Constipation/impaction/soiling/Movicol - feeling at my wit's end

[TheLightPassenger]

I have an 8 year old with chronic constipation - fussy eater, hates veg, sometimes has to be nagged to drink enough, which really doesn't help matters. After over 18 months on Movicol, and episodes of being close to sorted, it all goes wrong again . I'm particularly worries as DS is going on a residential next week, and we are going through a bad patch. School are aware and v supportive but am dreading the reaction from his peers. DS now showers himself after an accident, but has to be prodded to make sure the bath etc is properly clean with no traces of poo . I just don't know what to do. We are under the continence service, but they are proving hard to get hold of, I have left a couple of messages and waiting for them to get back to me. DS is currently on 2 movicols daily (upped from 1). I have no idea whether he is on the right dose, too little or too much/

oh, that sounds difficult, TLP.

I odn't know what to suggest. given the experiences I have had with dd1 (and incidentally, other family members - bowel health clearly not so great in the silverfrog genes), I would approach this from a dietary perspective. but that is becasue that is what has worked for us.

have you read any of eg the GAPS books etc? in the long run, I would be tempted to investigate via a nutritionist whether anything ws causing digestive issues, but that doesn't help for the residential, sorry.

I have in the past tinkered a bit with restricting dairy/yoghurt etc, but it hasn't made a noticeable difference tbh, except after stomach bugs. I have often driven DP mad with wondering if x/y/z food stuff has exacerbated matters. Probiotic yoghurt made no difference. DS is such a fussy eater that I suspect GAP diet would be v difficult to enforce. Also as DS doesn't have a proper ASD diagnosis, I feel a bit nervy about being perceived as overly restrictive of his diet iyswim? I wouldn't be surprised though if something was amiss, as he craves white bread, and used to have 4 pints of milk a day! TBH as a baby etc his stools were pretty grim till I cut back the milk to more sensible proportions...

In terms of nutritionist - how do you find one that is reputable rather than woo?

oh, i couldn't do GAPS, but the book is an interesting read - I gained loads of info about possible problematic foods, and ideas on how to avoid them (if I felt necessary), and lots of info on symptoms of food causing problems etc.

will PM you re: nutritionist

Hi TLP

The dosing information for Paediatric Movicol is here.

Ds2 had faecal impaction about a year and a half-ish ago and had to go through a high doseage plan. The dose was then gradually reduced and we were told by the doc to adjust as necessary to produce regular soft formed stools.

Iirc he needed about 3 sachets a day to keep things working properly and at the time he would have been 6.5 and on the small side of average for his age.

Unfortunately for ds, he turned out to be one of the few children whose electrolytes get messed up by Movicol and he became very poorly (weak, lethargic, headache, breathless). He'd been sent for a raft of blood tests and had both us and the docs pretty worried and stumped until I suddenly remembered the warning on the leaflet, took him off Movicol and he recovered slowly over the course of a couple of weeks. His constipation never came back though, so I don't know if perhaps he no longer needed medicating and that's why he reacted so badly.

Ds1 has lansoyl instead of movicol, and if we have a particularly bad patch he has a series of enemas at home to clear him out and start over.

The more we use use the enemas, the more Ds is keeping clean. Ithink he makes more of an effort to use the toilet (he is phobic about public washrooms and we probably couldn't do a week away without either dh or I, tbh) as well as it obviously removing some of the impact ion.

He's also seeing a psych about it at the mo.

(we also did semi gaps for a while but have lapsed a bit as he's also on ADHD meds and we wanted to be able to 'see' if there was an effect from the meds)

I think gaps would work longer term, but he is, um, very asd when it comes to food choice...

thanks madwoman and moose. Possibly over school summer hols will try upping the movicol further if no progress. Have to say getting a definite clear out with an enema does have a certain appeal right now!

glad to hear your ds's issues resolved, moose, reassuring that there may be light at the end of the tunnel!

The enemas were the paed's recommendation. She said if he refuses at home we should take him to a&e and get them to do it. we haven't had to go that far yet, but only because dh has way more patience than I do....

I would also go down the nutritionist route.

DD (autism) suffered for the last 2 years from severe constipation. we recently went gluten free and her constipation resolved within 2 weeks . so at least for us changing DD's nutrition worked for DD. we had been on movicol before but it did not work for us.

Choc, how did you get round the food change with dd?

