Impaction in my 3 year old & potty training

[CarrieDS]

My 3 year old daughter has been diagnosed with impaction (as in, the severe constipation).

She has been on movicol for 3 months now, we give her 4 sachets per day. Early on in this process she did poo golf-ball sized lumps of the impaction, and we hoped that would be a turning point. However, she has had many dark/ stinky nappies since then, and according to the consultant who I saw recently she is still a bit impacted.

I know this will not go on forever, that she will eventually become a child who will poo normal. But it is very difficult to know how exactly to proceed. She is 3 and a half next month (November), and next year (September) she will start school. I know September is a long way-away, but I really would like to have her out of nappies.

I know I should not care about what other people think, however of course many children we know a year younger than her are potty trained. All children her age at her pre-school are potty trained. The staff are totally unphased by her nappies and no doubt, have seen it all before. But I'm still conscious that the clock is ticking. Again, I know I should not care but every time my mother looks all concerned asks if she "still has this problem, and is still in nappies" I cannot help feel like it is something to be ashamed of (I know, I know...).

FYI she is my 3rd child, had no issues potty training etc. the first 2.

I just don't know when this will get better or how to proceed. Consultant said not to worry it is very common and she will be fine (ie. potty trained) long before school. But next appointment is December, so I just feel long gaps between support without the situation changing.

nb. my daughter is otherwise well, and very happy!!

Any advise appreciate, especially if you have been though something similar regarding impaction and also the potty training.

Thank you :)

Have you done a full de- impactation yet? The Eric website is really useful for this.

ps. I didn't fully explain, but she is in nappies because the movicol makes her do massive, stinky & diarrhoea texture poos. She would essentially, poor her pants if we put her in pants. She sometimes still has overflow between poos although not as much as she did pre-movicol. So, at least, I think she would poo herself.... again, any advise appreciated! She does know how to use the potty, and is pretty good at wee-ing in it. If it wasn't for the impacting, she would be potty trained.

@Lockdownseperation thanks for reminding me. Consultant did say to look at that website, I forgot about it. I will look now. Thanks again. The truth is, I'm not sure. But the consultant said 1 month ago, she was still a bit impacted (he could feel her bowels).

So have you done a disimpacting regime? Overflow should disappear once disimpaction and maintenance achieved ime.

Second eric website for advice.

X post.

I would undertake another round of disimpaction.

The time frame is long, and feels frustrating, but as others have said it does take time. From what you describe I think you are not clear yet and should discuss other medication with your doc. For my dd we added sennacot syrup on top of the movicol and used glycerine suppositories as required. Then once into good routine (age 5) started slowly reducing. She stopped needing it all around age 8 and it does get easier as they can articulate more how they feel and you can spot more triggers and early warning signs that they need more meds etc.

We’re in a similar boat here. She needs to be disimpacted fully so that any overflow soiling stops and her bowel is not getting overstretched.
Do you think that she knows when she needs to poo?
I really wouldn’t worry about her age, putting it off for a few months doesn’t matter in the grand scheme of things.

Another vote for the Eric website here. You need to fully clear the impaction for the medicine to work properly after. I have had to do this many times with my son as his problems come from him holding it in. After I read about Eric and visited the website I just rang my doctor to check that I wouldn't cause any harm to my son if I did the complete clear out. She was fine with it.

Thank you all for your replies. It's really helpful to read your comments and experiences.

Having just looked at ERIC, I think we have not given her enough movicol sachets. It would have been helpful if the consultant told me directly she needed more than 4 to be dis-impacted. I will increase it slowly up to 8 as per the guide on website, and maybe that will shift it. On ERIC says 3 is maintenance level, and I've only been giving her 4 for 3 months! Argh.

@milkjetmum yes I think so too. My daughter did have Senna syrup once before movicol, and it made her sick which was very off putting (and briefly quite scary), but I believe that previous doctor told us too much quantity. We gave her 5ml that one time, under her initial instructions. Later we realised the bottle said 2.5ml max for her age. I will talk consultant about this before trying it again smaller dosage. We did wonder it the Senna prompted the 'golf balls' which came 5 days later, but hard to say as by then we had also just started movicol.

@Baboutheocelot reassuring to not feel alone, thank you. She sometimes knows when to poo and will go to the potty and make a real mess all over the sides/ floor etc. but more often I think she does not know. However she was overflowing so long before the movicol as this took so log to diagnose (lockdown situation with phone appointments didn't help), I'm concerned she hasn't really learnt to feel when she needs to go in usual way.

Thanks re. her age. You are correct. I know it in my heart also.

I would ask to see a different Consultant as well. If he could feel she was still impacted but didn’t tell you to do a proper disimpaction regime, I wouldn’t be confident in any further advice from him.
I would follow the ERIC guidance to the letter and you can ring them or email them for advice too. I’m sure you’ll get it sorted with their help.
My family member had to go through this with their child and it only worked the 2nd time when they followed the ERIC instructions to the letter.

@BornOnThe4thJuly thank you yes, I had been thinking the same thing when I read ERIC yesterday. Wish someone had directed me to the website earlier in the year when this began. Great will do, thanks again.

There are different approaches to a full disimpaction, it worked with my daughter. She was impacted for 18 months or more, soiling daily. We agreed a more gentle approach with the specialist, mini disimpaction over weekends then maintenance dose of movicol and sodium picosulphate. I was concerned she wouldnt cope with the full on movicol scenario, she struggled to drink it and was distressed by the idea of more poo. After a few months trial and error she has not soiled for a year and it feels like a miracle.

I would follow the advice given by your consultant re potty training. Unless your daughter seems totally deperate to try, then perhaps call them? In my area you can leave a message and a nurse or doctor calls you back. Dont rush, it might cause more withholding.

Thank you CottonSock! The only thing is, the consultant didn't really give me advise with potty training. He just implied she'd be poo-ing before school. He didn't explain disimpaction to me either, so now I feel we have been doing it wrong for 2 months.

Out of interest what is mini-disimpaction?

Thanks again :)

For us a mini disimpaction was a reasonable dose of movicol for a few weeks to soften things, then sodium picosulphate liquid in increasing doses. She tolerated it well and ended up on it daily.

I'd probably try calling them, or Eric for advice. Have you seen the Dartford (I think) poo nurses video? If you want to fully disimpact this is essential viewing. I think Eric link it on their website. You can try Facebook group movicol mummies too. There will be loads of people in same position.

Hi I just wondered how you were getting on with your daughter?
My son turned 4 on the 29th Dec, he literally came out of nappies on the 1st, however he won't poo at all, 2 weeks ago the GP prescribed movicol and lactulose, it did nothing, on Tuesday last week the school rang asking me to pick him up early as he was leaking poo, Wednesday we ended up in hospital he needed an enema, we left hospital and he is now on x4 movicol a day and 20ml of lactulose, he has not been for a poo and is still losing the overflow which is like acid. I haven't been able to send him to school as he has no control over it..Thinking of ringing the ward again as I have no idea if this is normal or not