8y/o Constipation/impaction DESPERATE PLEASE

[Mamto2boys]

Desperate for advice from people who have actually had to go through this situation or similar...

My 8 year old started showing signs of constipation (less BMs and when he did go it was hurting him and eventually slight bleeding after) so took him to GP and they weren't too concerned and sent me on my way. A week passed and he hadn't done a poo at all in this time and had started slightly doing accidents in his pants.. so was getting more concerned And took him back to the GP, felt his stomach and wasn't too concerned and sent me on my way, few days passed and the soiling in the pants became so bad I put pads in his pants (I didn't know what else to do and the amount of pants that were being thrown away!) I contacted gp and they gave me laxatives for him to start a regime for fecal impaction, we started this for him increasing the dose every 2 days and his soiling became so so extreme I was showering him every 30 mins because it was all over him front and back up to his belly button... I thought maybe I was given too much at this point so started to decrease the following day, he still to this day from the 5th of April (today is 20th) has not done an actual poo on the toilet, only constant soiling... I'm honestly stuck, I don't know what to do. I haven't taken him off them ofc, but I'm not sure if I should carry on increasing or decreasing and doctors don't seem to be helping, like he still hasn't been to the toilet but I'm not too concerned in a sense as the AMOUNTof soiling and the sheer QUANTITY, meaning poo is coming out at least, but just not going to the toilet? He now is in pull ups because its just constant all day, and it's effecting him emotionally and mentally as well now from embarrassment, he can't go to school or leave the house much at all, and he has learning and mental disabilities including Autism which I have seen there may be a connection with the constipation?
Desperate for advice please!

There is the immediate issue which is that you need to see another GP or take him to A&E and make sure that he has cleared his bowels adequately.

Then you need to have a maintenance medication dose for a while and get referred to a specialist. So I’d try another GP who is better.

It takes a while for the bowels to ‘get back to normal’ after they have been impact, and soiling can occur as poo seeps around the ‘blockage’. In this time you will need to make sure he is drinking enough every day, and has enough roughage.

My DS was constipated and I’d say it took over 2 years of daily medication to get him back to healthy bowels. We saw a specialist and also the GP gave longer term medication.

Just to say I’m not a doctor, but I would see one very soon like in the next day and say that only soiling has occurred, not poo, and get them to feel his stomach. If it’s still impacted you can’t just leave it, he will need the laxatives.

And then he will need monitoring - once he’s cleared this if it continues with days without a poo you really should get him seen for longer term medication to help him.

Unfortunately if he is severely impacted there will be ALOT of poo. Are you using movicol/laxido? If so You need to get to the completely water consistency stage and then start reducing it down by a sachet a day until he is having formed stools again. Have a look at the ERIC website they have lots of info on constipation and a helpline with trained staff for support

I agree with @Wishiwasatailor - you’ve got to keep going with the disimpaction, even though you can end up feeling like you are completely swimming in poo.
We’ve done it a few times.
Once he is clear, it might turn out that movicol / laxido is not great for him for a maintenance medication (it wasn’t for us, we’ve had much better success with sodium docusate).
Lots of supportive groups on Facebook if you need support as you are going through this.

During disimpaction what you're trying to achieve is copious amounts of gravy like stool for a good 3 days. If they're already soiling at the start of disimpaction, the soiling will get worse during it, because the movicol/laxido loosens up the softer poo behind the backlog before it starts eroding away the hard rocks of the backlog itself.

Have a look at www.eric.org.uk

Hey, sorry only just getting time to check this. I've already been using the ERIC website and going by what they have advised, right down to dietary changes. He went back to GP today and it was someone completely different again (3rd doctor) and she actually really seemed like she knew what she was talking about rather just reading feom a textbook! She explained it so much better, and had much more advise for me and a concern like I thought there should of been! She's prescribing him senna I believe she said? And told me to only stick with 4 sachets of the cosmocol (he was on movicol originally but they put him on cosmocol last week?) And to start the other stuff in smaller doses when the prescription comes through-hopefully tomorrow, through the weekend and if he still hadn't produced a poo on the toilet during weekend to ring up first thing on Monday morning.
HOWEVER, in mid cleaning him up in the shower, about an hour or so ago for the 1727929387372th time today he started complaining of really bad stomach ache, so I said eight come on get sat on the toilet and just, just chill for a bit, got his foot stool, I sat on the floor with him and just talked. He was getting frustrated and 'bored'(as mentioned he has disabilities) and asked he stayed on for just 2 more minutes and no sooner I said them words the magic moment happened! Albeit it sounded like a tractor of sorts but he done it!! He had a happy tear and was so proud of himself! However my next question now is, do I start him with the other stuff tomorrow when he gets it now that he's done a poo and carry on with these laxatives he has or do I still go through with the other prescription too? I feel like this poo is what we all have been waiting for?!

