Fecal Impaction, i give in!

[katkit2044]

Okay so, my dd has been on a disimpaction dose of movicol from 4 to 6 to 8 since tuesday, shes been on 8 since thursday and right from day 1 shes had watery poo with little bits in it but no actual pieces of the impaction yet: however, when it came to the point of pure water was coming out i lowered it a little today and now shes straining to go again, she went from 8 to 4, but 4 seems to be not enough as shes producing small but really soft bowel movements but they are hard to pass. 8 gives her watery bowel movements and 4 makes them soft but really hard to pass still.. she hasnt properly been in 3 weeks and i dont know what to do. shes 15, and shes been drinking lots of water, eating lots of fruit and veg even though she has no appetite at all. PLEASE HELP.

It’s gross but sometimes constipated children are able to go if they go in a warm tub of water. Try her having a bath and then getting out and trying. But whatever you do, don’t hover or call up with “hows it going?” Just leave her be. She has to be mortified poor dear.

she has been taking baths, but i dont think its really working much different.

Can she give herself a suppository?

Lots of prunes each day? Juice veggies several times a day? Strong coffee? Sweeteners?

Can a pharmacist give additional advise?

Sorry if you have tried all these.

Hi, i feel you pain . I have been through the impaction regime 4 times with my daughter, its stressful and distressing for everyone involvee. I would definitely go back to the doctor, my dd needed both the movicol and lactulose at the same time. One softens the stool the other stimulates the bowel.

Also you may not see a solid mass. If the stool has been there a while and the laxative has worked it may come out a lot softer than you think. The first time my dd was impacted there was no solid mass that came out. It was a very large amount of loose stool.

Don't stop the laxatives they need to be gradually reduced and increased back up as and when needed. Go back down the same way you increased them. And don't stop completely until a totally normal regime is in place.

Things to monitor are the passing of urine. The doctor told us that when the impaction reaches a certain level you physically cannot urinate. If this happens then go to a&e.

Hope this helps.

Oh god poor girl. I have to confess to not really knowing what works in these situations but would a really strong cup of coffee stimulate her bowels? I realise this may be a ridiculous suggestion but it tends to get things moving for me.

Go to the Eric website for advice on disimpaction. At a guess it sounds like she may need to be on 4 sachets for the time being as her maintenance dose - you want to achieve soft but not watery stool (though as it sounds like you already know, some watery stool may be overflow diarrhoea - the presence of any hard or pellet like stools suggests the dose needs to be increased or disimpaction restarted).

If she has been constipated for years, she may need maintenance treatment for years. This is a case of adjusting to a new normal. Her rectum may have dilated over time (this is reversible) which is why even when he stool is soft, it may still be large and difficult to pass. It's good that she is passing something. Sitting on the toilet around 30-60 minutes after a main meal can be a good habit to help with this. Sometimes, when really large, soft but difficult to pass stools are a real problem, a 2nd type of laxative (stimulant) such as senna might be helpful. You could try senna OTC to see if it helps. I would continue the movicol (with good intake of water) as it is essential that her stool is kept soft. Use paracetamol to help her with discomfort.

This isn't a reason to go to A&E and I don't think you will get the help you need there. Try to book an appointment with your GP, she probably doesn't need an examination, so a phone consult should be fine. If it's very difficult to get on top of, she can be referred to your local paediatric / children's continence clinic.

Good luck. Constipation is very common but can be so distressing and a real slog to get through the initial treatment/disimpaction. It does sound like she is making progress.

Sorry for the crude post but is there any poo coming out when she wipes?
If there is, it’s overflow and she isn’t emptying her bowels. I would suggest you keep a high dose going over a number of days.
If there is no overflow and she is going regularly then I would slowly start to reduce the dose. Only because when our son kept getting a watery consistency, he was only doing really small but frequent movements. When we reduced the dose slightly he started to go longer between using the toilet and then when he did go it was a decent amount.
Your GP can give more advice. I hope she isn’t in any pain.

