So confused....constipation or not?

[WandJ]

Hi, my three year old son successfully potty trained at 27 months but in the last 9 months we have had a regression with his bowels.

I have no idea if it’s constipation or not. Constipation is in our family and I am on laxido myself so you think I’d know!

He can need up to 7 pant changes a day. The best way I can describe the accidents is that it’s like a cow pat. Soft and sticky, light brown and sometimes with undigested food such as sweet corn, tomato skin etc which makes me think it’s flowed through him at a good rate but why is he getting so many accidents.

The Dr prescribed him movicol and I have been giving him one a day but it seems to have made him soil more. I have tried leaving off it for a week or so and then he didn’t go at all and had watery leakage so I started it again. When the poo is of the right consistency he is able to get a big one out on the toilet or potty but that probably only happens once a week if that.

I’m waiting for a referral to bowel specialist but in the meantime the Dr told me to play around with movicol amounts but I’m losing the will to live. I also have a three month old baby making 7 pant changes in a day pretty tough going.

Any thoughts and/or experiences greatly appreciated.

Sarah x

[Cath88]

Hi Sarah,

I know we battled with confirming constipation versus another bowel disorder. Gp and the paediatrician were adamant that our daughter wasn’t constipated as couldn’t palpate any hard masses on examination and she passed a soft motion each day. We then paid to see a private paed urologist ( more issues with wetting) he did an abdo X-ray ( said it was the only way of really diagnosing constipation) Her colon was jam packed with poo!

You can also do the sweet corn test and see how long it takes to appear at the other end. My understanding is overspill is dark, sticky and liquid with hard bits...although may need someone else to confirm this! Not sure where you are but is there an option to pay for a private X-ray?

Hope you find some answers..so tricky when your not sure what you’re dealing with!

All the best

Cath

[WandJ in reply to Cath88]

Hi Cath,

Thank you so much for your reply.

How long should the sweet corn take to pass through?

Funnily enough was talking to my husband about going private but couldn’t find anywhere online? I have an 11 week old baby as well so it’s really taking its toll on me and my toddler so feel like the money would be worth it just to know exactly what’s going on.

Thanks Sarah x

[Cath88 in reply to WandJ]

Hi Sarah,

I’m in NZ so found a private consult just through google search. Not sure how it would work elsewhere but my GP can write a referral for X-Ray and we just rock up to a local private imaging dept to get it done, it’s located at our local private hospital. Sorry not sure how private health care works elsewhere. Perhaps GP can guide you? Not sure re the norms of sweet corn test either, sorry! My 9 year old will often pass it the next day or day 2 at the latest but this is when she is on Macrogol. I haven’t done it when she was constipated but it would have been helpful for a comparison!

It must be tough going with a baby too, I am sorry for your situation, it’s hard but once you get confirmation re the constipation at least you can be confident you are on the right track! Waiting for appointments to get support/ answers sucks!

[Cath88 in reply to Cath88]

Just found the sweet corn test on Eric website! Norm is 24-36 hours! Less than 12 means diarrhoea.

[WandJ in reply to Cath88]

Thank you Cath for looking up the sweet corn test, I only joined here yesterday so it’s all new to me.

I’m in the UK so it seems like it may be more difficult to source here. I think I may head back to the GP and see if they can give me any answers on the wait for the bowel specialist, like you say it’s the unknown bit that is so frustrating. Once I know then I’ll be able to treat it effectively.

Thank you for your support. X

[Loutylegarw]

Hi, I feel your pain, I could have written what you are describing 4 months ago. Don’t worry about thinking you should know as you have constipation yourself; I’m a doctor and I still didn’t pick it up- I thought my daughter’s regression was behavioural but the stickiness of it suggests there is faecal impaction. If you haven’t done a disimpaction regime I’d strongly recommend it...you can be sure you’ve got a clear bowel to start from them. ERIC website or NICE guidelines have a disimpaction regime to follow but you need to get your GP to examine your child’s abdo once you’re doing it to make sure they still can’t feel any faecal lumps, to be sure he’s cleared out. You then need a scale down regime with the movicol.

It’s amazing how limited and variable the medical understanding of constipation is. Our health visitor was useful as our Gp told us to do play around with movicol too, but the health visitor told us to do the disimpaction. Ask to be referred to a continence nurse too, and if there isn’t one in your area, then to be referred to paediatrics. My experience is that GPS just don’t have the expertise in this.

[Loutylegarw in reply to Loutylegarw]

They don’t like to XRay here as it’s a big dose of radiation for a child in a vulnerable area, it would be an option of last resort.

[WandJ in reply to Loutylegarw]

Thank you so much for your reply. I managed to get through to the ERIC help line earlier and they said exactly the same as you so I’m going to go for it. I’m going to wait a week though so I have a clear diary and can stay home for a good few days.

The Dr said they couldn’t feel any lumps in the first place when they gave us the movicol, would I still need to see them?