Congratulations! 🙂 I'm glad he finally went. But as other people have said already, getting over bad constipation takes a loooong time. The muscles back there will have been stretched out and soiling will probably continue. He needs to keep pooing easily & often, which is why the laxatives are not just a one off.

You should probably stick to whatever regime the doctor recommended, and keep giving him lots of water! Good luck

I'm just so confused as there's so much contradictory advice online. I'd read that if you give your child sweetcorn and it came out withing 24hours the impaction would more than likely be cleared, now I only lowered the dose initially back to 4 because 1-his soiling was so so severe, like constantly leaky diarrhea up to his belly button and his back within 20/30 mins after being cleaned up it would be back to that state, so I thought he was getting too much. 2-he was constantly conplaining of stomach pain more than usual and feeling sick, and 3-because I'd read about the sweetcorn thing, we had a meal a few days prior with lots of peppers and different beans and the next day in his soiling there was whole beans and peppers in his poo so again because of the extra soiling and seeing food come out so quickly I thought I had given him too much.

So I think what I'm going to do is just check with the pharmacist when I pick his prescription up of he's okay to take it given that he's had a poo finally and just carry on with 4 sachets and alter up or down when needed unless he doesn't poop again.

Google the poo nurses and watch the video all the way through. It can take years to retrain the bowel and you really do have to follow the regimen consistantly.

Check out Movicol Mummies on Facebook, lots of very useful advice on there.

From our experience, clearing that first blockage is a huge relief but nowhere near ready to start reducing dose. They need to be completely clear before starting to reduce back down and if this has been going on a while, there is a huge change that there is still a lot of old poo in the bowel that needs to be emptied. As per advice on Eric, he should have 8 sachets each day until passing just brown water with no poo at all. Then should gradually reduce the no of sachets until passing one soft stool each day

As PP have said, it can take years to resolve but he is young and will grow into the bowel even if it is stretched if can get control of this

Also just so you know, cosmocol and movicol are the same thing

Oh I don't believe I'm out of the woods yet by a long shot, and I'm in it for the long haul, I'm just over the moon he's actually finally done a poo on the toilet for the first time since the 5th and not just extreme soiling, speaking of which I can confirm so far, since having the poo, he hasn't soiled either! (Yet) so hopefully finally going forwards from here and will continue with the 4 sachets tomorrow, just my inly concern for this moment, now that's he's actually done the poo, does he need the senna when the prescription comes through? This cosmocol already gives him pain, more so in higher doses so adding something else (if at this current moment might he unnecessary) might do more harm than good? Or put him through more pain and discomfort when not needed right now? (Could be a different story in a few days/weeks depending if he doesn't keeps up the toilet movements)

You need to complete the disimpaction regime as directed. Sounds like you stopped too soon. Basically you only know the full blockage has been dealt with when they’re passing entirely watery stools (a paed said to me “like gravy” 🤢).

This website explains the process really well:
https://www.thepoonurses.uk/disimpaction.php

I never 'stopped' he got to 12, then I lowered back down when I started to worry about giving to much so lowered to 10, 8, etc etc each day back down 4 and have stayed on 4 as advised. I just wanted to clarify, that it wasn't just "stopped"

@Jellycats4life isnt saying you’ve stopped Movicol, they’re saying you stopped the disimpaction regimen too soon.

It is very hard to judge without full medication diary of what’s given and poo diary of what’s come out but all we can say is the advice we were given which is to keep going until passing watery brown gravy type liquid.

My DC is under bowel specialist and we have approached other avenues, used enemas and use picosulfate on daily basis because they lost the urge with movicol but need a specialist to guide on this

Yes I think what people are saying is that you are trying to second guess if the impaction has cleared, but usually it’s important to follow the doctor’s prescription. If you had queries I’d phone the GP and ask for a quick call back but don’t change what you’ve been advised.

It’s a bit tricky but as your child is still eating and forming poo, if you change around or cut back too much not with GP advice they can quickly become constipated again. It needs a lot of supervision at first.

