Chronic constipation in toddler - I'm panicking now.

[Jekyllywoo]

dd is 19 months old and has mild cerebral palsy - she has been constipated since starting solids at 6 months - we were told to not let her go more than 4 days and to use suppositories. She used to strain and go red and try to hold her legs straight.

In the last 2 months she has stopped trying - we never see her strain, it's like her body has given up. If I give her a suppository her body melts it and it comes out liquified but with no poo.

She has been on lactulose 10ml a day for the last 6 weeks but still no joy. The only time she has pooed in when I take her for Bowen Therapy (an alternative therapy) but I can't see my therapist till Wednesday.

At the end of last week we were also prescribed Senna - 2.5ml a day. She had it Friday night and last night but still hasn't pooed.

I'm no starting to panic and don't know what to do. Should I phone NHS direct? I'm gutted that the problem has gone on for so long that her now her body has forgotten how to poo. She hasn't pooed at all for 8 days now so I'm getting to a point of real worry.

By the way, prune juice, apricots etc will not work, she has been constipated for over a year and we have got to a point where even drugs aren't working.

Any advice?

A friend of mine had a dd who had serious constipation problems. She comes on MN sometimes - will point her in your direction. I think things have improved greatly since she was potty trained.

I think my friend's dd went loner than 8 days on quite a few occasions

See your GP and ask for a referal.

This can all be sorted, but your dd may need some other laxatives to 'clear' the blockage. This happened to a mate of mines dd, who ended up having picolax, which empties the bowel. the little girl is now 7 and her bowel habits are totaly normal.

I also had this with dd, and used to have to give her lactulose and senna. Dd would strain to keep it in....it was a control issue with her. Once she was potty trained it all resolved, almost overnight

My dd2 has SN and is quite immobile, which seems to be a factor in her constipation - she has been constipated pretty much since birth. Like you, we had been on a mixture of lactulose, senna and suppositories. The senna was no use at all - just stimulated her bowel enough to cause small amounts of overflow every half an hour but not a proper poo. Also like you, after a while, the suppositories stopped working - I think the bowel gets used to them.

All is not lost however! Ask your GP for Movicol - this is a powder that dissolves completely in water. When your dd is very constipated, you have to give gradually increasing doses over several days and then there is an explosion! Then just keep her on a regular daily dose and it seems so far to be working for us.

I think the NHS is particularly useless at dealing with constipation btw, if my dd is anything to go by.

dh is on movicol for his opiate induced constipation. I need to get him to up his does a bit i think....

The longest dd ever went without pooing was about 14 days before we had Movicol... The only bad thing I have heard about Movicol is that they become dependant on it, so that if you stop it, it is very hard to get the bowel action back to normal. It is very stressful, isn't it?

Thank you everyone - bigwombat, someone told me that Movicol can't be given till they are 2 and also that it is hard to get down them as it tastes foul? dd barely eats and drinks at the best of times. I will ask though as we've reached a desperate point. Totally agree that nhs not interested in constipation.

there are specific clinics that specialise in it, but it is sods law that its isn't everywhere!

Dh finds it hard to hold down the Movicol, but poor love finds it hard to hold down water some mornings

yes it is stressful isn't it? I actually dreamt about her pooing last night, and every time she cried in the night I wondered if she was in pain. My biggest worry is that we can't see how the problem will end as she really has got to the stage where her bowel has forgotten how to move. Someone on another message board said if doctors keep ignoring it, go straight to A&E and demand an x-ray to see how bunged up she is.

You are right, the Paediatric Movicol we have is from age 2, sorry. However, I still think it's worth asking about, sometimes I've found the consultants are prepared to bend rules... It does taste a bit salty, but not too disgusting - my dd will drink it mixed in with squash or just plain - but she did used to be much more fussy about it than now.

There are definitely drugs out there that are powerful enough to clear her out (sodium picasulphate?? but may not recall correctly). Then apparently the nerves in the bowel take time to recover - it sounds to me like her bowel has 'forgotten' what it's meant to be doing, needs clearing out and then needs regular medication to get it going again - but I'm not really an expert on this... You need to see a consultant not just a GP imo.

The awful thing with this is the negative spiral that they (and you) get into. It hurts to poo, so they don't, so it hurts more, and in they end when it does come out, it hurts, so that starts the whole thing all over again.

With my mate's dd, she was given lactulose on a constant basis to soften the poo, she would then have senna to force the poo out, and when that didn't work she had picolax which really shifts things, but is quite 'harsh'.

In the end, the pain was less, because the poo was softer, and it gradually became less of an issue. the same was true for my dd. Being potty trained also helped a lot.

If your dd is getting impacted, she needs to have something to shift the blockage. Ask for a referal.

Jenkey - you do need to see someone. She sounds impacted and probably needs 'clearing' out before you can get her regulated. A specialist will possibly prescribe Movicol 'under-age' - picolax can be given to children over one.

We have used Movicol for several years - the 'Plain' doesn't taste too bad - for some reason dd finds the flavoured one worse . You could mix the plain in juice.

Have you been given a referral for a paed? Ds had this - constipated pretty much since starting solids.

