ERIC
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Potty training related constipation

Hi I’ve just joined as a bit desperate! My lg is having Movicol for constipation. We are on a disimpaction regime as advised by ERIC. Dimpaction is taking a long time (still not at stage that ERIC advised us to get to before dropping to less than 8 sachets per day and we’re on day 14 with Senna added from day 10. Our gp is now refusing to give us enough Movicol to carry on with disimpaction and has told us to drop doses from tomorrow. I’m concerned that if we haven’t finished disimpaction then we won’t be solving the problem long term but not sure what our options are. Anyone got any advice? Thanks in advance.

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I wouldn't stop when you are nearly there! You can get Movicol over the counter I think...x

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Hi thanks for your reply...I tried in my two local chemists and they both told me it was only available on prescription as it’s for a child.

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It's really odd. We had to get it last minute once and one chemist said no but the next said yes and asked no questions. Have you explained the situation to your gp?x

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Oh ok...maybe worth trying somewhere else. Thanks! This has come from the gp. We tried to argue that disimpaction hadn’t finished and we needed more but they’ve just given us enough for a maintenance dose for a few weeks and then they want to see us again 😡😡

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That's so silly. Hope you manage to source some somehow!x

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Hi ya. Has your Gp given a reason why they won't give you any more movicol.

To be honest when I was doing a discompaction programme on my son and took him up to 8 my gp was feeling uncomfortable with it hence I did not increase the movicol further. Looking back I should of done.

What I have found different gp have different views on it. Perhaps It may be worth asking to speak to the duty doctor of the day and ask for advice or another doctor at your surgery you feel you can talk to.

Perhaps you should enquire if you could increase the senna dose.

It may be worth requesting a referal to a peaditrian because there views on higher doses seems to be more informed especially when it comes to discompaction programmes. Don't know if any of this helps but hang in there.

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Hi thanks for your post. The gp was concerned about large amounts of Movicol over a long period of time. We argued that it was not harmful but she got an on call paediatrician from local hospital on the phone who agreed with the gp (I was surprised at this as thought paed would be more knowledgeable). I feel our next step is to get referred but now have doubts about any paediatrician being in any way useful after the phone call. We have been forced to cut down today as our previous repeat prescription has been cancelled! We’ve so far seen three different doctors and the nurse and not really convinced any of them are advising us correctly. I’m so annoyed!

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To give you an idea my son has been under three paedititrian. His current maintenance dose is 7 and he has just turned 6.

When we were doing our second discompaction programme he was up to 12 sachets and they were happy for this to proceed for the whole of Easter holidays. But due to the lack of movement they took another route.

I found the school nurse more useful than the gp. When I came across his second paeditrian she was a god send. Alot of this is persistence and alot of battles on your child's behalf.

It got to the stage I doubted myself. But at the end of the day, you know them best and just believe what your gut is saying.

Sorry about the essay.

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Thanks for the info...it must be really tricky for you as your son is school age and any disimpaction has to be timed around school hols ☹️ We started to reduce the dose from yesterday but are doing it a lot more gradually than the gp recommended. Just by chance she had her first type 7 poo yesterday so I’m really hoping she’s fully disimpacted. I’ll just have to ask for referral if not.

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We have tried to do his discompaction programmes in the holidays but he has ended up having 7 weeks of school this last year.

At the moment I'm breaking the year in to smaller pieces. So my aim is to get him to October half term without any time of school.

I will keep my fingers crossed your little one is discompacted.

I don't know if you are doing it I would keep a diary of there toilet habitats. This helps prove your point and also they can see what medication they have been on at what dose and how long. I also tend to put notes if appetite is increasing, stomach pains etc. This would help if you go for a referal.

I don't know if this helps or you are aware but quite often when they are getting full you will notice them weeing more frequent and quite often it would be small amounts.

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Thanks so much! Yes we’ve started a poo diary so I’m logging anything...trying to make it legible as I know I might need to be showing it to people! Out of interest what are your thoughts on the reduction of sachets following disimpaction? The gp said go straight from 8 to 4 and then reduce by 1 daily and aim to have her at 1 per day ASAP but I’m ignoring that advice! I really hope you get through to half term without too much stress.

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Thank you.

When I have reduced my son's medication after discompaction I did it gradually.

However if you have got limited access to movicol. Personally I would perhaps drop straight to 4. On the intentions if your child needed to be at this level for awhile you would have enough to keep going.

Our paeditrian told us to aim for at least one bowel movement a day. Really you are aiming for a 4 on the Bristol stool chart. I work on the theory if my son is slightly loser that is better ie a 5 instead of a 3.

I find with my son it takes him a couple of days to adjust to the new rate. I was finding sometimes I was altering things to quick. Hence once I go from 4 to 3 sachets. I tend to leave it until I'm confident they are two watery or to constipated before going again. When you are getting somewhere near on finding the right dose perhaps start reducing it by smaller quantities ie half a sachet. As a smaller increase can make a dramatic difference to some children.

What I have found as a parent you want them on a low dose if they have got to be on it but it's not always realistic.

Personally I think you need to be led by your child when finding the correct dose for them. When you get to a 4 on the Bristol stool chart then I would maintain that dose until things change.

You will be fed up of my essays!!!!

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Thanks so much! I’m going to do it as gradually as I can considering our low supply of Movicol but am making a note of everything so that I can show that to the gp if it becomes obvious that she neeeds more. The gp want us to cut down to 1 sachet a day by the time we see her next but I don’t think that’s going to work. As her whole issue began from anxiety over potty training I think I need to keep her quite loose for a while so that it’s very easy for her to go if you know what I mean! Thanks for all your essays...they are so appreciated!

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That makes perfect sense. I'll keep my fingers crossed for you.

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Personally if your son is impacted I would go to A&E and get admitted. They will then scan to see how much he is impacted and probably issue an enema to clear him out. Then you can start again with a fresh regime of Movicol. I had to do this with my daughter 3 times before we got onto a plan that works. Good luck xx

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Oh and recommended dose is normally 2 sachets a day but like frustratedmum says you have to tailor it to what the stools look like. My daughter is on 2 morning and 2 evening and she is going everyday albeit mushy. But again like frustratedmum says better to be on the looser side than hard. I aim for the bottom end of the chart. Pedatrician said better to slightly overdose than go the other way. Seems to be working so so far so good x

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Thanks for info...if I’m honest I stupidly hadn’t thought of going to A&E! Coincidentally she had a type 7 poo just after we saw the gp so I’m really hoping she’s disimpacted. We’re currently on day 2 of 3 sachets so will see how it goes. Thanks for posting!

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