Toddler Severe Constipation

[Cb2022]

My 2 year old daughter has always been constipated since she was few weeks old. She would only ever go every other day. Over the past few months her stool has become very hard, big and difficult to pass. It has now gotten to the point where she is afraid to go as it is hurting her. She held it in for so long that she became very unwell and began vomiting.

She had already been on 5mls of lactulose twice daily, eating prunes,pears, other fruit, flax seed and drinking lots of water. She will not take laxido sachets as she does not like any drink except water and can taste it, so we cannot get them into her. We have tried freezing it into ice lollys etc also but will not eat them.

We took her to a&e when she became unwell and an x-ray showed that she is full of stool right up to her ribs. After 2 enemas, a hard bit of stool has come away. We were advised to up the lactulose to 10mls in the morn and 5 mls at night. I assumed that because the 'blockage' has shifted she would be able to go more regular but she has only gone once since the second enema that worked, and that was 2 days ago.

The lactulose is now hurting her stomach and making her cry with discomfort. We were told to up them again if they do not work but I do not want to put her in any more pain.

Does any one else have any suggestions on what to do or try? I'm very worried about her.

The standard treatment for pretty much all of these children is high doses of the softener type laxatives such as movicol, until they have cleared the big "cake" of poo, then gradually wean down to a dose of these that gives approximately 1 soft stool per day. Then a long time on this dose until the bowel has learned when to tell it is full and not stretch out again. They only work if you are drinking the corresponding amount of water/fluid.

GP should be happy to initiate treatment, they may contact a paediatrician / specialist nurse as well. The basic information is on the ERIC website.

Thanks @Unseenentity

We just cannot get her to take any of the macrogel laxitives as she can taste them in her water, and we would need to get her to drink up to possibly 8 sachets a day if we are to clear out the backlog.

I'm worried that we are upsetting the stomach with lactulose if it's not even going to help.

I've looked at the ERIC website a few times but can only find information on the macrogel laxitives for the disempaction regime.

I guess I'm wondering if the lactulose will help clear her out or do we need to switch/add something else in/force the macrogel laxitives somehow?

Poor thing, that sounds so uncomfortable. Has the GP given clear instructions for when to come back to the doctor if the lactulose and treatment doesn't work and what the plan of action would be then?

No, the GP is really unsure. It was them who told us to take her to the hospital and it was the hospital that actually us we could up the dose after the GP said she was already having the max dose for her age/weight.

I will call the GP again and keep pushing for more help if we don't get any more movement soon.

I feel you OP, I have a poo witholder and it's a nightmare, same age. She's been on lactulose but as she's holding it she's getting seepage in her nappy and her bum is now horribly sore. Are your daughter's poos any softer? My DD's are quite soft now so I think it's purely psychological but if the lactulose isn't working to soften then you prob need to try something else. We've just tried califig and she had a good clear out last night so that might be worth a go?

Is she actively holding it in? Can you see she's feeling the urge? With ours it's very obvious, she'll cry and squirm and clamp her cheeks together to try and stop it. It's honestly a nightmare, I sympathise so much.

Is there anything else at all she will drink? Have you tried all the juices etc? I think you can stir Laxido into any liquid

Just to say as well, my daughter just went 6 days without going, she has never gone every day and I think for some children it's normal so don't panic if she's not going every single day (every other day would be a dream for us!)

I think the main thing is just to try and make it as soft as possible. Does she still have milk? We've been mixing prune juice with milk which also seems to help.

We put laxido into strong squash - or dissolved and then mixed with apple juice. It is truly grim and tastes weirdly slimy but keep going - and be aware when it shifts it really does, and quickly! Hot water bottle helped my boy as well when really sore.

Our 2 and a half year old DS has been on movicol for 2 years. They do chocolate flavour ones that he loves. Won't go near the plain. The longer it goes on the longer that treatment needs to be so I'd start soon as really

Having had an impacted child, that small piece wasn't the whole blockage, it's a tiny bit of it. She is still blocked up, that's why her tummy is still hurting and she isn't going regularly. The lactulose softens the poo by pulling in water - which makes it bigger and I think is why this stage of disimpaction can cause discomfort. Enemas help get lumps out the bottom end. For the lactulose / movicol, the first step of a disimpaction is normally you get runny over flow, which is the softener mostly going round the dried out stuff and only gradually dissolving a little bit, that initial liquid stuff doesn't mean you are done! Eventually the impacted lumps do get softened enough they start moving and you get more solid poo out as you start to really clear it.

