Stuck in a cycle of toddler constipation-lactulose-skin breaking down

[FLI881]

My 22 month old has had constipation problems for months now. She is also withholding due to the pain of passing a stool. We have been using lactulose but we’ve become completely stuck. We give the lactulose, it works after a couple of days so we carry on, but the poo makes the skin on her bum break down, even if we catch it quickly. It gets so sore that she fights every nappy change and it’s so hard to clean her. We then stop the lactulose to help her skin but the constipation comes back. It seems whatever we do she is in pain. She’s not eating much and also barely drinks so I can’t help her with diet.

I’m also convinced that the lactulose is giving her painful wind too so we’ve been given movicol to try but she hates the taste and doesn’t drink enough anyway. Feel completely stuck, writing this on a morning of constant straining and crying 😢. Has anyone else been stuck in a similar cycle?

So sorry to hear you and your daughter are having such a tough time. My son was on Laxido for about a year which worked well for him - maybe go back to your GP? I'm not sure what age it's recommended for. I think I used to mix it into squash. It sounds difficult if she barely drinks, I'd be tempted to try lots of different drinks even if they are sugary etc as drinking more will help. My friend's daughter has been on Laxido for years and will only drink it in chocolate oat milk! It will be easier when she's older and understands better, health issues can be so hard to manage with toddlers!

Could she try sitting on a potty?
A warm bath to relax her tummy. Maybe a belly massage.
You need to get her to drink more, to soften the poos.
Can you give more fruit and things like yoghurt to increase her fluid intake?

You really need to find a way to get her to drink more. Lots of kids barely drink unless they’re reminded. It’s your job to keep giving her drinks. If the constripatiin is as bad as you describe then give her diluted fruit juice. There’s no point giving her movicol if she’s not hydrated enough - it just won’t work.

We mix movicol in chocolate oatley.
Sugary drinks aren’t ideal but sometimes you need to balance what is worse.

Not drinking much will be adding to the problems as it cause’s constipation. Try adding more fluid to her diet.

I have no advice OP but to say that Lactulose gives me wind too so it could well be that. I'd go back to the GP likes others say

It's really hard. We found lactulose to be less effective than movicol for definite. Can you hide it in something? We put our son's in milk, which is his favourite drink and it became no problem. Other people hide it in yoghurt.

If you could get more movicol into her, it'd be softer allowing her skin to heal.

If you're on Facebook, movicol mums is a great group to join.

Hi @FLI881 , once you have mixed the movicol with the specified amount of water you can mix into something else. So if she is still having milk you can add it to that. We used to make smoothies with kiwi and mango or mix it into thick yoghurt. You could try soup or custard maybe.

It took us months to get DD to take the movicol, she is very stubborn 🤦‍♀️ But once we found an acceptable food to hide it in it really worked.

You need movicol (or laxido/cosmocol, they're all the same). It's the first line treatment recommended for constipation in children I think. Lactulose does give people wind and it won't be enough to break down the hard Lumos of poo which build up when children withhold their poos. You will need to stay on it for some time (weeks/months) until her poos are reliably soft and not painful, gradually tapering the dose down over time as her bowel will probably have become over-stretched due to the chronic constipation and it takes time to return to normal size.
Lots of information about constipation on the ERIC website, they have a helpline too.

Also if she is poo withholding you may find this book helpful

Re: skin breakdown, possibly a good time to start potty training? Although I have to say it was potty training that started off my son's cycle of poo withholding, so you'll know if it might be helpful or not.
I would use a good layer of bepanthen or similar every day & especially if you know you are going to be giving any laxatives as she's likely to have more poos then. If you get it on the skin before the poo touches it, it should form a barrier layer and prevent damage.
In adults I've seen this used with very good effect for incontinence associated skin damage so you could try it:

Movicol is the right course of treatment because you need to be on a medication for the long term, just to stop the cycle of stop-starting Lactulose and having the constipation quickly return.

Lactulose is very ineffective anyway (weary voice of experience).

Do you mix Movicol into squash? Drinking it alone is absolutely disgusting, you need to disguise the salty taste somehow.

I always recommend this site because it’s so comprehensive (NHS): https://www.thepoonurses.uk/

Sorry forgot to add the picture

My granddaughter had trouble as she was lactose intolerant when younger. DD would plaster her bottom with nappy cream - bepanthen? Every time she changed her nappy - even if she was just wet. That way, her bottom had a barrier to temporarily protect it from poo. It was heartbreaking changing a dirty nappy as she’d be hysterical knowing that her bottom was going to hurt. 😭

We got her to drink more by letting her use ‘mummy’s water bottle’ with cucumber and mint infused water and ice cubes. She wanted to be grown up like mummy so would drink loads!

Also: yes Lactulose does cause painful wind but Movicol doesn’t. Disagree with the poster who says you should potty train. No way should you begin something that causes a lot of children to withhold poo - especially in a child who is already withholding. Don’t even think about potty training until you’re in a good bowel routine.

Thank you all so much for your advice. I’ve had some success with movicol in her morning milk today. I tried it with squash and orange juice first as I didn’t want to put her off of her milk (the one thing she drinks well), but it didn’t seem to bother her this morning. Really hope that continues and it doesn’t cause the painful wind like the lactulose does. I will keep trying this and if we don’t have luck then I’ll go back to the GP.

I usually have a couple of drinks out for her through the day (water and squash or juice) and do offer them regularly but she very often says no or will only have one sip. Chocolate oat milk sounds like a good shout though. Fruit and veg is also really tricky to get her to eat (most things are), but I’ll keep trying different ways.

I did try the potty but she’s scared to go and I don’t want her to associate that scared feeling with the potty, so will hold off on that for a while I think.

I will try and find some better cream today and make sure to keep putting it on as often as I can. I have found this hasn’t prevented the sore skin but perhaps I haven’t been using the best one.

Thank you all again.

Another thing - how much milk is she drinking? The ERIC lady told me too much milk can also add to constipation so if she's having a lot you could consider watering it down maybe 1/3 water? If it's full fat milk she prob won't notice.

Ice lollies?

@RapidlyApproachingEndOfMyTether she drinks around 250mls in the morning and another 250mls in the evening. I hope that’s not too much as it really is the only thing she definitely drinks! It is whole milk so I’ll try adding some water to it.

@Papernotplastic thats a good idea. She tends to hold things for ages and just lick now and again and then gets bored and doesn’t eat it! So I will have to try that on the warmer days so that it can drip in the garden!