Conflicting advice from 2 different paediatricians re chronic constipation

[Nearlygreen]

Hello there I wonder if anyone can help. My daughter is 3yrs old and has had chronic constipation since she was 13 months. We saw a paediatrician a few weeks ago. She said that when doing a clear out, instead of reducing the dose once water diarrhoea occurs, we should carry on until we see hard little lumps of poo pass - that is the impaction. She also said not to use senokot/senna until the impaction is cleared as it is a stimulant designed to push poo along the bowl but when the poo is hard it cannot move down so it back up the bowl. So I felt quite confident and like I would be able to do this. However. Today we saw a different paediatrician. I already had this appointment booked before I saw the one a few weeks ago and decided to keep it because I thought I'd be seeing a paediatric nurse who would advise us on the day to day practicalities of constipation. But that wasn't the case, we saw another paediatrician. He told us the complete opposite to the one we saw a few weeks ago. He said we should be giving her senokot/senna during a clear out and that once she reaches watery diarreah to then reduce the movicol as that means the impaction has cleared. I told him we were told to carry on until we see hard lumps of poo and he said you won't get any because they will be softened by the Movicol and that hard lumps would normally be passed first not last. Sorry for long post but I'm so frustrated and feel like we are never going to get my daughter free of this. I would welcome any perso al experience that may help me. How do you know when an impaction has cleared and should you give senokot when there's an impaction. Thanks xx

[Chocolate-chicken]

Hmm in general we've been told the same as your first paediatrician, we're still in the process of it all and to be honest the advice has been a bit conflicting as we never actually reached "gravy" but had had a few lumps come out and were told to reduce movicol then.... 2 months on and still having major issues so I think we should have stayed on high doses of movicol for longer. We have just now been prescribed sennacot, so it does tie in with what your first Dr said sort of. I did question our advice when it starting contradicting, but the nurse said that as everyone is different, there isn't really a one size fits all proceedure.... Don't know if that helps....?

[Nearlygreen in reply to Chocolate-chicken]

Thank you chocolate/chicken it helps a lot. I hadn't thought about it in the context of each child responding differently. I sort of thought there would be a set method that you'd follow and it would work. I guess we have to try it and tweak it x

[Chocolate-chicken in reply to Nearlygreen]

I think so... My worries are that all medication discussions seem to be based on my descriptions of my daughter's poo - and a lot of those I'm getting second hand from school or my husband.... If I say sloppy instead of soft or firm instead of hard, it seems to have an impact.... Agh, it's so hard isn't it...?

[Nearlygreen in reply to Chocolate-chicken]

Yep! My OH and I had that conversation today. I'm talking about hard poo/rabbit droppings and he kept saying "no the doctor was talking about pebbles, they're different!". Sometimes I get so confused by it all I want to scream! Dr said she's not impacted. If that's the case why oh why can she not pass a normal poo?!! Feel like I need a degree in poo to understand it x

[SallyandPaul]

Morning. So agree with all that you and the others have said, you certainly need a degree. I have never tackled anything so complicated!! We are off for scans tomorrow. Have been dealing with this for over five years. I would just say that I think from what I've been told , is the reason they struggle to pass soft poo is because the bowel is stretched and floppy with some loss of sensation. The consultant we saw a few weeks ago said that they may give her a Botox injection to help tighten the muscles in the bowel.

[SKY01]

Hi. We are on day 4 of our first movicol disimpaction with my 4.5 year old. Spoke to ERIC this morning as poo is now very soft (6 on chart) but not tons coming out yet. They said it's perfectly fine to introduce Senna now to speed things up a bit. So we will try that this evening! Good luck!Very tricky when you get conflicting advice x

[Frustratedmum1]

It feels we will all have a degree in poo when we get our children through this!!!!

I was always under the impression they need to be watery before you reduce the movicol. From personal experience you have to question has enough poo come out of their bodies.

My sons whole colon was blocked. They only reason we got movement was they took him of movicol and put him on senna and sodium picolate for a short period of time. These both are stimulants so make things contract. This has moved a large portion of the blockage so we are now back on movicol.