Stool-withholding and Movicol

[bth20]

Apologies I realise this topic has been addressed a number of times but I’ve not seen this particular question answered.

DS has just turned 4 and has basically had a stool-withholding problem for the last 8 months.

Following an all-too-infrequent proper bowel movement the cycle goes something like this:

Phase-1: a couple of days of happiness and clean pants (hooray!). Movicol at one sachet per day (at most).
Phase-2: a few days of soiling pants a couple of times per day (but not by much). Movicol at one sachet but moving up to two.
Phase-3: a week or two (or more) of progressively worse soiling of pants (may be more than 5 times a day with varying amounts) during which we significantly increase his Movicol until he finally does a big poo and phase-1 begins again.

He’s at nursery during the day and we give him plenty of time on the toilet / potty at home (which can need the promise of some TV time …which then means too much TV). When on the potty/toilet, he kind of panics and generally won’t let the poo out except in small "worms".

When he has the accidents, sometimes it’s obvious and he knows it (we can see him trying to hold it in), and other times he seems to have no idea at all. The total volume being "set free” during phases 1 & 2 is probably equivalent to a few normal poos.

Anyway it’s a NIGHTMARE for all concerned so any advice welcome. In particular I would like this question answered:

I am aware that impacted poo can cause accidents as more fluid stuff works its way out around the blockage. BUT presumably a significant levels of Movicol could give similar results when there is no impaction remaining. So when he’s leaking poop all the time (phase 1 or 2), which is it? Is it due to impaction or a recent surge in Movicol (which takes several days to act)? This is important because it seems to me they have precisely opposite implications (increase Movicol in one case, and decrease it in the other). It’s difficult to believe that there’s new impaction so soon after a clear-out but then nor can we be sure he completely cleared it. Or is it to do with a lack of control caused by past stretching of the bowel which needs to correct itself (via months of more Movicol)?

Many thanks in advance

Are you making him sit on the toilet for a little while every day?

My DD6 is going though this. We were told to up to 2/3 maybe 4 sachets a day u til she was cleared out then Mai rain at 1 sachet a day and make her sit on the toilet for 20 mins a day. It's pretty much worked except for when our routine is Interrupted on holiday for example.

Sorry typing whilst walking

My DD6 is going though this. We were told to up to 2/3 maybe 4 sachets a day until she was cleared out then maintain at 1 sachet a day and make her sit on the toilet for 20 mins a day. It's pretty much worked except for when our routine is Interrupted on holiday for example.

Omg I literally could have written this post!! Going through exactly the same at the moment and just don’t know what to do?? Please tell me how your doing?? Would be great to chat with someone in a similar situation x

We took him to a private paediatrician (NHS paediatrics appointment would've been months away). She gave us a new plan involving a surge in Movicol first (done before but needed to do again to clear out any impaction) then routine of going on potty after breakfast and after dinner every day and if no improvement within about 10 days (there wasn't) then onto toddler doses of stimulant-laxative Senokot which we give at bedtime. This then (ideally) guarantees a normal bowel movement the next morning. We've only just started the Senokot so can't yet say how successful it is.

I would definitely recommend finding good paediatrician. Apparently it's all about retraining the bowel-brain neuro pathways because having these problems for that length of time means they no longer get the signals telling them they need to go (hence the accidents as they have no warning etc. etc.)

We are about to run a faecal disimpaction regime in our house. The ERIC website is helpful.

Thanks so much for replying, your information has been really helpful. We have done a couple of disimpactions now but could never be very sure if they actually worked? About a week ago we introduced a trear box and got him sitting on the toilet after breakfast and after dinner. The first day he sat on the toilet 3 times in the space of half an hour just so he could get the treat which was costing me a fortune but hey we remained upbeat and positive and just encouraged him to go. Four days in while at nursery he came home dirty and said he was too busy playing to go to the toilet. 6 days in he had a BM on the toilet after breakfast, 2 accidents at nursery and one on the toilet at nursery so today I didn’t give him any movicol as I’m thinking the dose may be too high. I’m going to try one a day now instead of two and see if that helps? His mood was absolutely terrible by the time he got home from nursery yesterday though, it’s one of the worst aspects of this whole thing for me. Im never sure which DS I’m going to get from one day to the next. I’m not surprised though, it must be so upsetting for him having so many accidents, especially at nursery. He is starting school in 6 weeks and I’m so worried he is still going to have the same issues when he starts. He’s such a fun, outgoing boy and the last thing I want is for it to knock his confidence.
I feel like we might be on the right path now though, so we’ll stick with it for another week and see how things go. He had one BM in the toilet after breakfast this morning and one after lunch at nursery and he’s like a different boy today, so happy and no sign of a meltdown what so ever. Fingers crossed 🤞

This sounds very familiar. It makes all the difference once they’re cleared out doesn’t it!?

One thing I forgot to say is that according to the paediatrician, the Movicol can go on indefinitely as it just softens the poop. And that the dose should be increased if you travel or stat somewhere unfamiliar as that’s when they’re most likely to get another bout of constipation.

Th ask you that’s good to know. He’s actually been on movicol on and off since about 1 1/2 years old I think. He had a lactose allergy as a baby and the hyrolysed milk they put his on made him constipated.
mom now just looking at his tummy and thinking it looks very bloated, his stools are also like worms as you previously mentioned. Does this sound like he may be constipated again? I know this sounds terrible but I can’t go through another whole week of disimpaction not to mention miss a weeks earnings. Do you think it can be done over 2 or 3 days? X

Sorry my typing is terrible in that last message, hope you can understand…

It’s unclear isn’t it. We were in that boat which is why we went to a paediatrician to get a fresh plan

We had this with DS2. We were lucky that we got to see Dr Anthony Cohn as he works locally, but he has a great book available about ‘Mr Poo’. DS ended up on pico liquid as it’s non-negotiable, impossible to withhold as you get a poonami after a few hours. He was older than toddler age at the time, so it was safe for him. He’d started withholding after being unwell for a few days and not going, when he did go it hurt, so he’d withhold and it became that horrible vicious cycle. Once he’d had the pico a few times he stopped trying to withhold as it was pointless. It was coming out whether he liked it or not!