Think DS constipated. What to say to doctor to avoid being fobbed off.

[pooka]

DS is nearly 3. Still in nappies. Am taking him to the doctor tomorrow because am increasingly worried about his pooing at the moment. He is, about 4 or 5 times a day, straining and trying to poo, but only producing small smear instead.

Background to the query is that took him to docs about 6 weeks ago to say was concerned about possible constipation. He is a fussy eater, but does eat lots of fruit and drinks fruit juice. The doctor I saw basically said improve diet, go away, is bad idea to intervene because can result in lazy bowel.

Since then there has been little improvement. Maybe a day now and then where he has a big poo, but then several days of smears. It is becoming increasingly problemmatic for him, he has started to be very shifty about telling me he has done a poo, says that changing his nappy hurts, and generally is getting pretty bothered about pooing.

Also, had been planning to potty train as before this was showing some signs of readiness but not am keen to avoid potty training as don't want to increase any worries he has about pooing, and given what is happening, he isn't likely to have much success on the potty WRT poo.

Have been giving him lactulose, but only 10ml (5 in am and 5 in pm) a day, and this seems to have contibuted to the leaking, but doesn't seem to be helping him to develop a regularity or consistency wrt pooing.

Am worried that the doctor will poo-poo (excuse the pun) my concern - reading what I have posted, do you think this is something that should be treated in some way, or am I being over-anxious?

Am feeling so sad for him, and for me, because I feel completely at a loss as to how to help him.

Any advice would be hugely appreciated. Off to bed now to prepare speech ro doc, but will be logging in tomorrow, so apologies if I don't respond before then. Thanks.

Sounds like he has impacted faeces. You need some movicol, that should get it shifted. Have a look at this site
here

THanks for the link - do agree that it sounds like he is constipated. Feel really sorry for him, because it's a bit like a grey cloud over certain parts of the day: the whole nappy changing, sore bottom thing.

Have to agree with cece, small amounts seep past the blockage which is probably what you are getting .... you could try a stomach rub to help it along (if it works he bay break wind first, so you will know it's working)

rub up the right side, then across the stomach under the ribcage, then pull your fingers from his back (below the kindey area) over the hip and down along the pelvis into the groin - 5 mins of this a few times a day could help to get it moving.

If you see your GP yous could ask for a supository (nasty but effective) my little one has Movicol which may help.

Best of luck.

Much sympathy, this is a rotten one that we've gone through a few times with DD.

We were told that if the constipation has been going on for a while it can temporarily weaken the intestinal muscles, making it even harder for them to go. Plus in anticipation of it hurting, they sometimes "hold on" which makes it worse, so there is a psychological element too. We were prescribed lactulose, and told to give on the first signs of constipation in order to break the whole cycle.

When everything got back to normal, we were advised to give DD a fibre and fluid rich diet to keep things regular..

Sounds just how my ds2 used to be. He was ecentually given Lactose and senekot by the gp and was better in no time atall.
Feel for your both as I know it's horrible seeing them sore and straining.

If you get one laxative and it doesn't work - go back and try a different one. You need to break the cycle and give the intestines a chance to shrink back and regain elasticity.

I don't think you're being over-anxious at all, my ds has chronic constipation and he's now on movicol for at least 6 months to fix his bowel which has stretched (thus the seepage).

It can be quite a serious, long-standing issue and your gp needs to take it seriously. I would ask for a pediatric referral, we left asking with ds (he was 3 when it started, now 4.8) and it's just made it a much bigger problem. Trouble with asking for movicol is that you're not sure what to do with it, if your son is impacted you need to give him a high dosage for the first week and then gradually reduce it until he's going every day. I would be happy to list the advice the pediatrician gave us for ds, and we were given some very useful leaflets as well.

A pediatrician will give you proper advice, my gp knew absolutely nothing and clearly yours is ignoring it when it's very very common with boys his age. A referral might take a couple of months, so you could ask for Movicol whilst you're waiting (on repeat prescription if you can). Lactulose will only make it softer, won't push it out, movicol does both so it's better for this.

Oh God. I am so worried.

Saw a different GP today who said to up the dosage of lactulose for one week, so 15ml in total.

If no progress next week, take him back.

