Soiling whilst on maintenance dose. Is this normal?

[76middleton]

Is it normal to continue to soil after disimpaction and on a maintenance dose? Would they be soiling because the maintenance dose is too high? Or is it because the muscles in the bowel are too loose? My daughter is doing a type 4 poo daily but still soiling and I don't think it's overflow.

[SallyandPaul]

I'll be interested to see what others say about this as my daughter is exactly the same and has been on and off for six years. However if we try to reduce the medication she just gets constipated.

[lyns08]

It sounds like it could still be an indication that she is constipated. We did a couple of disimpactions that didn’t quite clear enough out and the soiling continued but the last one we did was a success and soiling has stopped. Do you also think your daughter is getting enough poo out when she does her one a day? My son is 3 and I’m sitting him on the toilet 5 times a day as routine and he goes for a poo at least 3 of those times. I’m surprised at how much he actually has in him to get out! We had a year of my son being constipated and soiling and the toilet routine has definitely helped make sure he is not getting backed up again x

[Frustratedmum1]

Hi ya. What I have found you will get some form of marking for awhile but it should not be as severe as it was previously.

What we found is when we decreased the dose the soiling severity would increase hence we then increased the dose and it did decrease. Hope this helps. What I find if my son is slightly wetter it does help so I work between a 4 and a 5 on the Bristol stool chart.

Basically it takes a very long time for the muscles in the bowel to regain there strenght and the key is to keep them empty.

The one thing i used to think after a discompaction programme everything would return to normal but I have not found this. But the improvement should be significant.

The other thing that is noticeable with my son is he needs to go more than once a day to stay unblocked but this varies with each child.

[SKY01]

How often is she soiling? I think the occasional accident can be expected as the muscles recover their tone. They are initially unlikely to have the same level of control as a child who has never been constipated (according to our continence team). In my son's case he had never been bowel trained before the problems so it was also a case of learning to take himself for a poo, as if he was toilet training for the first time. We successfully disimpacted in July and have seen huge improvements but he still has an accident every 10 days or so, usually when distracted or tired. Also the movicol makes the poos so soft that they are harder to control. But I find this is necessary to stop him backing up again.

[Louloubelle23]

The $50,000 dollar question! 😂

Personally I think it’s a mixture of the bowels, having been stretched due to the constipation, is failing to tell the brain that a poo is coming, plus the laxatives make the poo so soft/runny that it comes too quickly.

If your daughter was constipated for a long time then this could be why. It takes a very long time for the bowel to get back to normal. I was told a year but we are nearly at 2 years! We’ve been seeing big improvements the last couple of months since lowering laxatives though.

Good luck 🤞

[Yippieyay81]

Hi! I guess it depends if there is any reduction in soiling at all? As others have said I have heard the bowel does take a while to recover. Also when talking to a poo nurse about finding the correct maintenance dose she said to increase/decrease by half a sachet and then stay on that dose for a few days to gauge the correct dose. Infact we ended up staying on each dose for about a week before deciding what to do next.