Three Year Old Doing Frequent But Incomplete Bowel Movements (But He's Not Impacted). Any Ideas?

[Jellylorum]

I came across this forum recently and it's been a great source of advice, but we have a slightly unusual issue with my son (who's nearly 4) and I'm wondering whether there's anybody here who can help? Basically he has been producing multiple but incomplete bowel movements per day since he was under a year old. Initially I suspect this was due to chronic constipation. However he's been on Movicol for around 2 years now and we are still experiencing this problem. The Movicol changes the consistency of the poo, but he is still doing a ridiculous number of bowel movements per day - usually around 8, but it can be as many as 20. Some are fairly small, but others can be pretty large. We have followed a disimpaction regime twice, which made no difference either time, so we know he isn't experiencing overflow soiling. He has tested negative for coeliac disease.

My son is fully potty trained for wees but still wears nappies as he doesn't appear to have control over his bowel movements (he says they "just come" and don't leave him enough time to get to the potty). It's crossed my mind that he might be subconsciously withholding (or partially withholding), but most people in this situation talk about their child having no bowel movements for days, which isn't our experience.

Does anybody have any ideas, or a child with a similar problem? We've seen consultants at the hospital and recently paid for a private consultation but we don't seem to be any closer to identifying what's going on. Both times we've been advised to continue with the Movicol, but we've been doing that for 2 years now (2 sachets per day) and are no further forward. My son will start school in September 2019 and I'm desperate to find out what's going on so that we can improve things for him before then.

[SKY01]

Hi. Sorry to hear that you're having a tough time. Sounds similar to my son this time last year. I think it probably started with him subconsciously withholding due to being too busy playing/not comfortable using toilet at nursery etc. He also pooed very regularly as opposed to going days without a bowel movement, which is partly why we didn't identify the problem for a long time. Have you had an x ray to be 100% sure there is no impaction/build up? Also have you evrr tried a stimulant like Senna to help move things along and possibly get just one or 2 full movements a day? X

[Jellylorum in reply to SKY01]

Thank you so much for replying, it's really useful to know that you experienced the same symptoms when your son was withholding. No my son hasn't had an x-ray and the doctors seem very reluctant to do one as they don't think it will show anything they don't already know. We have an appointment at the hospital on 20th Sept though and I think I will push for one then, just to be 100% sure.

Did you try Senna with your son? We tried it briefly but it didn't seem to have much effect, but the dose was very low so that might have been why. Interestingly I also spoke to my brother about this - he's a physiotherapist in Canada (though we're in the UK). He says that over there lots of physios work with children who have this problem to help them learn how to fully relax their bowel muscles so I thought that might be worth a try as well. I think my son has been withholding since he was about 12 months old (when he had the initial bout of constipation) so it's probably an automatic reaction now and he might not even be aware that he's doing it.

[SKY01 in reply to Jellylorum]

Hi. Yes we give my son 3.5ml Senna daily, which is a low dose but seems to keep things ticking along. He also takes 2 movicol daily. We have done 2 disimpaction in the last 6 months. The first one didn't work as I don't think we pushed on for long enough but the second one has been amazing! We only finished it a month ago but he has completely stopped soiling ever since. He starts school in 2 weeks so you can imagine how relieved I am! Of course I'm really worried and aware times could easily go backwards but we will keep the movicol and Senna up and hopefully it is now under control. The one thing I would say is did you definitely go far enough with the disimpaction a (a few days running of very pale brown water?) The first time we didn't and it didn't work whereas the second time has been so different! I'd also say definitely get an x ray. If he's been withholding that long it's highly likely there is some build up/impaction. Physio idea sounds interesting too!x

[AANN1977]

Hi. Sorry you’re having these problems. It’s tough. We had similar with my 3.5 year old; lots and lots of accidents (more big ‘smears’ rather than anything more substantial) which we think was the overflow making its way around the blockage - she always said she wasn’t aware/couldn’t stop it. We did a disimpaction and had a couple of days of rusty water before reducing the dose. We followed the disimpaction guide and think we got to one day of 8 sachets of Laxido before reducing the dose again. She’s now on 1-2 sachets of Laxido and 5ml of Senna. The disimpaction made a huge difference. Have you done the sweet corn test? I think it should appear in their poo 24-36 hours after eating so if it’s taking longer, maybe there is still a block? The frequency of accidents sounds similar to what we had, and it was the overflow from her block. If your son is definitely not still blocked up, I really hope you get some more ideas/support/suggestions from your September appointment. Have you phoned the ERIC helpline? They were amazingly supportive and helpful when I did. Good luck. Xx

[lyns08]

