc for advice Monday but hoping someone can help over the weekend.

My LG, 5, was prescribed movicol 2 weeks ago for fecal impaction. She was up to four sachets and she had a bowel movement which I guess cleared it. As per doctors advice I took her off it over a few days, as she was having normal bowel movements. The only problem is even though she’s having normal poos around once a day, she’s still leaking into her underwear at least every hour, usually more. Should I maybe put her back on the movicol?

Yes. If she is still leaking then she is still impacted. Some of the impacted poo may have broken off and come out, but there is still a blockage and the leakage is liquid poo sweeping round it.

The rule of thumb is that, once the impaction is cleared and regular pooing with no seepage is the norm, then Movicol treatment continues at a maintenance dose for as long as the child was constipated. This may be for years. And there will be regular disimpaction regimes, too.

IME the GP was really not much use with constipation. 2 weeks Movicol and that was it. However he also referred dc to the Continence Nurse and she was excellent. Provided wonderful support and advice for years. In my area the Continence Nurses are part of the Community Nursing service, and I think you can self-refer for a child.

What dose would you recommend? Starting with just the one?

Don't take her off it!

It will have taken a long time to get that constipated and so a long time to recover - her bowel will have stretched and she won't have proper triggers of when to go.

She will need ages and ages of being on enough Movicol to produce a soft stool she can pass easily without it being painful - you can experiment to see how much that it.

However if you just stop, you go straight back to the scenario where she became constipated in the first place and repeat the cycle, as you have found.

www.eric.org.uk/ is an invaluable source of information and advice.

Exactly what @AnnaMagnani said. Been there and got the t shirt, and still dealing with this now my dd is 10, it's a nightmare. 4 sachets is nowhere near enough to clear impaction, to give you some idea, when we've had to do a 'clear out', we increase by 2 sachets daily, up to 12 sachets. You need to get to the point of them producing basically brown water, so you know any build up is gone, then gradually reduce the sachets back down until the right consistency returns. As others have said, DO NOT stop the sachets, the specialist we're under advised we must continue the sachets for at least a year after getting things sorted. It can also help to give them a stimulant, for us it's Senokot, at night. We're still struggling with it all, but getting her to sit on the loo after every meal definitely helps, as they don't feel the normal urge to go. Good luck!

Ah I’m definitely going to ask for a referral to someone who specialises in this. The doctor literally told me to increase the sachets until she has a bowel movement then reduce it over a couple of days and that should be it.

Sometime the fecal impaction is still there even when they are having regular bowel movements. It's like Movicol opens only a passage around the block, no space to hold what is coming inside the colon and the leaking happens. So first thing is the diet, she should eat tons of vegetables and fruits, everyday. Then Movicol, four sachets barely do something that can be considered a solution, you should use it for weeks and increase the sachets until there is a consistent normal situation (no accidents, no leaking, regular daily bowel movements).
Like in the case of @NuzzleandScratch, if that is still not enough (12 sachets daily are a lot!), as unpleasant as they are, next step are enemas. Movicol is a stool softner, an enema just brings out the impaction. For chronic and very big constipation this website bedwettingandaccidents.com (take it just as a reference because everything there is available only on payment and I would start something like the mop treatment only if a doctor consider it appropriate on my daughter's case, like we did years ago) daily enemas for one month, then every other day for the second month, then once a week for the third month. In my opinion it's too much and even too drastic, but I've read it worked for a lot of kids when everything else failed, even shortening the monthly steps to weekly ones. Just to say in many cases Movicol or even only one enema do nothing.
Anyway only a doctor who specialises in this can give you the most appropriate solution for the particular case of your daughter, every situation is different.

This is a wonderful source of dietary fibre (see photo). Wonderful because it tastes pleasant, can be mixed into so many foods, and it is very effective yet gentle. Some people can't tolerate wheat fibre - it gives them wind and tummy ache and can reduce their appetite, which is not good for children, who need to eat. This fibre mix does not contain wheat. I'm not suggesting using it instead of Movicol, but to boost the fibre in your dd's diet.

Now that my dc no longer need Movicol, if there is any suggestion that they may be tipping towards constipation again, the first thing I do is have them eat a spoonful of this fibre mix in their food every day for a couple of days. Works every time.

What kind of food do you mix it into @Dilbertian?

What kind of food do you mix it into @Dilbertian?

This is my area of expertise sadly!

Mistake one is to have assumed that having a bowel movement after four sachets cleared it. The full Movicol disimpaction regime involves going up to 12 sachets, until the child is passing liquid with no, er, lumps. Then gradually refusing the dose until the child has a bowel movement every day. Only then can you be confident the impaction is gone.

