recurrent daytime wetting and soiling

[custards]

hi, my boy is 4.5 and has been having issues with constipation since last summer. he was prescribed movicol at a low dose last year, and since then we have tried varying doses. he manages to do at least one soft sausage pooh each day, so doesn't appear to be properly constipated, but after a really good period of keeping dry, is now soiling and wetting pants again. we have kept him on a 1 scahet of movicol on an evening, as a maintenance, and have increased it to 2 scahets now to see if that helps, biut am at a loss as to whether he still needs medication, or if it's more of a behavioural thing with not emptying his bowel fully when on the toilet? he doesn't want to go if really consumed by an activity, and will often try to resist going for toilet time when we suggest. i've ending up shouting at him again this week, as i'm getting frutsrated again. he wanted to dry going without pull ups at night, so we tried at his request, but obviously that wasn't successful! i don't want to rush that though, just want his daytime issues to be resolved. he also is not bothered by sitting in his own wet or soiled pants too, which seems to make it more of a challenge! didn'y want to speak to gp again unless necessary, as i've had 3 conflicting gp opinions about how much movicol to give! thanks, sorry if its too long winded!

[Yaleamanda]

Sounds like you need to disimpact him vimeo.com/179497116

bornready.uk/blog/the-mecha...

There is lots of information that you may find helpful on the Bladder & Bowel UK website at bbuk.org.uk/bowel-resources/ The leaflet that may be most useful at this stage is the one at bbuk.org.uk/wp-content/uplo...

[ERIC-Charity Partner]

Hi there, please don't feel bad about getting annoyed, we understand just how stressful and frustrating this can be. Wetting and soiling can be symptoms of constipation. Have a read of our advice sheet eric.org.uk/advice-for-chil... . A backlog of old poo can only be cleared with a disimpaction. The disimpaction process is explained in this podcast by ERIC's specialist nurse: eric.org.uk/episode-6-disim... best wishes, ERIC

[custards in reply to ERIC-Charity]

Thanks ERIC!! I did as you advised, and disimpacted him. Stopped at 6 sachets on day 6 when he'd done a few watery ones. Then put him onto 3 movicols as a maintenance. However, since then there is some soiling, like overflow, again, despite doing good soft poos each day in toilet too. So now I'm concerned as to whether there could still be blockage, or is it the aftermath, or maintenance dose?! Confused once more! Thanks

[ERIC-Charity Partner]

Hello custards

You might like to read our section 'what to do if watery poo has been achieved' in our eric.org.uk/pdf-a-parents-g.... Lots of info there including this bit -

It will take a few days for the poo consistency to settle down – the bowel will have been very ‘busy’ during disimpaction. So stick to the same dose for the first week. After that, look at the poo your child is passing. They need to pass at least one soft poo every day – so adjust the laxative dose to achieve this.

If it has been a week or two then for some kids, a small amount of soiling (small soft lumps of poos) is expected and normal, and nothing to worry about. However you could call or contact or Helpline if you want to chat about options to help your child cope whilst they are experiencing this small amount of soiling

Well done for disimpacting!

@ERIC

[custards in reply to ERIC-Charity]

Hi Eric, I've tried calling a few times with no success, but could really do with some advice. The soiling of small amounts is continuing, weeks down the line after disimpaction. Sometimes it smells like constipated poo. But he does at least 1 soft poo daily. I don't know if he's on too much movicol or too little?! 2.5 a day currently, did reduce to 2, but then had the smelliest soiling which worried me! Have booked a gp appointment to finally review him too. I know you're extremely busy on the phones, but any advice or links would be appreciated. Thanks.

[ERIC-Charity Partner in reply to custards]

Hi custards , we are sorry you haven't been able to get through on the phone. Unfortunately lines are very busy. You can complete a web enquiry form ( eric.org.uk/using-our-call-... ) and ask a member of the team to get in touch. If you ask for a phone call, I'm afraid the wait will be several weeks. If you request an email response, we can respond much more quickly. You may be aware that, following periods of constipation, the bowel and rectum can stay stretched for quite some time (months). This means that soiling can still occur. To help with this, we recommend following a timed toileting programme. Toilet sits, 20-30 minutes after eating. That's when the bowel is most active. Sit on a secure seat, feet on a step. Also encourage him to sit to wee. He's more likely to realise he needs a poo. Blowing, coughing and laughing all help to push the tummy down. best wishes, ERIC

[custards in reply to ERIC-Charity]

Thanks Eric, I'll do the Web enquiry. That's helped put my mind a bit at ease though!

[Hobnob2006]

We use fibre sachets and lactulose with a nearly 5 year old and these have helped so much. She is now off the movicol which I didn't rate to be honest.