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!

This is as a mum, but as one who has sat in a lot of medicals and read the Eric advice.

As a rough guide it takes as long to treat as it’s been an issue.
I think being sorted by September might be a rough goal to have in mind.

I would disimpact again, very slowly wean down. Give Senna 3 times a week just to stimulate a bit.
Set up a chart of toilet sitting, 20 min after each meal, and at bed. Use the iPad or have things just for this. Try a foot rest to raise legs slightly. No pressure, just sitting is the goal.

sorry I’d sit first thing too

I don’t know, for DS it was also a cycle of holding and then painful poos, but it was more subtle at first. I think he probably had issues for 6 months but it didn’t get bad until the last month and that’s when I went to the GP who gave him movicol. It took a week to shift the impaction, then a few months of every 2 to 3 days a poo, but sometimes quite a bit of soiling (which I tried to just be very matter of fact about), by 6 months he was going every day, and then after a year I reduced the movicol gradually over a year before he was off all medication and going every day.

I’m not surprised you haven’t been given great advice from the GP. In my experience they don’t have much detailed knowledge of kids and disimpaction.

Not sure if you read the link I posted but it really is very good. Since you’re not sure how to proceed re. a maintenance regime, please do give this a read. It’s more informed than your GP will ever be.

https://www.thepoonurses.uk/maintenance.php

Our experience also began with DC holding and then subsequent fear from this leading to impaction. Unfortunately lack of GP knowledge and Covid made things get much worse and we are dealing with much longer term issue. Call Eric if needed and see link pp have posted as they are far more useful

Hey @Mamto2boys I have just been through this hole rigmarole over the last few weeks with my 12 year old daughter. Some of the comments on my post (click here) might help you.

She too had bleeding after a poo which has been diagnosed as an anal fisher. Sounds like your GP has been terrible. My daughter didn't poo in 5 days at the time hard abdomen we gave her home medication, she was seen by the GP, given movicol, and sent to the hospital for scans just to make sure everything was working and full examination. Sounds like your GP has been lazy about your son. Feel free to reach out if I can help or share my experience in any way. I hope your little guy will be on the mend soon

Hey, yes originally after the bleed I thought he had an anal fissure too but doctors didn't seem to agree at the time ( the one yesterday brought it up and said he might have caused himself one back when he did the bleed.)

However, today he still hasn't had any accidents which I cannot express in itself has changed his whole entire mood/self! (He cried to me yesterday morning saying he felt like he was going -and I quote- insane and that she just wanted to stay very still and not move because of the pain) today its like hea a whole new kid. He even done another poo after lunch today!!! Which I just can't get over how it has just changed dramatically in the last few hours (less than 24), and pharmacist can't even get the prescription in for senna so having to ask (waiting for a reply) a doctor to see if there's an alternative they can prescribe(I live in a village in the middle of nowhere with no help and unfortunately don't drive due to my own health so picking it up elsewhere was not an option) so it really is so so lucky timing that he's currently achieving poos! (I'd asked if he would still need it with the added new info that he finally done a poo last night) and they said to pick it up anyways incase he struggles again through the weekend, but not to take the dose today like initially advised as he's managing to finally go, however, no senna in stock at all 😅🙄, has done 2 sachets so far and another 2 still to do today for I believe maintaining and adult as and when needed. I think I just panicked was too much yesterday as I thought nothing was changing and getting worse but I just think the doctors hadn't advised me well enough at all.

That’s great news for both of you.
If you do end up needing it Senna can be bought from online pharmacies. Your GP could also prescribe an alternative eg sodium picosulfate.

It’s so great that your child feels happier, it’s traumatic for them isn’t it and can quickly become quite a big issue. But it all sounds great!

Just one word of advice, I found that ‘stopping and starting’ with medication like movicol was counter productive. At first on GPs advice he only had a short prescription, but quickly became constipated again. You asked whether this was a long or short term issue? I found in the end that it was better to have daily movicol until DS was really, really regular and only very, very gradually wean him off it.

So I’d say don’t be too quick to just withdraw all medication and think it’s all normal - keep an eye on this for a few months at least. This will need monitoring and also your child to be able to be really honest about their poo etc, it sounds tricky but I had to monitor the ‘type’ of poo, when and where for ages! Whilst also trying to give DS privacy.