Advice on Fecal Impaction please

[Hangingbellyofbabylon]

dd is 4, for about 3 weeks she has been going to toilet and when I wipe there is no poo but she says it has disappeared down the toilet . When she does go it is very loose. At the weekend she appeared constipated and was only getting a bit of poo in her pants but none in the toilet. I gave her a sachet of her sister's Movicol and on the Sunday she produced a large poo but the problem has since got worse. She is suffering fecal incontinence and is off to the loo at least twice an hour, often more. Again nothing in the loo and just a bit stuck to her body. What is coming out is quite loose and her tummy is still like rock. I think she is impacted and has bypass poo coming out.

She is meant to be starting reception on Thursday this week but at the moment there is no way I can let her as she is literally soiling her pants 10 times+ a day. I tried to get a doctors appointment this afternoon but the shitty receptionist wouldn't do anything until I phone tomorrow morning

dd is really upset and I need to know what to ask for at doctor tomorrow. Do you think they will consider an x-ray to see what's going on? If she is treated for fecal impaction how long does it take to get over the worse and be able to go to school? Poor dd, she was in floods of tears tonight as she is really upset to be pooing in her pants and having no control. I haven't even mentioned not starting school on Thursday to her as I know she'll be gutted.

Any advice?

[TheArmadillo]

I would get her to dr in morning - though referral may take quite a while. Ds had ultrasound scan but had to wait to be referred for that and then another few weeks (possibly month or more) to see paed who prescribed him movicol.

It may be worth asking your gp to prescribe movicol - building up to high dosage to clear blockage and then reducing down to maintainance dose. Ds took about 2-3 days to clear out.

If she has lost control completely and is in a lot of pain, and you can't get appt tomorrow, it might be worth then taking her to walk in clinic.

Does sound like really bad constipation/fecal impactation.

[thisisyesterday]

oh the poor,. poor thing. I Have a young family member who had this. lasted years and years, with GP just prescribing lactulose and stuff.

turned out she was dairy and wheat intolerant, and once they cut them out of her diet she was totally changed.

so, once this episode is over it may well be worth looking into allergy testing. or trying with an exclusion diet to see if that's the case with her?

[Hangingbellyofbabylon]

Thank you, she does need something sorted straight away. I feel really upset that this has passed me by until it's this serious. She has a really good diet with loads of fruit and veg and I just didn't notice. DD2 on the other hand has cerebral palsy and has been taking Movicol so I watch her bowel movements obsessivly! It just worries me that dd2 was severely constipated for nearly a year before anyone would listen enough to sort out the Movicol.

[TheArmadillo]

for ds was a year-18 months. He was vomiting with the pressure/pain before they would do anything. He has had eating probs as wouldn't eat for ages because of the pain.

I was furious and horrible that you have had same problem.

How hard is it to diagnose constipation?

Be confident you know what it is and take to walk in if dr won't listen.

It is horrible to watch them go thru so much pain. Movicol might be quite harsh but it was the only thing that worked on ds. Lactulose and senna were a waste of time.

[Hangingbellyofbabylon]

I was just thinking about her diet - she eats really well and has plenty of fruit and veg so I was wondering if there is some other reason and perhaps a food intolerance. I'm just so upset that she can't start school on time now as there is no way I can send her when she is having accidents twice an hour - she also smells pooey the poor little girly. I did the usual mummy thing and promised I would make it all better in the morning when she was crying before bed-time

[accessorizequeen]

Have you already been through this with your other dd? As you already know about impactions and movicol - as armadillo says it's the best thing for clearing an impaction. DS1 took about a week to clear out completely but 2 months later he is still having several accidents a day unfortunately (started school 3 weeks ago). It's making school difficult from that perspective as poor nursery nurse has to clean him up twice a day nearly every day which makes me cry really. But postphoning reception start has other factors I guess.

Took us 2 months to get a paed referral, now we're waiting on a constipation clinic referral. I don't think you'd need an x-ray to see whether she has an impaction, both my gp and the paed just felt his tummy and said instantly. Push for movicol prescription for her, and start on a high dose, nappies a good idea whilst it clears out. If her bowel has stretched this much that she's doing 10 accidents a day, it's going to take some time before it is 'fixed'. We've been told (by paed) at least another six month, possibly a year on movicol.

[TheArmadillo]

with ds (also eats alot of fruit/veg, never stops moving and drinks plenty) he hasn't got an intolerence, but milk apparently can cause constipation if they have a lot of it, so the paed told us. He suggested watering the milk down and making sure he didn't have too much.

I notice now ds definately gets it again if he has a lot of milk. BUt we have movicol for if he gets bad and he has one dose and it helps.

[TheArmadillo]

agree with accessorizequeen ds has recently come off it after a year of movicol, but we have some in case he gets it again (to stop it getting so bad). Started with high dosage to clear out (would def recommend nappies for that) adn then down to maintaince dose for a year, then a couple of months to wean him off.

[Hangingbellyofbabylon]

my other dd had ongoing constipation but never soiling and it was mainly as her diet was really poor and she would only really eat meat. She was on half a sachet of movicol as maintenance but now her diet is much improved she now only has a sachet every few weeks or so if she has had a few days of not eating so well. dd1 on the other hand has always been fine, I think this all started when we were on holiday at the end of August and was out of normal routine. I think it will be obvious as her tummy is really bloated and rock hard, I will insist on Movicol. I just can't believe I'm going through poo problems again, I work really hard to cook decent meals with loads of veg and we are also really chilled about things so don't have any hang ups about pooing, I just don't get why this has got to this stage and I hadn't really registered that it's a problem. I've been so hung up on dd2 and her cerebral palsy that I just assume that dd1 is ok

[emma1977]

Poor thing- sounds as though she is severely bunged up and has poo overflowing causing the accidents. A trip to the GP is definitely in order.

