How to get the dose right

[lil21lucky]

My Daughter is 5 she has suffered with constipation since 3, hiding and withholding. Gp started her on CosmoCol half which we did well with up until she turned 5 in April. This time I can't get her dose of CosmoCol half right. She has seen a pediatric gastro consultant in May as I wanted to make sure there wasn't anything else causing a problem. She was on 3 (morning, afternoon and evening) sachets a day. She then started soiling in her pants, but still going 5/6 times to the toilet. She would come home from school soiled. Wouldn't say anything to anyone until bath time when we saw. The Dr advised to increase her sachets to dis impact then reduce until she has 2/3 poos a day and she doesn't have accidents. We got up to 6 (2 each morning, afternoon and evening), no soiling but we have the poo explosion in toilet and that she can't hold for long. Which led to accidents at school if she is on the field or if we are out and about. So reduced to 5 (1 morning, 2 afternoon and 2 evening) back to soiling. Yesterday I did 6 (1 morning, 2 afternoon and 3 evening). She had poo explosion in the toilet before breakfast, soiled before we left for school. I didn't give her the usual morning sachet as she had school and felt she would then more than likely have an accident if not near a toilet. Soiled at school, which required a full change of clothes. We are now on school holidays, I have a 2 weeks off with her to crack this. As then she will be at holiday club going on trips. I'm just not sure how to get the dosage right.

[Yaleamanda]

You need to work up to the maximum dose in order to completely disimpact. As for soiling ensure she has regular toilet sits after every meal, pop a panty liner in her underwear too. Unfortunately disimpacting can take time and shouldnt be rushed, you will only end up back to square one again. Once you have achieved watery stools for a few days reduce the doses down extremely slowly, i.e. one sachet every three days until you find a suitable maintenance dose to stay on. Ensure that you mix the sachets correctly and they drink plenty of fluids on top as the sachets/liquid does not count towards their daily allowance of liquid.

[Bambie83]

I second what yaleamanda says - spend this next two weeks completely disimpacting her then when you’ve got to the tea stage for a couple of days take it down slowly I.e reducing by 1 sashets every few days. I’m afraid it takes time.

I think what you’re doing at the moment is adding a lot of water into her stool but she hasn’t built her muscles back to control it.

My daughter is about the same age and has been doing this for about the same time. She’s currently in about 1-2 sachets.

Also FYI they will still have accidents but you can help this by getting her to sit on the toilet after each meal. It’s a battle I know!

[lil21lucky]

Thank you both. We did get to watery poo for disimpaction that's what I call poo explosion. Think we were up to 8/9 sachets for that. Then we slowly reduced to 6 still the watery poo. When I went to 5 the accidents happen. I agree with her not being able to control her muscles. The amount of sachets plus drinking water with this weather, means she does have a lot of water in her.Will start again, and concentrate on getting the poo consistency right, the accidents next.