Disimpaction help - the day after

[NowIveSeenEverything]

Dd almost 4 years old has been disimpacted yesterday, at home with movicol and dulcolax. Im fairly certain it's complete, soup everywhere with old raisins (sorry), must have been more than a litre total and more than 10 movements in 10 hours. Up to her scalp. Today, she has had 6 movicol sachets, 10ml senna, and no action.

We attended a&e yesterday following almost 3 weeks of v light soiling and nothing else - because she stopped drinking fluids and passing wind. She had been seen 1 week previously with paediatric gastro, who suggested disimpaction with movicol. A&E gave us one night grace at home to empty her (she was frantic not to be stuck there for days with enemas and NG tubes for the laxido). Now she's empty but I thought she was meant to carry on pooping soup for a few days? I have no way to imminently contact the consultant so I'm a bit lost. It's taking literally all day to coax the movicol into her (yes bribes and every trick in the book re taste and texture are being used).

She's not pooped without movicol or senna since she started weaning. She's had a negative celiac test, dairy free had no impact, and because this is how she is, her diet is heavily fresh fruit (grapes, strawberries, apples, blueberries - no bananas) and fruit juice and ice pops. As well as the breastmilk she wont give up. I dont think it's entirely behavioural but I cant identify the issue.

In short - disimpacted 24 hours ago, no poop since dsspite 6x movicol and 10ml senna, what do I do?

If you were already seen by a paediatrician / gastroenterologist, I'd leave a message saying you've had this unexpected outcome. They might have a constipation nurse who'd get back to you sooner than a consultant might?

ERIC have a helpline I think though might be somewhat generic.

A non ige food allergy is a likely culprit. Did you cut all dairy out for 8 weeks? Soya too? It could be a non-ige allergy to something else.

Hey - I noticed your statement about fruit and her having these issues since weaning. If you’re heading toward an eventual IBS diagnosis, which is possible, then high-fructose fruits like apples and grapes may be problematic (even though I know it’s confusing as hell, since the guidance on apples is so contradictory - the main point is if it’s not helping her, time to try something else, and a high fruit diet can be the opposite of helpful in some situations), especially if you haven’t noticed they’re helping.

@Barrellturn I was dairy and soya free for 9 weeks before birth and 3 months after while exclusively breastfeeding - her big brother was cmpa with severe reflux and couldnt breastfeeding at all. So I think it's not that? She was fine, textbook, until she started solids. We cut out dairy again recently but only for a month - she doesnt actually eat much anyway, only yogurts, she doesnt like cow milk or cheese.

@FFSToEverythingSince2020 I was the same as her as a little girl and now I have a microscopic colitis diagnosis - but the symptoms are obviously completely opposite! I dont eat fruit because of the resulting diarrhoea. Her constipation isnt typical either, the stools are large but soft, I cant see why they take so long... i will explore high fructose fruit thanks, and alternatives.

@NowIveSeenEverything Hmm. Yes, I definitely understand. I was the same as both you and your daughter, and was eventually diagnosed with an auto-immune condition and IBS. But my issues were also affected by trauma - I couldn’t always go right when I needed to, due to abuse, and as a result, it only exacerbated the situation. I’ve also heard of children who don’t want to stop playing so they don’t go as soon as they need to or don’t feel comfortable enough to go at nursery or school, so it needn’t be just a trauma or abuse issue. Is there any chance this is happening with your daughter? Existing issues could cause her to not want to go, maybe even become a bit scared of going to the toilet, and so doesn’t go as soon as she needs to. Just throwing out ideas and things I’ve already read about this, because I understand that it’s probably excruciating for you to see her so uncomfortable and feel unable to fix it, in addition to being difficult for her obviously.

@FFSToEverythingSince2020 There is definitely a withholding element to it, she's very sensory (like her big brother) and doesn't like to do it. Im thinking of trying her on lactulose instead of the movicol, because she'll take a morning and evening syringe or spoon, but I cant keep her hydrated enough for these softening meds to actually work right now, she's worried that the (movicol) juice will make her poop.

@NowIveSeenEverything Oh, then I definitely understand. I have difficulty hydrating enough and I absolutely cannot use an osmotic laxative like Movicol. If I really get into a bind, I have to use a stimulant laxative like Dulcolax (bisocodyl). If you can’t hydrate her enough, Movicol (how many times is it going to auto-correct that to Monica?!) will usually do sweet fuck-all, sadly. If, as you say, her poos are large but already soft, then it’s not an osmotic laxative you need anyway; as I’m sure you already know, those are meant to gather water into stools that can’t be passed because they’re too hard. It also makes it more likely that yes, the withholding element is definitely playing a part in this. As a benefit though, bisocodyl comes in teeny, tiny coated pills. You can absolutely put one in applesauce or something and basically sneak it past her taste buds or gag reflex.

Also, consider chia seeds. You soak them first, and they develop a clear, odorless, and IMO tasteless, gel that makes the actual act of “going” easier. Once soaked, they and the gel can easily be thrown in smoothies (you can put chia seeds, and even spinach and spirulina, in a smoothie and still get her to drink it - the key is frozen berries and a bit of honey; they completely cover up the chia seeds AND spinach), oatmeal, even cereal, though it may be a bit harder to get her to eat them in cereal.

The thing with non-ige allergies is could be anything. Egg, wheat, fish etc.

If you don’t mind me asking , What caused your microscopic colitis ?

No idea sorry, ive had these symptoms for about 20 years, and bowel issues since my youth.

Thanks for replying! How is your daughter !