Your son's symptoms sound exactly like what my 3 year old has had for the last year. In the beginning he was obviously impacted and we had attempted 2 disimpactions in the months after but he continued to poo around 8 times a day on average. We were originally told by doctor to just give it time as his bowel was just getting back to normal after the impaction. I still felt though that he just had a huge amount of poo inside him and that most of the time it wasn't felt when he was examined as the movicol softens it. The paediatrician still wasn't convinced that he was constipated still but he eventually got a transit study Xray done a couple of weeks ago which is where they swallow capsules with little shapes in. It showed that 90% of the shapes were still in him after 5 days when they should have all been out. After they saw this they have given him an enema in the hospital and we have then had to do another 7 day disimpaction with movicol and I know now that he is much more cleared out compared to the other disimpactions we did previously. I think because he had such an excessive amount inside before we were never able to clear him out completely but this time the enema has also helped. We are just coming to the end of the disimpaction and we have to now start giving senna alongside a maintenance dose of movicol and hopefully this will improve things now.

My son also starts school in September 19 and I have been so worried as we have not yet been able to potty train him even for wees because of this problem. Just getting this xray has helped everyone to understand what has been going on inside him and now hopefully we are getting the proper advice on how to fix it. Please push for this xray for your son as what you have described sounds so similar. We were close to paying privately for it but after I wrote a letter basically begging for help they gave us it. Good luck!

[Sam2020]

Hi, so sorry you’re having problems too. I don’t have an answer but have very similar symptoms. My son does multiple soft poos a day at the moment, some big, others mostly small and soft. I do t think he’s constipated but I do think he withholds and doesn’t fully empty bowel. I think it may be due to not knowing how to relax muscles. He sticks his bum in air and jiggles around to poo. If we try potty he can sit for an hour and nothing. He then starts withholding so I’m at a loss. Very interested in physiotherapy ideas that help with emptying bowel.

Hope things get easier soon!

[Jellylorum]

Thanks all. It's helpful to know that we're not alone with this problem, although I'm sorry that you're having to go through this too.

When we saw a private consultant recently she suggested that the nerves in my son's rectum might have stopped working properly because they had forgotten what an empty bowel felt like, hence the multiple but incomplete bowel movements. She felt inside and said there was a fair amount of poo in there, although it wasn't totally packed in like some other children she had seen. Her suggestion was to increase my son's Movicol dose up to 8 sachets per day until his bowel was empty, then keep it up for a further 10 days before reducing to a maintenance dose. She showed me how to tap around his tummy in order to identify when his bowel was completely empty. In total he was on 8 sachets per day for nearly a month, which is why I can't see him being impacted after that... but of course anything is possible. It's interesting that you had such similar symptoms lyns08 - I will definitely ask for an x-ray when we go for his appointment in September.

AANN1977 - thanks, I will try the sweetcorn test, that's a good idea! I will call the ERIC helpline too as soon as I can do it without him overhearing the conversation.

Sam2020 - my son is the same with the potty. He's produced a couple of soft pea sized blobs but never a normal sized poo. I think he genuinely tries. I'll keep you updated on anything we discover along the physiotherapy route. My brother said that the people he knows who do it in Canada are generally women's health physiotherapists who also cover paediatrics, but of course it may be different over here.

[Michymoo85]

Hi, my daughter is 6. 7 next January and I am going through a similar issue. Sometimes she does get compacted quite badly but most of the time she is like this. The Nurse we see says that this is compaction still and that I should carry on with the routine but I’m not convinced. She isn’t bloated either. She has been tested for hershprings and we will be looking at allergies next. I really don’t know what’s going on here either. It’s such a difficult situation. She has and appointment next month so I will come back to you and see what happens next.

Have they done a test for lactose intolerance?

[Jellylorum in reply to Michymoo85]

Thank you for your reply and I'm sorry you're in a similar situation. It's so hard to know what's happening isn't it? No my son hasn't been officially tested for lactose intolerance but I have conducted my own test by cutting lactose out of his diet for a little while. It didn't seem to make much difference though so I'm thinking it probably isn't that in our case.

I had another discussion with my son today about poo as I was changing his nappy. I asked him to show me what he did with his bottom when he felt a poo coming out and he clenched his muscles, which was interesting. I asked whether he did it to stop the poo coming out and he said no. It seems to me that he is unable to relax his anal muscles properly when he poos and this is why he is only producing partial bowel movements. I'm sure he's not consciously doing it, but it could initially have been a reaction to the painful constipation he had when he was a baby and then it became a learned behaviour over time.

I've found a useful book called 'Stool Withholding: What To Do When Your Child Won't Poo!' by Sophia J. Ferguson. Obviously I don't know whether this is what your daughter is doing, but if you think it's a possibility then I'd definitely recommend it (it was sold out on the ERIC website but I found it on Amazon). It sounds as though it's a very common thing for children to go through after struggling with constipation and impaction, though none of the health professionals we've seen has ever suggested it as a possibility.