Please help - first time disimpacting

[Winford]

Hi there. I’ve just discovered this forum and hoping to get some advice. My 11 yr old daughter, who has severe additional needs, has struggled with constipation for years. Been on 2-3 cosmocal sachets a day for a long time. However after frequent vomiting episodes at school we finally managed to see a consultant who took an X-ray last week. She’s severely impacted (he says the 3 parts of the intestines/bowels are all packed full) and we’ve to take aggressive & urgent action. He suggested 16 movicol sachets per day but we just can’t get that amount into her. Maybe managing 9 plus 10 mls picosulphate. This has been since Wednesday and she’s only had 2 dirty nappies. Both very loose with lots of undigested food. She’s clearly still in pain but I’m surprised there hasn’t been more bowel movements. Any advice? I don’t even know what to expect!! We kept her off school last week and not sure when to send her back 🤷‍♀️

[Yaleamanda]

How are you giving the sachets? Are you spacing them throughout the day? How are you mixing them? Once they have been mixed with the correct amount of water first they can be added to anything else afterwards. Why did he recommend 16, the usual dose for a disimpaction and this worked up to over a period of a week is 12 sachets. Movicol can take a few days to kick in and water is key to it's function as it is an osmotic laxative. You are aiming for rusty water looking stools for a few days, this needs to be consecutives days to ensure that the old poo has gone. Once this happens stay there for a few days to ensure that she is clear and then reduce down very very slowly i.e. one sachet every three days until you find a suitable maintenance dose to remain on.

[Winford in reply to Yaleamanda]

I’ve no idea why he said 16…but he’s a gastro paediatrician so I’m sure he knows what he’s talking about. We’ve been using movicol for years so continuing with the normal routine of mixing with water then adding to diluted juice. And yes, spaced throughout the day. But if she doesn’t want to drink…she won’t drink! She’s cognitively impaired so doesn’t understand why she has to drink more etc. It’s starting to come away now but still very lumpy. Good to know we have to continue until we get to the rusty water stage - nobody had told us that! Thanks 😊

[Yaleamanda in reply to Winford]

No worries. We had a paediatric gastro too, except he was clueless and we sought a second opinion, I dont always hold out much hope on them knowing what they are taking about to be honest.