Impacted Movicol

[DJC1102]

Not taking Movicol at the mo (have been previously but never achieved rusty tea)as I thought we'd wait until advice from paediatrician we have been referred to, however my 5yr old is still soiling, being funny about sitting on the toilet, though he did an enormous poo on the toilet yesterday. I also noticed the other day he passed sweetcorn he had eaten few days before. Does it sound if he is still impacted?

[Robinia]

In my experience soiling means constipated but others may have different opinions. Is the soiling every day?

[DJC1102 in reply to Robinia]

yes it is and he usually runs out the room & stands holding his bottom when it happens. I try to encourage toilet sits but he almost gets hysterical when I try & push it☹

[Helen36]

I agree with Robina... the sweetcorn test is a really good way to work out how quickly the bowel is working and what you’ve said shows that things are moving slowly (it should be out within 24-48 hours max) and the large poo you described suggests he is getting backed up. I’ve just read back on your previous posts and I would suggest getting back on a reasonably high dose of movicol ASAP. Even if you don’t feel like doing another disimpaction it looks like you did see a positive difference from movicol, even if you didn’t get things totally sorted from it. The problem is that if he gets properly impacted again it will only make it a longer road to recovery in the long term as the bowel can get so stretched from constipation and his bowel wall is probably a bit stretched already. Whilst you’re waiting to see the paediatrician keep the poos nice and soft with movicol and encourage regular toilet ‘sits’ to try for a poo twice a day, ideally after a meal, along with lots of fluid. It might sound a bit dramatic but I really can’t emphasise enough how important it is to keep up the movicol if he has been constipated before and is his best chance of success until you get advice tailored to you xx

[DJC1102 in reply to Helen36]

Thank you, I have started increasing the dose now, but still difficult to get him to sit on toilet!

We will try again to disimpact.

Thinking back over the years I think he's alwsys had a problem, always huge poos, just didn't know any of the signs re.being impacted.

This site has been a godsend!😊x

[Helen36 in reply to DJC1102]

Oh bless him, it’s so hard isn’t it. My daughter is 7 and I still have to battle her off to the loo for her sits. Do whatever it takes - iPad/choc/Haribo and reward the sitting rather than the poo if that makes sense. Start with a low bar - 1minute!

Also, be really sympathetic that you know it has hurt in the past. The accidents might be poo leaking out, it might be that he has lost feeling of a poo coming or it could be withholding because he is scared of the pain (or all three of the above). Hold his hands if a poo is coming and help him breathe outwards as that engages the right muscles to relax the poo out. We have to be the midwife. I call movicol ‘the poo softener’ and I think that helps with the fear if they know it will be softer. Xxxx

[DJC1102 in reply to Helen36]

Thanks for advice , I'll do that😊

[mabelrose4 in reply to Helen36]

Hi Helen,

Ive just been reading your advice to DJC.

We are on day 22 of 12 sachets of movicol with 1/2 a Senna tablet every other day ( more gives her cramps).

We have reached rusty tea once about 10 days ago but it went straight back to Poo soup . I am getting concerned that the food she is eating is what is being turned into the Poo soup and that we will just stay like this . Or will we eventually get to brown water with bits as opposed to a brown solid liquid ... which then stays like choc mousse in the bottom of the pan . ( sorry for the graphic detail) .

I will try the sweet corn and someone else suggested red juice to see if you had disimpacted.

Last night she was wet at night but we have had several dry nights . It seems to happen in stages . I would like to think that the wet nights mean that she still has blockages that need clearing but It s hard not to lose faith .

Has it taken anyone else this long to move from brown soup to rusty water !?

Robinia , You are also always super helpful around this subject .

Many Thanks 😊

[Helen36 in reply to mabelrose4]

Oh it is hard to know isn’t it. How old is she? The sweetcorn test is my ‘go to’ test to work out what’s going on so definitely try that. Give her a decent size portion and inspect whether lots comes through or just a bit. As I said on my last reply, 24-48 hours is normal, but 24 is ideal. Is it just night wetting you are seeing or is there any day wetting or soiling still?