I'm really surprised that the doctor didn't take the issue more seriously because faecal impaction can be serious! My son is chronically constipated and was having frequent accidents like your son, I had called his doctor and explained symptoms, and they wanted to see him immediately. He was prescribed laxido, and we started off on 2 sachets, and that worked miracles for him. Now he's on only 1 sachet of movicol and goes every day usually. Unless he misses one. Definitely keep giving him 4 and reduce accordingly. It could be that he may need to take them for a little while, ofc speak to your doctor about when he should stop taking them

Get a referral to the Paediatric Continence Team from the GP. Listen to them. I understand that you get very different advice from different GPs and it therefore makes sense to check online but that can also be problematic. The Paed Continence Nurses will be a proper source of help in all the stages. Some GPs don't know about them, our referral was through Health Visitor.

He started on 4 sachets and increased 2 every day until her got to 12 and was on 12 sachets for 3 days before I started decreasing 2 every day until he was down to four and has been on four sachets for 4 days now so a total of 15 days of laxatives so far, before hand from the 21st of March till the 5th of April He had only done a total of 4 poos that caused him pain and the last 2 of them slight bleeding. Which is when the laxatives were introduced around the 5th.. It was the doctors advice today to carry on with only the 4 sachets as I had been doing for last few days but with the added extra of senna, but ofc this is without the knowledge that since we've spoken he has done a poo so my most recent query is, is it worth asking about him taking the senna now he's been to the toilet, and wait and see how the next few days go with just the cosmocol, or just go with the advice given earlier in the day (again this was before he had done a poo, and she had stressed to me that if over the weekend if he hadn't done a poo to ring 8am Monday morning sharp) which is why I'm on the fence as I feel the single poo is very important news in effecting his next steps.

Please, someone say they understand me?😅

Okay. If he is disimpacted (which we don't know for sure) then the maintenance dose you are aiming for is the amount that has him easily passing a soft squidgy poo every day. His rectum will have been stretched up by the impaction, and will only heal up and shrink back down if you manage to keep it empty of any hard poo.

I also want to just make it aware that any advice given to my by a doctor before today was very minimal, almost like they had zero clue what they were talking about and was reading from a screen when I was there so before today any advice I was given was very very minimal, amd they sent me away twice without any help the first 2 times, and the regime and steps I have put into place have purely been from what I've read from the ERIC website and other reputable recourses and not actually advice the doctors given as they wasn't really any given. Up until today with the lady who seemed to actually know what she was saying, and reassured me.

Have you joined the Movicol Mummies group on Facebook? You will get lots of support there with disimpaction and re childhood constipation generally.

Unfortunately after years of experience in this field with my two affected children I would say that the vast majority of GPs are totally clueless when it comes to chronic childhood constipation. They just don't really get any training.

FYI, Movicol, Laxido and Cosmocol are all the same drug (Macrogol). These are "stool softeners". If you ever run out and can't get a prescription in time, note that you can buy the adult version over the counter. It is exactly the same but just contains a double dose of powder in each sachet. Don't mention you are buying for a child.

Senna (Senokot Syrup), Dulcolax Pico Liquid and Bisacodyl are "stimulant laxatives".

Senna can be bought over the counter if you ever need it in a hurry whilst waiting for a prescription (Senokot Syrup best for children, or ExLax chocolate squares from the US if you can get it).

Some children get on better with Dulcolax Pico Liquid than Senokot Syrup - it just depends on the child and takes a bit of trial and error.

Your child may have to stay on a combination of stool softener and stimulant laxatives for quite some time (six months / a year / many years) in order to stay on top of the constipation. If the colon has stretched out of shape you need to use laxatives/softeners to help keep stools soft and moving to allow the colon time to recover.

Some people end up disimpacting during each school holidays.

Hope this info is useful

Senna might help him feel the feeling of needing a poo, as it stimulates the bowel.
I think I’d give it a go.

I have added myself to the Facebook group, just waiting to be accepted..

As this is something he's never dealt with before and I think to start with it might of been psychological because there was pinworms going around school about 6-8 weeks ago and when he learnt that, he was frightened to poo because he was scared to see worms as one of the kods at school had told him that there was aome in his poo and told my son it wasnt that bad and my son actually came home rather distraught that day (there was no worms in any accidents and i even treated the whole household because I read that if you're in close contact with anyone you should treat) so when he realised he was actually okay and didnt have worms was when he started to do the painful poos and I think that then the painful poos scared him into not wanting to do further poos and it's been a cycle? Do you think because of the way this has come about, it will be something that may be dealt with quicker than some other children? (As some children have issues for years and this is the first time anything like this happened and I think it stemmed from physiological issue originally rather than something internally wrong with him, does this make sense?

And he's already had his first sachet this morning and since he's done a poo yesterday, so far, still no accidents/soiling and usually when I give him a sachets, you can smell him 5 minutes later.