Left feeling quite tearful as I still don't think it's being taken seriously but at the same time don't know whether me actually thinking a laxative would help is me being trigger/intervention happy.

The GP was very nice, and did take all my points on board, though she did suggest that the increased dose of lactulose should help any blockage through, and from what I've read, I'm not so sure about this.

I asked about suppository, and she said she felt that this might be distressing for him/might be overkill (at which point I felt like saying honestly, a suppository is not going to turn him into an emotional wreck with example of calpol suppositories in Europe).

I had similar diffs when I was the same age, according to my mother. Remedied by a 2 week course of suppositories.

I will give him the increased dose and will be back there on Monday if no improvement. Also will ask for a referral. So wish I could overcome the paranoia about making A FUSS.

Thanks so much for all the information and advice.

Hi, pooka, try not to get too worried and blame yourself - it's v.hard to be assertive with doctors I find. It's only because my dad's a pediatrician that I asked for Movicol, would have been fobbed off with diet advice otherwise. If he's impacted, then a combination of lactulose & senoket (as suggested by slavemum) would accomplish the same thing as movicol just with more hassle & you'd need the correct dose of senoket. Did she think he was impacted? If he's holding on in anyway, a drug is needed to push the poo through so that he can't control it and thus the impaction will be cleared. Lactulose is a stool softener so doesn't accomplish that, I wouldn't have thought. Give it a week as you suggest and in the meantime, read up as much as you can about chronic constipation - there are plenty of people on mumsnet with ds's who suffer from it (much more common with boys) and can advise no doubt. It's taken nearly 2 years for us to identify the problem for ds1 and get some help + proper medication and he's starting school next week with it still existing (i.e. accidents) - a week will not make a huge difference in the long run.

BTW, lots of fluids will help him a great deal - really makes a difference with constipation if you can get him to drink more. Also, bananas for some reason will make it worse although other fruit all fine!

Apparently I too had these issues as a child (and still do!), it's quite common for children to inherit the problem.

THanks so much for all the advice.

Have printed out the poo record from the site cece linked to and am filling it in. Feel that if no progress this week, will make sure that am completely au fait with the subject and armed with evidence and my own take on what would work best next time I see the doctor.

A friend recommended making sure ds walks and walks and walks, and I tried the massage last night as well.

Also, we found with DD1 that introducing a potty actually helped.. We didnt take her out of nappies but we did let her try and do her wees and poos on the potty when she fancied it. Mostly after bath when she was running around naked anyway.

I think it is something to do with the position she could get herself into, but a couple of times she could poo into a potty when she couldn't in her nappy..

If you do end up going back to the GP I would ask for the movicol, although you might have to play with the dose a bit ... I still can't get it right 100% of the time!

we have the same thing with lo all the time, someone on mn suggested increasing the lactulose from 5ml in morning and evening to 10ml to help along and then regulate it to what will keep her 'going' & it seems to be helping her a bit, she's not screamed like she used to for a few days now although she's still not regualr by any means

Also someone suggested asking about a constipation clinic or something similar which is what we're seeing the Dr about tomorrow (at least I think it's tomorrow, best double check)

Also suggested was potty training because of the crouching position which would help make it easier

there's all sorts been posted on the thread I posted the other day about my 18mo, it may be of some use to you? then again, it may not.

I have to say I agree with all on this site.

My ds1 whois now 8 went through this at the same age, upto when I eventually camped out at the drs when he was 5, and got a hosp appt, previous to this he was being given valium to relax him about every 8 weeks for him to go!!!

Was put on Movicol, and out life turned around.

He used to get "paid to poo" and in the last year we have been able to stop doing this. Fight, fight , fight. There are lots of people out there who have been though it. If you need to talk about it let me know

Can't say thank you enough for all the excellent advice here, and links/references to other sites and threads.

Feel like I now know more than I ever would have hoped to know about poo and bowels!

DS seems to have been marginally better today - was with the childminder who texted me whenever she changed him with size, consistency (!) so have been keeping a record, including what lactulose he's had and when.

Still not right though - but interestingly have remembered staying with my grandmother and her and my aunts making reference to senokot (hadn't a clue what it was then) for themselves - maybe a hereditary thing?