Starting school with poo issues

[DappledThings]

Not NCd so anyone can see I'm not the poo troll.

DS starts school very soon. He is fine with wees and has been for a long time but we have never managed to get his bowel quite right. We have been on and off Movicol and when he's been on it he's been on a multitude of different doses. We under the care of a specialist HV who has been consulting with the bowel and bladder team and I've had a call back from Eric.

We either have him medicated which results in 9-10 small, solid (but not overly hard) poos a day. Some of which he gets in the toilet but some not because it's a lot of times for him to interrupt his day. Or we can have him unmedicated where he will do perfect, large poos every 2-3 days but has multiple smears inbetween.

Both scenarios require him to have help. He wipes well but needs to be with actual wipes that he can then put in a nappy bag and throw away, toilet paper just disintegrates.

I have no idea what is reasonable to expect from the school. Obviously it's not like nursery where they are happy to change him and clean him. But it's not that we haven't been doing everything we possibly can to get this problem sorted.

Anyone started school in this position or is a Reception teacher or TA who could tell me what they would be able to do. We've had no contact from the school bar a pack being sent out, home visit and meeting the teacher all cancelled because of bloody corona.

Hi we had this, and had a meeting with the teacher before term started. We had the benefit of a diagnosis which said the issue was mental rather than physical- withholding because they didn’t like the sensation (would perform perfectly in a nappy). In the end, it was a combination of a movicil clear out followed by a regime of senna daily to increase recognition of the urge signals and support from the school (albeit this was a year earlier at nursery rather than reception) in talking about the difference between babies / big kids and how they use the loo rather than nappies etc. Good luck!

I'm also really impressed at your dc taking himself to the loo and cleaning himself up! My ds, at nearly 9, still doesn't reliably do the first and rarely manages the second! We also had the same presentation with occasional big poos but constant soiling, and concluded that even withholding for one time can cause the issue. The muscles lose their tone which can contribute to the problem. Does your ds wet himself much? That's often the first sign that my ds is backed up as the poo presses on his bladder and he just can't control it.
Very occasionally wets and only when he has also had a poo that has surprised him. Otherwise no issues with wee. He is still in a nappy at night but at 4.5 I don't think that's massively unusual and the ERIC woman said that was fine.

The taking himself and cleaning really isn't consistent! He's doing very well but we do get hiding and pretending it isn't happening as well so it's all a work in progress.

I've given him two sachets of Movicol this morning. Depending on what GP says that can either become day 1 of disimpaction or it will be the minimum dose they will suggest anyway I am pretty sure so seemed daft to wait. And he followed it up with his daily prunes pouch. He does still love those even though they are really for babies.

Movicol diesn't contain any fibre. It works by osmosis, drawing liquid into the bowel.
Dulcolax should never be used long term, particularly in children.
Bulky roughage is a bad idea in a child with a stretched bowel due to impaction.
OP, you really do need a proper diagnosis and specialist advice.

Definitely talk to the school.
You need to get the HV to pass him over to the School Nurse and then have a conversation with them. They are very used to these situations.

@endofthelinefinally

Movicol diesn't contain any fibre. It works by osmosis, drawing liquid into the bowel. Dulcolax should never be used long term, particularly in children. Bulky roughage is a bad idea in a child with a stretched bowel due to impaction. OP, you really do need a proper diagnosis and specialist advice.

Apologies, it was lactose NOT dulcolax

Also agree with PP that you need medical advice (I know you're seeking it), rather than internet randoms like me.

Re the cooked carrot. This was just for my DC. Probably fine for other kids. We just noticed a strong correlation to a seemingly benign food. There might be something else your DS reacts to in the bowel department.

Good luck

Lact_ul_ose (grr)

Thank you! Still waiting for this call from GP. Last time I tried to have one it didn't come till 17.39 by which time I'd assumed they were done for the day and turned my phone back to silent and missed it.

Would you believe the call came at 17.39 again! GP is referring us to paediatrician with no arguing about it at all which was a relief.

On day 1 of the disimpaction regimen and he has just done a decent poo. About 5cm long and solid but with quite a lot of liquid round it. Sorry for the graphic description but is that what you would expect at this point? Should I definitely continue with the full plan on ERIC so getting up to 8 sachets on day 6?

Sorry, another update just in case anyone has any more advice. Since my last one he's now done a proper big poo. Very soft but definitely solid.

That suggests to me we should keep on a dose of Movicol for now but not up it till we get to the full watery brown which suggests an full clear out. Or does the amount he has done today not indicate that and we should still carry on?

GP was a bit vague and said to carry on up to 4 sachets tomorrow if we hadn't seen a good result but not massively helpful on what a good result is.

No I would encourage you to keep going with the Movicol until it’s watery. Otherwise the blockage in the bowel which is causing the overflow won’t have been treated.

Have you watched the poo nurses video OP?
It describes the disimpaction process in minute detail. All your questions will be answered.

Ok, have now watched the video. From their description of overflow soiling I don't think that's what he had. It wasnt constant, foul-smelling, needing to be scrubbed off and he wasn't unaware of it. He was trying to get to the toilet and at least once actually did. And after only one double dose this morning he has now done 3 poos (another one since my last post so 3 between about 5.45 and 7.45) all of which were a good 4 on the Bristol stool chart.

They also said disimpaction should only be started under medical advice and this isn't what GP said. He said to carry on with a dose and increase it until there was a good poo. So now, between that video and the GP it seems we should continue on the 2 sachet dose and see if that means he continues to do a number 4 regularly.

I did certainly relate to the Poo Nurses saying that many parents come to them saying they wish they had had better information about Macrogols much earlier on. We definitely feel we've been left to guess at it way too long.

That sounds like a good 0lan OP. Stick with it for a couple of weeks and keep a food and stool diary.
You never know, you might spot a food intolerance or some other associated factor.