I’m also interested in the senna, when did you last try increasing it? I found with my daughter that when she is impacted her sodium pico makes her have tummy ache because it is squeezing/moving the blockage. Movicol will only soften but the senna/SP is the stimulant or ‘pusher’ as it makes the bowel muscles squeeze and is therefore important to help the muscle regain tone after being stretched from constipation. Have you ever been offered a liquid senna or sodium pico? And what time of day do you give it?

I have seen people talk about very long disimpactions before (mainly on the Facebook group - movicol mummies) and there are families on here who are on 12 sachets a day as their maintenance dose. Others may have a different view but I would suggest that if the sweetcorn comes through quickly then I would suggest starting to come back down very slowly. How light or dark is your poo soup? If it is dark choc colour - that’s not a good sign, but if it is a lighter pale brown, milk chocolate, pine or rusty colour then I think you can probably relax. I always find the wetting takes a little while to catch up with the benefits of a disimpaction, especially at night as some of it comes down to the bowel wall being stretched and floppy and then pressing on the bladder when there is poo arriving in the bowel. I’m afraid this is all art more than science and I hope the above helps rather than confuses x

[mabelrose4 in reply to Helen36]

Dear Helen ,

Thank you so much for taking the time to reply in such great depth .

We only started on Senna tablets last week . My daughter is 10 . She was fine the first night but on the second night she was in immense pain and said it was like a knife was stabbing in to her .

She got very sweaty and distressed for half an hour before it calmed with a busco pan / and calpol.

So we laid off for a few days and then I gave her a third of a tablet . she seemed fine but gets a lot of wind and tummy gurgles . I have been giving it to her at bedtime .

The Poo soup is definitely still a dark chocolate and it stays at the bottom of the pan . That reassures me to know that it takes others as long , as I was starting to worry that I was misinterpreting the consistency and should be reducing. I’m not on Facebook so I can’t join the Movicol Mummies’ .

I have never disimpacted before and she has had tummy issues since being 3 but her only really symptom has been tummy ache and being wet at night . She has never had any soiling .

Over the last two years she has had severe cramps and has been into hospital three times . We have just been sent home with no clear advice but a diagnosis of constipation . We had allergy testing and she has a wheat allergy , but the results were so low 0.46 ... out of a possible 100 .. 0.35 being no allergy , that I’m not sure if wheat is actually the issue . We have cut out onion and garlic since being advised to cut out high fodmap foods and slowly build them back in . We thought she had ibs but the Eric lady said that the constipation is probably the real issue . ... hence the disimpaction which we started building to four weeks ago .

Thanks again for your advice Helen .. any help is greatly received .. and we will keep going for now !

Many Thanks

[Robinia in reply to mabelrose4]

Great advice from Helen ☺️ . Based on my experience I think you are right to keep going to ensure all the old poo is out. Meds can cause discomfort- my son’s pain is related to trapped wind but stuck poo has made his pain worse. Now he’s clear he seems to cope with everything so much better incld the meds. Once my son was clear the poo looked quite different- like it was fresh - seems odd to say but looking at it, I could tell it was fresh poo! It tends not to sink so much in the toilet bowl and it’s normal poo colour, not dark and stinky at all.

We tried low fodmap as well. I’ve also worked out we have to watch intake of insoluble fibre very closely- he was getting blocked so easily (things like nuts). Based on my experience, disimpactions can go on for weeks and might need to be repeated multiple times. And then you might need a high maintenance dose which you can reduce down gradually.

Do let us know how you get on xx

[mabelrose4 in reply to Robinia]

Thanks Robinia , so appreciate your replies . I am aware that my daughters condition is comparatively mild compared to what you and others have been through .. . Still Poo soup/ choc sauce this morning so we will just continue on and I will let you know when we are done ... x