Lactulose and prunes x

Get a step and get her to put her feet up on it whike on the toilet. Should be aiming for knees up high. Has she tried to read or watch a show while sitting on loo (not straining to go but jjst relaxing) if her mind is elsewhere she might find it comes along more naturally when relaxed. That is what i often have to do.
For my kids, pineapple works for one, oranges work for the other. Caffine works for me. A lkng walk can also help. She is probably getting anxious about it now and not realising she is holding it in addition to tghe original problem.

I'm sorry to hear massage hasn't worked. I would say please keep trying regularly, even if you don't think it's working. Perhaps just once a day. I'm very sure that it's an effective method and as long as it doesn't hinder any other treatments then hopefully it's worth a try

In my experience you need to keep on with the Movicol without reducing the dose and in the end it will work. Impactions can be as hard as bricks and can take some time to shift. Once it clears she will know, it's very obvious. It doesn't sound like anything significant has happened yet. Keep the dose up and stay near to a toilet.

My son had issues for 2/3 years when younger and we were often stuck where you were now. Never really clearing and in an endless cycle of pain. Saw a specialist who prescribed sodium picosulphate alongside the Movicol.
It was an absolute game changer, to the point his long standing problems were resolved fully within weeks.
The consultant described it as “giving the bowel some oomph”

I’d wasted so much time and energy on gp and pharmacy trips and we were literally sorted after referral to local hospital and one appointment- please push for this if you haven’t already

Sorry, it was picosulfate! Wrong spelling above

Yes, you do need to preservere with Movicol at high dosage. It might take a few days to resolve itself.

DD has ASD and we've been in that position many times.

Alternatively, buy some glycerin suppositories over the counter or Amazon and get her to administer them herself. That will probably solve the issue in a matter of minutes or hours.

Brits are seriously weird about suppositories, but in mainland Europe we use them specifically for children.

She needs at least 4 sachets of movicol

She can use a glycerin suppositories on herself

Sounds like she needs an enema in hospital tbh

Is she feeling ill.

Like others have said, walking / exercise and adjusting her position so that she is in more of a squat or has her knees up will help - a small stool in front of the toilet to put her knees on? I think it's likely she has the rectal dysfunction that accompanies chronic constipation. Now, even though her stool is soft, her rectum is "used to" being loaded with stool, has become dilated over time, and the normal peristaltic motions she should have are weakened and not happening when they should. Trying to re-establish a regular time to have a poo (often after mealtimes is good because of something called the gastro colic reflex), exercise, adjusting position (being seated on the toilet is not physiological for human beings and anything approaching a squat is much better) and stimulant laxatives or suppositories are the way to go, whilst continuing the movicol (if her stools become hard again her progress with everything else will reverse). It's going to take time and will be uncomfortable. If she is used to passing stool being painful she may be tensing on the toilet unconsciously. Perhaps screen time on the toilet?

Try hyssop tea. Very good for digestive problems and natural too. Available on amazon.

Magnesium in the form of soaking feet in Epsom salts in a foot bath work!

If you look up Bristol stool chart it will give you an idea of types of bowel movements she's having and an indication of severity of constipation. Watery stool can be overflow from constipation. I would record how often she is having a bowel movement, size and type based on bristol stool chart. Go back to your gp and explain the pain she is in, the frequency and type of bowel movements she is having.

Have you thought of a psychological cause, a youngster of this age should not need regular laxatives.

Dried apricots always worked very well for me! I hope you get it sorted.

As an imp action sufferer myself, I’ve tried everything. The thing that works best is good old milk of magnesia. Worth a try?

Magnesium citrate in warm water

She will poo all day

I really do feel for you and your daughter.

Can you try some ducosate? My mum takes one a day for a couple of days to relieve severe impaction caused my cancer meds. Her district nurse refers to them as bowel bombs.