Not sure what to do about DD, worried about feocal impaction

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And its my fault . She is on movicol after a year of bad costipation which started when she was put on ranetidine (which was to help with the stomach irritation her other meds had caused).

She came off ranitidine a couple of months ago and I noticed her poos were a bit too runny and she was getting sore from it so cut down to one movicol every other day. Then when she still had loose nappies this weekend I decided maybe I should leave it three days to see what happened. She went on monday and all was fine but didnt on tuesday so I gave her movicol. Still nothing so today I gave her another but she got more and more uncomfortable and was straining, nothing happening etc so I gave her another and we went out. On the way home in the car she started screaming and pointing to her nappy saying uh oh and so I tried to comfort her and got her out quickly when we got back(short journey bt I think sitting down ort of forced her into a position where she couldnt hold it in anymore). She had done a very large poo so I changed her and carried on, she then did another one again too large.

In the bath she started screaming again though pointing at her bottom and saying wee wee then pointing to the toilet. I tried putting her on the seat but she cried more so I had to get her out, she then brought me a nappy its as if she is frightened to not be in a nappy?

I am really worried that she has got some sort of blockage or damage has been done, she is asleep now but keeps crying out every now and then as if still in pain.

Movicol isn't nice stuff, once the poop starts moving it's hard to stop it. Is her tummy sticking out, like it's swollen (distended)?

Should have said, I am worried about impaction because they mentioned she may have it when she first started on the movicol. I am also panicking that it hurts when she wees but maybe she was just saying that meaning nappy. She ate her dinner and had extra so must have felt ok atthat point, she's not been eating well at all the last few days so I was relieved.

Yes it is a bit swollen. Not like it used to get pre movicol but it is sticking out.

or was before she went to bed.

www.nyrdtc.nhs.uk/GMMMG/Groups/Publications/GMCCN/Constipation%20Guidelines%20Published.pdf here, this should help.

As far as I am aware, movicol is used to get the bowel moving to prevent impaction (the poo becomes so hard/too much and the child can't push it out) by moving it on. Patients do poo alot, some loose bowel continence and it just comes out. If she last had her bowels open on Monday then there shouldn't be enough in there to cause impaction and it sounds like anything left since Monday is now out. Check her nappy for poo though and take her back to the GP if you feel like she's in pain. It would have caused some discomfort to open her bowels so this is maybe why she was upset. She maybe feels as if she needs to go hence the want of a nappy.

Has she been vomiting at all?

Thanks scrooged just read through that its a good link, looks like DD probably hasn't got impaction at least this time because she ha only gone a day and a half without going.

Sorry x posts. She was sick a tiny bit into her hands earlier, when I got her out of the car she stood refusing to move it was like she couldn't walk properly, probably the pain? Then she was sick a bit whilst pushing but fine after it was done and she was changed.

What colour was the sick? (I know it's gross. Im sorry)

It was literally just the water she drank I think..

Not brown then. That's good.

Do call NHS direct if you are worried. They are better qualified then me.

Thanks scrooged, I will call them if she wakes up in pain I think. Poor thing, I hope we aren't back to square one with the constipation now.

Movicol's horrid and does help some children, but not all. Did the doctor go over other things you could try like diet (soft pears help, as does prune juice)? plenty of fluids?

Yes she was referred to the community constipation and excema nurses in the end after trying everything, senna and lactulose and also looking at her dit which is generally very good as she loves fruit and most veg. It seemed to be due to the ranetidine so I hoped it would improve when that stopped,well it did improve but maybe I jumped ahead of myself a bit.

Hmm. Does she have an allergy to cow's milk?

Well not an allergy because when all the stomach irritation stuff was going on when she was 7 m they did allergy testing at the hospital. But I was intolerant to it nd still can't take much so it is probably ossible.

keyboard being silly again! possible!

I would look into this further. My friend has a little girl who was allergic to milk and had the same symptoms. She used to sit on my knee and cry her eyes out she was that miserable. Her skin was so dry and sore. She's so much better now she's off the milk. Have your tried soya?

DD has psoriasis and excema and I have been thinking of cutting milk cows milk out to see if it helps. I drink soya so it would be easy enouh if she would drink it. She only has it at niht and with breakfast but eats too much cheese.

There are other things that contain calcium (spinach etc). I'd try the soya milk and see if that makes any difference. They normally test for a milk allergy by giving the patient a drink and then getting them to blow in a machine. How did they test it on your little one?

good question, I am pretty sure it was a stool sample. But it could have been blood tests as she has those a lot. I seems a long time ago and there was so much going on at the time but I remember the stool sample bit! At that point she wasn't constipated yet btw, that only started when she was put on ranitidine for the stomach problems.

It can be a side effect of certain medications I'm sorry to say.
What was wrong with her tummy?

She had reflux then got very bad irritation from aving her medication (she is steroid dependant) on an empty stomach due to vomitting. She threw up blood quite amazingly twice and needed an ambulance and three days in hospital each time and a third time less violently. First they said a mallory weis tear, then that it was irritation from the steroids. I asked if it was an ulcer and they said they didn't knw, possibly and that the ranitidine would treat that anyway. So the constant throwing up feeds stopped, she was finally able to get on with solid food without choking on it but then the constipaton started! I hated the first year!

That sounds horrid for both of you. It does sound like she's on the mend though so I would be tempted to chat to the doctors about reducing the medication with the idea of getting her off them, especially if the reflux is resolving itself. There's no need for them.

She is off the ranitidine so I was really hoping we could lose the movicol now. I'll ring the community nurses tomorrow I think and then go back to one every other day if they agree (they are a bit over eager with the movicol sometimes I feel and may tell me to keep on with one or two a day.) Anyway thank you for talking to me you have been really helpful. DD has (touch wood)not woken so hopefully the worst is over.