We had 1st appoint with paed in June - this was from a locum, after ds had begun vomiting with the pain. IT had taken that long

HE's just turned 3 and is on movicol everyday and has been for the past few months. Paed explained to me that it wasn't enough to give a dose for a few days until they pooed. It had to be for a few months as otherwise the problem would keep occuring as the bowel had been stretched - taking longer to fill adn so always being constipated.

Ds has eaten a lot better since being on laxatives, he has really bad problems wtih food now thanks to the constant pain in his tummy - am really pissed off that gps couldn't see constipation as a problem.

Anyway what I'm trying to say is see if you can get a referral for someone who will put her on a course of laxatives for several months. HEr eating and drinking may improve once she is on them.

We have the plain movicol that we mix into apple juice.

Ds loves it - freak

Jenkey - also if she's very constipated it will reduce her appetite there's no doubt about that.

x-posts with the Armadillo.

Thank you for your advice - we are under the paediatrician for Heather's cerebral palsy and tried to get to help us with the constipation last week when we saw her for Heather's review - she was not interested. I think now she has been diagnosed with cP that is all anyone is the medical profession can think about but she still has other health issues to contend with. We are also under the community paediatrician who prescribed us senna last week. I will see how it goes and if nothing happens by tomorrow morning I'm seeing my GP. I do have some hope as I have managed to get an appointment for her Bowen therapy tomorrow and every other time she has had it she has pooed within an hour!

Hi Jekyllywoo. I'd agree that your daughter may need intervention to help clear her bowel before regular pooing can be re-established. I wonder, in the meantime - and certainly once she has a clear bowel - if any of these might help?

• Grind up golden linseed/flaxseed in a coffee grinder and sprinkle them on every meal (they're packed with soluble fibre)

• Supplement high doses (1,000-2,000mg per day for an adult - not sure about a child) of vitamin C. It's a fairly gentle, natural laxative, and apparently would benefit most people taken up to 'bowel tolerance level'

• Supplement magnesium. Known for relaxing muscles, and can help improve function of the bowel. It's generally quite lacking in Western diets

• Supplement probiotics, especially if your daughter has had antibiotics. An imbalance of gut flora can contribute to constipation

• Plenty of fluids

I have only ever had laxatives once, after ds was born, and their explosive effect scared the living daylights out of me! Since then, if I've ever been constipated, the usual options of prunes, etc, haven't worked for me, but the above five in combination get me back on track every time, and comfortably.

I'm not sure how appropriate some of these would be for a child, and for your daughter in particular, but thought they might help a bit.

Best of luck.

sorry not read them all.
dd has been constipated since having cows milk, she has peadiatric movicol she is 18mo the dr prescribed it so ask, mine has said give her two sachets a day she very often gets away with one a day sometimes every other day shes not dependant on it yet do try to give her every third day without hth take her to gp in morning even if its appts only as a toddler not pooing is big problem

My dd is a bit younger - 10 months - about a month ago she started to develop multiple anal fissures from (we hope) constipation.

I think the regular laxatives are the key - we are doing ok with lactulose but by weight it is probably a bigger dose than your dd. It does take days to work. Odd doses here and there don't really help. They also said to decrease her milk - I was about this at first, it seems a bit controversial to me (but have decided to try it).

I hope you get someone to work with you - I should have pushed before things got so bad for my dd.

agree with the posts about movicol.

DD2 has been on it, and thankfully we are now coming out the other side.

She was on the sachets for aabout 3 weeks in the end and we tailed it off until she was pooing normally.

LActulose didnt work, and suppositry (sp?) were not much better.

The only thing that has got DD2 back in the habit so to speak was this movicol stuff.

we were told to water down ds's milk as it can apparently amke kids constipated.

Movicol worked for my ds. We started mixing it with orange squash and he drank it without knowing.

However if she is too young, then you need to up the senna. We were told that chocolate ExLax was the easiest way of giving it to him.

There are constipation clinics in alot of NHS hospitals. Most GPs seem to be unaware so push your to find out.

Also once you have got her going, you have to reduce the laxatives over a VERY long time - possibly years, or she will stop again.

Sorry, don't have much knowledge on how the CP affects it. Good luck and don't be afraid to increase her doses.

Ok... the latest.

Still no poo so I saw GP at lunch time - a locum this time but for once he seemed concerned. He wanted to give her some oil but it was not recommended for little ones so he asked the district nurse and health visitor for advice - all 3 decided that Heather needed to be admitted to hospital for an enema (apparently no-one in the community can do them - so what can GP's do these days? )

Anyway, he phoned hospital who said they won't look at her until she has gone 14 days without a poo - we are on day 10. Hospital recommended - Movicol. So she's had one sachet tonight, she then has to have 2 tomorrow, 3 the next etc until she produces. If she hasn't pooed by Thursday then we're off to hospital. I'm hoping we'll have results tomorrow but a bit worried as I've heard it can be explosive.

I'm glad we've been given Movicol as it looks as if from the experiences here it is the one thing that works. Whatever happens I'm going to go back to this GP and ask for a referral as things should not have to get this bad before something is done.

Thank you so much for all your advice - I will let you know when things move for her. I hope she isn't going to have too much of a crampy tummy tonight, poor little love.