In the short term, she needs a really good clear out. I tend to use a few days of high-dose movicol combined with glycerine suppositories if there is a lot of hard poo near the anus. Senna and lactulose are OK for maintenance but not so good for clearouts.

In the longer term, prevention of constipation and exclusion of an underlying problem is the key. Prevention by dietary measures, good fluid intake and toilet training. A referral to a paediatric constipation clinic or paed gastoenterologist may be helpful but can take a couple of months. Sometimes tha HVs can refer directly to a continence nurse in the community (the poo nurse) for support and advice.

Good luck

[TheArmadillo]

oh sweetheart, don't kick yourself over this. These things can be a small problem and then seem to suddenly change into a big one.

[cece]

DD has movicol. She was prescribed it by a paed. He felt her tummy, no other x rays or scans needed.

She started taking it in Recpetion and tbh while she was in the clearing out stage she wore pull ups. This made it easier for the TAs to clean her up. All very discrete and none of the other children knew what was going on.

She is now in Year 3 and is on a maintanence dose of half a sachet per day.

I was told by paed, only one glass of milk per day and absolutely no apple juice. If she doesn't follow this then there is a difference and I have to increase her dose for a day or two. I have also found excess chocolate bungs her up (afer Easter is always bad)

[Hangingbellyofbabylon]

Thanks everyone - I'm got to go and do some work on the 'puter now so will have to tear myself away from mumsnet. I'm going to see GP and also phone the school to let them know what's going on.

[accessorizequeen]

Good luck with it babylon, and pls don't beat yourself up about it. It took 2 years before we finally made some progress with ds1 and it looks like another year before it might be finally sorted. I thought it was behavioral only for a long time as he'd hide in the corner & never tell me.

DS1 doesn't seem to be suffering from any ill effects having accidents at school, I think the nurse just whisks him off and back in identical trousers.

Re: the diet, why is apple juice so bad? We rarely have it in the house as I can't drink it but he might be drinking it at school so I'd best check that.

[Hangingbellyofbabylon]

Well as expected the doctor wasn't really interested. Acted like i'm a fussy mother and felt dd's tum and pronounced that there is nothing there to worry about. Would not give movicol until we have gone done the crappy lactulose then senna route which we had to do with dd2 and all that stuff did was cause abdominal pain but still no poo. She has had a better day , no poo but about 10 rushes to the loo and then poo covered bum cheeks , I will have to tell the teacher tomorrow and ask that she can leave the room when she needs it and just hope for the best. First day of reception tomorrow! [must try to chill out, must try to chill out]. So I'm going to play ball with the doc but will be back as soon as I need to if (when) the lactulose doesn't work.

[orangina]

Hi Babylon... poor you, so sorry your GP isn't taking this seriously. This is reminding me of another thread which I have been following (but didn't post on) with similar (though more advanced I think) issue...

here

Is there another GP in the surgery you can see? Your poor dd, I hope tomorrow is ok, and good luck to you...

[emma1977]

I'm cross on your behalf.

[Hangingbellyofbabylon]

Thank you for the link to the other thread. I had her on the loo tonight and is was like she was in labour. There is a huge poo right at the 'entrance' so to speak and she is holding it in and says she will not let it out. She's had lactulose tonight before bed so I hope we can shift the boulder and take if from there. Please God let her not have pooey accidents on her first day at school ; I'm so worried she'll be the smelly kid. Her little school uniform is all laid out ready so I guess we will go for it - at least if the school say anything I can tell them that the GP told me to send her and told me I'd be worsening the situation if I kept her off school.

[orangina]

Hope all goes ok today hangingbelly... will be thinking of you and your dd...

[Hangingbellyofbabylon]

Am pleased to report that it all went well today - inspite of the fact that dd was up 5 times in the night trying to poo! She told me that she had kept 'her bottom closed' at school which is good. More goes this afternoon but no real results as yet so I'll probably give her Movicol Friday night and then leave dh to deal with the poo all weekend as i'm on a course! feeling so much better about it all, and so glad that dd had a great first day at school.

[orangina]

Glad to hear it... poor little mite, up 5 times in the night! Hope the weekend goes well...

[emma1977]

Glad she had a good 1st day.

Laughing at the thought of you leaving your dh with poo apocalypse!

[redders32]

Wow. Just read this thread and I'm both relieved and a bit worried. Mine has had issues pooing for ages. Has always been shy of it but as he has got older it's got worse.
I work so many hours and have been believing pre-school teachers, family etc and not realising how many accidents there have been.
Although I've been concerned about his lack of decent size poos and the number of accidents I've let other people push my worries aside including the doctors.
Having done some research tonight I've realised that Impaction is where we are & the poor mite doesn't know when he is leaking!
I feel ashamed and upset that I've let this happen. I'll have a big cry tonight & start to deal with this properly tomorrow - starting with another doctor appointment for Movicol, & stopping telling my 4 year old off for his many accidents.
Thanks on here for making me realise I'm not on my own!!

[beachyhead]

And I'm sure you are all aware, but Movicol comes in chocolate flavour... We had major blockage during the summer and it took ages to regulate, trying different doses, but we are got to maintenance management for a while and now just when necessary. My DS is pre teen though.

[accessorizequeen]

Redders, glad this thread has helped. I've always found it very helpful to come on here and find others with dc in the same boat. My ds is 9 now, still soiling although sometimes we get on top of it and feel there's been some progress. I didn't know about chocolate movicol. Can you believe it!!?? 5 years of soiling and I missed that