We've tried gaps (ish) but it can be hard. Did you find it ok?

thanks choc, that's v interesting that gf sorted it out. suspect I am more likely to do probiotics or enzymes than do anything that drastic tbh. but food for thought.

we are only GF atm. thinking about cutting casein as well. don't think I could do GAPS though, it looks really daunting.
we stopped bread (still on a mission to find nice GF bread). DD had beans or gluten free con flakes for breakfast. I make a lunchbox for nursery. other than that, it is not really an issue as we don't eat out/have takeaways. I tend to cook pretty much from scratch, so I found it easy.
should maybe add that DD (autism) does not have food issues and will happily eat most of the dishes I put in front ofo her :)

i have to share with you my tip for this problem - high dose of movicol (DS2 on 2 sachets a day) but also add red lentils as much as you can to your cooking! Seriously it works. We havent had a hard poop for 2 weeks. If your doing anything like casserole, bolognaise, cottage pie the lentils are so small theyre barely noticable. Just add a couple of handfuls and some extra stock or water, bring up to the boil and simmer for 20 mins. Easy and masses of fibre added to every teatime. Sometimes I blend the bolognaise sauce and mix with spaghetti to make sure that its all eaten up with no fuss. Hope this works for you! X

A woman i know is a reflexologist and works a lot with sn children and adults, with great results for constipation.

Culd that be a option?

dd was on movicol but gp put her on senna as well.....couple of nights a week so she could have a clear out. this helped her.....ask gp if this is an option,

Oh my NT 8yr old is just coming off her constipation meds after a year of them, she is now doing a poo a day hurray! She had a sachet of Movicol in the morning and Sennakot at night. Don't think it would have happened without the senna too. If she slips 2 days without a poo apparently we have to give her Sennakot to stop it all backing up again.

FYI Our poo nurse says liquid Sennakot is being discontinued so we'd have to grind up pills if we need it again.

thanks for the further advice. Good advice re:lentils but DS is such a fussy eater I doubt I could hide them in anything that he eats (he's not keen on homecooked food unfortunately, prefers the uniformity of processed).

Thanks also for the info re:senna, one thing I need more info on is what to do when 2 days w/out a poo, I have vaguely been told to up the movicol, but not for how long iyswim.Unfortunately I seem to be playing phone tag with the continence service!

and glad to hear your DD is able to come off the meds, Silk, it's nice to hear positive stories

Movicol is just a stool softener, carrying water directly to the poo. Senna is the thing that actively stimulates the bowel muscles to squeeze out whatever's there. Constipation makes the muscles slack from lack of use (even stretched depending on the size of the poo) so they need the stimulant to contract hard enough until they've done enough regular poos to get 'fit' again. Like oxytocin or electric shocks in a way.

Hi MNetters. Been watching this post as my DS aged 7 (awaiting ASD diagnosis)has had this problem for years now but we cannot get him to take the movicol or docusol. Have tried disguising it in fruit shoots etc but he knows its "different". I just know though that if we could get him to take meds it would help. The main problem is that if he hasnt pooed for a while it starts to leak and then he has been smearing it everywhere. So, no leaking = no smearing! Any ideas anyone?

New 'special' opaque drinks bottle? Just for breakfast times? With a particular flavour hi juice squash perhaps to make it special and so he can't compare it.
The trick with Movicol is not to stir it first, just add water and leave a couple of minutes to dissolve then add squash and stir with a straw. Everything tastes better with a straw after all.

Sennakot is pretty gross but DD used to manage it with apple juice in a wine glass. With a straw, natch.

hi keeping.....my idea sounds silly but worked for my ds when he wouldn't take meds......every day i would open a can of cola....(red can) leave it for about 2hrs....takes the fizz out and allows it to get to room temp.....gave him this and for some reason would make him go to the loo......know it's worked for other ppl......diet cola doesn't work so i was worried about sugar intake but it worked for him.....sorry i haven't got any other ideas

My son has ds and has always had problems with constipation. A few years ago he went 16 days without going to the loo and was in a lot of discomfort. We took him to a&e one night and they prescribed movicol and to keep increasing the dose til he had bowel movement. We had to go for another 3 days and 10 sachets a day to get movement. It all calmed down and now he takes 2 sachets a day disguised in fresh orange juice and everything is under control. The doctor allows me to increase/decrease dosage accordingly

My son has ds and has always had problems with constipation. A few years ago he went 16 days without going to the loo and was in a lot of discomfort. We took him to a&e one night and they prescribed movicol and to keep increasing the dose til he had bowel movement. We had to go for another 3 days and 10 sachets a day to get movement. It all calmed down and now he takes 2 sachets a day disguised in fresh orange juice and everything is under control. The doctor allows me to increase/decrease dosage accordingly

Thanks for the ideas everyone. Just wasn't sure if you could mix with anything and it would still work.
doesmybumlookbiginthis 10 sachets a day Hope we don't need that much.
Anyway will give these ideas a go. Thanks