Ok that makes sense about the x rays, and obviously I wouldn’t want him put under unnecessary risk.

How is it best to give the dosages? Is it evenly spaced throughout the day or all in one hit?

I really hope this works, I’ve resorted to sanitary towels in his pants to save the scrubbing and washing! X

[Loutylegarw in reply to WandJ]

Hi. Yeah it affects everything in daily life doesn’t it?! I’ve cancelled a friends wedding and a mini break away with my husband because we can’t leave her with anybody, it’s not fair on either party. We’re back in pull up nappies now as it’s 5/6 v loose motions a day. Similarly dreading her first day at school and wondering how they are going to cope. Luckily the childminders have been amazing and have been filling out the bowel chart diligently too. So helpful. Did the nurse give you a bowel chart. It really helps you and the medical team know what’s happening so they can advise on dosage. Am sure I’ve seen one on the ERIC site. If you can’t find it, let me know and I’ll describe the headings on the one I’m using.

Best to give doses spread out a bit but do what’s best for you, and your kids routine and if you’re going to be out of at home so can deal with a big explosion! We’re down to 6 sachets- 2 first thing, the childminders give 2 and we give 2 after work. I have bunched 3 or 4 in one go occasionally. Need to make sure they’re drinking plenty of other drinks as none of this liquid with the sachets is absorbed- it stays in the colon and is pooed out. Challenging to get enough drinks down them in this warm weather. And also making sure the sachet is dissolved completely in water before you add anything to disguise the taste, or it won’t be effective.

V best.

[Loutylegarw in reply to Loutylegarw]

Especially if you were going to wait, I’d be getting an appointment with GP when you get to stool type 7 to feel his tummy and reassure you you’ve cleared everything before you start decreasing the dose.

[WandJ in reply to Loutylegarw]

Thanks. I popped down to Drs today and asked for a message to be passed on as recommended by ERIC to inform them that I’m starting the regime so perhaps I’ll also book an appointment for the end of the 8 days so they can review things. When I saw Dr initially no I wasn’t given any charts just told to play around with dosage. I have seen pictures of the poo types on the ERiC site, is there one that you have to fill out as well?

When I thought about his current poos I don’t know what they fall under as they’re just like a cow pat.

The other thing I was wondering is between now and when I start what do you think would be best to do with movicol? Still just do one a day as I have been?

Is this the first disimpaction you’ve done? Well done for cancelling plans that couldn’t have been as easy decision. I literally have a completely free week the week I’m starting so I can stay at home all week thankfully. X

[Loutylegarw in reply to WandJ]

eric.org.uk/pdf-poo-diary

See this for example of poo diary and Bristol stool chart.

This is our second disimpaction. The first time I followed ERIC’s advice after disimpacting by then giving a daily maintenance dose of laxido that was half the number of sachets required to disimpaction...but she quickly became constipated again so we are following our paediatricians advice to slowly reduce the laxido from the disimpaction dose by one sachet per week until we get one type 4 or 5 type poo a day.

[Hidden]

From my experience, the frequent spoiling in underpants is a sign of constipation. If they have had a painful movement in the past due to constipation they try to hold it in rather than experience the pain again... the frequent spoiling is them.trying to keep it in... regular, daily osmotic laxative (like movicol) has helped in our case- we always had initial huge loose stools when starting on the laxative which was to me backing off/ stopping, then we would inevitably end up at the 5+ dirty undies again. i also has a newborn and it got worse, i wasnt sure if it was attention seeking behavior and was at my wits end, so i put my girl back in pullups as she wanted this, let me do her sneaky poos in the cupboard and now, a month later she is doing a daily poo on the toilet. Don't think we r completely in the clear but it's looking up. I spoke to a child health nurse while waiting to see the specialist who assured me it was constipation, and to give the laxitive regularly... good luck, soo hard i know x

[WandJ in reply to Hidden]

Thank you Nemo84, reassuring to know others have got through it.

So did you just stay on one laxative a day and ride it out when it got worse before it got better? Do you just keep her on them now? X

[Hidden]

Soo what the child health nurse told me to do was: find a dose that generally gives a once a day poo. We did tinker with the dose when it seemed like she was doing heaps of loose stools, but yes essentially kept going and now it seems to have stabilised. The child heath nurse was great as she really ressured me that it is more important to keep their bowels moving tto avoid constiption than worry about if u are giving too much (within reason of course). I make sure she drinks it all first thing in the morning. If she doesn't open her bowels that day she gets another dose that evening. She will be on it now for at least another 6 months we assume, to make sure she doesn't regress and to make sure she transitions to kindy oky. This was from the child health nurse but ill be claryfying this with the gastrosurgeon...

[WandJ in reply to Hidden]

Thank you Nemo84. I’m glad things are settling down for you. Let’s hope I can move forward in the next few weeks.