If she'll tolerate them, glycerol suppositories are available over the counter and would help. Otherwise, if she'll only take lactulose it's going to be long and slow. We hide movicol with strong squash, and started by syringing it in whilst DS was distracted by the TV.

@Cb2022 if you’re on Facebook join Movicol Mummies. Excellent support group for mums of kids with chronic withholding and constipation

My DS is autistic and has taken constipation medicine for 6 years now. He wouldn't drink Movicol at all so we were moved on to sodium picosulphate which works really well for him.

Thank you so much for all of your replies.

After my original post she went twice more, but both very large and hard and caused a lot of screaming. She's actively holding it because it's hurting her to pass it so it took a lot of convincing and helping to get her to go. She also had a lot of stomach pain this morning so I decided to try and switch to the laxido as I've been told by so many that it's that better option. Managed to get around 1.5 sachets worth into her by adding the solution to her cereal, yogurts and syringes she can 'play' with and take them herself. Will keep going with this for a while and upping it more until we get soft stools.

I'm unsure If I need to do the full disimpaction regime as she has no overflow, just very hard , caked in stool that is starting to come away now.

Thanks @LapinR0se I have requested to join the group.

Will definitely try and get some of the calfig and glycerin suppositories to have in as well.

I know how horrendous this is as my 3 year old has been constipated since we started weaning at 6 months and he's had a few episodes where he's been completely impacted and needed glycerol suppositories. It obviously then becomes a cycle of withholding and fear which makes things worse.

It sounds like her diet is good with all the fruit etc. Our son eats at least £5 worth of berries everyday , has lactulose, lots of orange juice (I know it's bad for his teeth but we get desperate). I then realised it's likely the cow milk protein allergy which he had as a baby which we believed he had grown out of when he stopped having blood and mucus in his poo - CMPA can cause severe constipation.

Obviously your priority right now is getting through this severe episode but food allergy/intolerance is something to consider exploring with the GP

Good luck x

Thank you @clinellwipe
This is something that had actually crossed my mind again recently.

We had so many feeding /reflux/ colic problems with her as a baby that I actually questioned the if it was a cows milk allergy but Health Visitor and GP just put it down to bad reflux as there was no rash or blood in poo etc. The reflux did istop when we weaned at 6 months and reduced the amount of formula.

She no longer takes any bottles of milk, but would still have it in her cereal and in other forms in yogurts and cheese etc. I think I will trial cutting the diary for a few weeks to see if there is any improvment and also bring up a lactose allergy with the doctor again. Thanks!

Note there's a lot of confusion out there between lactose / dairy.

Lactose is a sugar, you can't be allergic to it and intolerance is unusual among white Europeans.

Dairy protein can cause gut-specific allergy symptoms.

Thank you @Unseenentity!

Coeliac disease can also cause constipation problems.

One of my DC suffered frequent bouts of constipation for nearly 10 years. After years of being fobbed off and told it was something he would grow out of, he was finally seen at the paediatric unit. A biopsy confirmed he had coeliac disease.
He hasn’t had constipation since he started a gluten free diet. It may be worth asking your gp for a referral to the paediatric unit.
It’s horrible to see them go through so much. I hope she has a good clear out soon.

We had the exact same issue with my DS - we thought he'd outgrown of his CMPA and had passed the milk ladder. Instead, his symptoms had changed. We only realised he had become constipated when potty training was a complete fail. An allergy was only suggested at the point he immediately blocked up again post disimpaction.

Just to echo a poster above, it is much more likely to be a cows milk allergy, not a lactose intolerance. Lactose is the sugar in all milk, including human. Older children can become intolerant as they lose the ability to digest it, but it's rare in 2 year olds of any race - until very recently in evolutionary terms they would all still have been breastfed at that age.

Thanks all!

We have managed to get the laxido into her by playing with syringes and playing 'doctor'. She has had 2 sachets per day for the last 3 days and we got some movement. Yesterday she had 2 small soft stools, and today 3 small porridge like stool. I'm glad things are moving, and soft. Just hoping we get some bigger clear outs.

The only thing is, she is up with stomach pain during the night which I assume is the laxido. So I only gave her one dose today. It's hard to find that balance.