Mistake two was stopping. If a child gets badly impacted then the bowel stretches out. It gets impacted again easily. The key is not stopping the Movicol for months or even years.

The leaking sounds like encopresis.

GPs tend to give terrible advice. If you have a constipation nurse in your area then that would be better. Failing that, a paediatric gastro consultant.

This (NHS) website is fantastic. It honestly contains all the advice you need when it comes to Movicol dosage. I really recommend reading it all: www.thepoonurses.uk/

Reducing not refusing. Damn you autocorrect.

Totally not blaming you by the way. The GP have you bad advice. Movicol is more of a long term solution than a quick fix.

NuzzleandScratch, my personal favourite is in yogurt with something else that has texture, like berries or nuts. My dc like it in smoothies or on crunchy cereal. Dm likes it in porridge.

@Haworthia is correct. I sadly know of this, one child on it for 2 years, as the constipation had become chronic. You will need to keep a very close eye on this as it is likely that what caused it may have been going on for some time, and your childs bowels may need time to regain their muscle tone and healthy trigger to go to the toilet.

We got referred to a specialist the second GP visit. Used one a day, and then I reduced it over a 4-6 month period to half and then stopped.

Also you need to make sure your child is getting enough to drink. Again best ask your GP, gradually change their diet, and tackle any issues underlying this if possible (there are some good websites) - having painful poos can make a child fearful and a vicious cycle of withholding etc occurs.

The ERIC website is brilliant. DS began having problems aged 6 months and at 12 we still have bad patches, it's the site we always go back to. It helped DS understand the behavioural element way better than I could explain.

Thank you for your help! The instructions that came with the prescription only say ‘2-8 sachets daily, titrate to effect’ so not exactly helpful. I’ll keep increasing her dose for until I’m sure she’s clear then will keep her on a maintenance dose ☺️

We had this same problem with our 3 year old. He had 8 sachets a day to clear the impaction which sounded so much but did the trick. We had 3-4 days of horrible wet pooey nappies and the final one was basically just water so we knew the impaction was clear. He is now on a maintenance dose of 1 sachet a day which is keeping him regular. We do get the odd bit of smearing still and then we'll up it to 2 a day. It's a constant battle.

Ds ended up in hospital with impaction, it was awful, our GP thought he may have meningitis as he had a high temperature, was in so much pain he couldn't speak or bear to be touched, was lapsing in & out of consciousness. After spending a full day in hospital they diagnosed impaction, gave him an enema & I have never seen so much poo in my life, his temperature came back to normal within an hour & he was out of pain. He had to go in to pullups for about a week despite being 8 as he kept on having accidents, thankfully it was the Christmas holidays. The hospital sent us home with a massive box of Movical & told me to give him 2 sachets a day as a maintenance dose & to increase it if he didn't go for 24 hours. He is 16 now & still needs to use laxatives as he still suffers from constipation, according to the hospital it is part of his Autism.

I find the link between constipation and autism fascinating because that’s my experience too @Nat6999 and yet I can’t seem to find any research addressing it or explaining it.

Of all my dc, my autistic one suffered the worst with constipation. We're pretty sure it was triggered by him being told off in Y1 for spending 'too long' in the toilet. He had been avoiding the toilets at school because some of the boys in his year were behaving very badly in the toilets, and he was afraid of them. So he rarely used them. The one time he had to go, he needed to poo, and he was told off.

I should have mentioned I know all about the behavioural and dietary issues common in autistic children that might cause constipation/withholding, but I’m convinced there are physiological issues with gut motility as well.

School toilets are the worst. I avoided them throughout my school career.

My DD was a poo withholder and she was on Movicol for about 18 months.

Highly recommend the Eric Website.

Also make sure they drink lots of water it helps as constipated poo is very dry which is why it gets stuck and is difficult to pass.

I would make sure you don’t make a huge deal out of doing a poo or not. Don’t get too stressed about it or it will pass to your child.

Movicol is not a short term solution and gp's often dont give enough info. General time is that it will be needed at least as long as the time the problem built up over. Ds was on it for 3 years. First disimpaction was terrifying, no one told us he would just go and go, so we stopped it, which was exactly the wrong thing to do. Over time learned to watch like a hawk and the second he didn't poo one day, he would get an extra sachet before bed and two in the morning. As soon as it went any longer than a day he would withhold going o fear of pain and we were back to square 1. Even after 3 or 4 months of vwinf fine it could spiral quickly. Good luck and agree with others about poo nurses video and Eric. Also there is a facebook parents group, which I found helpful.