Can’t find a balance with movicol

[ivory_47]

Hi,

My daughter is 3 and 1/2 and has been severely constipated since she was one. She had severe faecal impaction, which was cleared in November 2017 and we have been on maintenance ever since.

However we are still struggling - she is supposed to be on a maintenance dose of 2 sachets movicol plus 5ml lactulose a day. However on that dose, which seemed ok for a while, we have recently just seen really runny, poops multiple times a day. It’s not overflow as she knows she needs to poop and will taker herself to the toilet, there is no soiling at all.

We upped the dose just in case so that she had 10ml of lactulose but that made the stools even runnier and really explosive.

We now stopped giving any lactulose and are just giving 2 x movicol, and the stools are a better consistency, however they are smaller now and we are concerned that she is not emptying her bowels fully as she still goes multiple times a day, sometimes 3 times in a short period of time despite the stools not being runny.

We try to get her to stay on the toilet for longer, however she can’t get any more out despite trying to.

Should we decrease the dose further or is it possible that she is partly impacted still?

Or could she just be a child who poops multiple times a day?

Her tummy is nice and flat...

Any thoughts would be greatly appreciated.

Many thanks

[Allyem1976]

It has taken us 2 years to get the right dosage. Currently we are on 2 Morning, 2 and half evening with 5ml Picolax twice a week. Consistency can be either way; sometimes loose and we have accidents and sometimes type 4 so just right. I also worry that when it's runny you cannot gather just how much has been cleared out and worry it's building inside again. We have been admitted to hospital 5 times this year. But since we have been on this dose she has not been impacted or sick since beginning Oct. I think sometimes if it's loose or she's going 3/4 times a day you just have to think we'll it's coming out and that's all that matters. To be as long as they happens I know she's not going to get I'll even if it does result in accidents. Better out than in!!! X

[Helen36]

It took us a very long time to find the right maintenance dose as well - and we were at a similar stage in the process to you when my daughter was 3 1/2. I always think it’s safer to stay on the softer side so I wouldn’t worry too much about it being runnier than a sausage or multiple poos a day. My daughter had a stretched bowel from her impaction and we were advised to aim for type 5 for a while. I’d suggest talking to someone about dropping the lactulose as that is the ‘push’ rather than the softener so will be being prescribed to work with the Movicol and is important to help the bowel empty properly. It may be a case of trial and error with more subtle adjustments and taking a couple of tea spoons out of the Movicol and trying 2.5ml lactulose. It’s amazing what difference just a tea spoon less can make with Movicol. Just keep a really careful note of what you’re doing to monitor the changes and give it a week each time to get a good sense of what’s changing. I know it’s terrifying that she might get impacted again but you know what to look for so trust your instincts xxxx

[Allyem1976 in reply to Helen36]

We have had to mess around with the dose for over 2 years before we have got to this stage! It really is trial and error. And if she hasn't had a poo for a day I give her a 5ml of picolax before bed so I know it will stimulate a movement to avoid getting impacted again. Definately trust your instincts xxx

[ivory_47 in reply to Helen36]

Thank you - that’s really helpful. we have added the lactulose back in, as we actually feel she is better with it.

We will try playing around with the movicol dosage instead.

It’s so difficult and we struggle to know what’s right these days....

I feel like we should eventually be able to reduce then stop the medication and i worry that we give her too much and strip her of valuable nutrients as she poops so much each day.

[Helen36 in reply to ivory_47]

Glad to be helpful Don’t be afraid to play with the lactulose too. I’ve recently adjusted my daughter’s senakot by a fraction and it’s proved to be the difference between soiling and not. Unfortunately it is a case of trial and error and adjusting for what you see going on.

Don’t worry about her being on this though - Movicol doesn’t enter the blood stream or impact nutrient absorption at all. It literally just holds the water in the bowel to soften the poo. The most important thing is to make sure she drinks plenty on top of the Movicol as the Movicol drink doesn’t count as a drink for her because the water in the drink isn’t hydrating her.

I know your fears on laxatives more broadly but the more and more I have read on this has reassured me that it’s ok. The nutritional impact we all think of with laxatives is really only relevant to people with eating disorders using them as a dieting tool. I try to remember that if a child is constipated it’s far worse for them than having a fast transit.

‘I’ve also felt better about volume of poo since having my second daughter who doesn’t have the same problems but regularly produces poos of the same volume as my older one. She’s also 3 and what comes out of her daily often doesn’t seem physically possible for a small person!

The bowel wall is stretchy and after an impaction it is a bit baggy (a bit like a mummy tummy after having a baby!) and the laxative helps the muscle recover by encouraging it to push and develop the muscle tone again. It won’t make the bowel lazy but can take a long time to recover.

I’ve been on this forum for quite a long time and I’ve seen people get to the stage where they have been able to come off meds but lots of us are on them for a long time. Try not to worry, I think lots of people make the mistake of worrying and trying to reduce too soon, which can then mean you end up back at square one (me included!). Have faith you will get there in the end... you will