how long to plan for disimpaction?

[purpleheather34]

Hi,

I've only just discovered this website.

My 5 year old boy has been having poo accidents since he was toilet trained at 3. Last year we were referred to the bladder and bowel service after a lot of persuading the health visitor.

We have had 2 appointments with them. He has been on 1 sachet of movicol each morning for nearly a year and a half. They are asking him to sit on the toilet for 20 mins a time, 5 times a day. He has been on sticker charts, rewards etc. It is an uphill battle as he refuses to sit that often and for that long. When he has an accident he is embarrassed and refuses to go to the toilet. He is still having daily accidents and is really anxious about it.

My questions are:

How do you implement a toilet routine at school when they point blank refuse to go?

We are planning disimpaction in the October half term. Will that be enough time? I see the plan is for 7 days. Then 3 days of watery stools. Then slowly reduce the maintenance dose but they still will be watery. When can he go back to school?

What helps reduce the anxiety? Even after the disimpaction how do we cope with his emotions? He gets so angry and frustrated.

Thanks in advance for any help or advice.

[Bambie83]

I’ve been dealing with a similar situation for a few years now so I can tell you it does get better but it’s been a long and frustrating journey so far. Sometimes I feel like I’ve bee cleaning up poo for years! 😭

Disimpaction wise it really depends on how blocked up the bowel is to how long it will take to fully disimpact. Unfortunately, the worse thing you can do is not do it completely - I made that mistake the first time and had to do it all over again a few months later!

What you can do it start upping the sachets before you reach the half term - I normally found my daughter could get to six before I saw any movement. Then you need to stay at the highest amount until you get three days of tea like watery poo. The reduce slowly - around 1 sachet every 2-3 days until you reach a maintenance dose that produces 1-3 soft snake like poos a day.

Toilet sits wise, try once after each meal (about 20 min after a meal) and do some blowing - balloons, party blowers, bubbles or even just a bottle with a straw in to blow on. This helps the muscles and make it a bit more fun.

We’ve also found rewarding for sitting rather than pooing helps and also putting a timer on you phone or iPad they can see it count down. Try a little target first like 3 or 5 minutes and it makes them see they’re not sitting there forever. We find if there’s poo coming it will come by the time the count down gets to zero and if it doesn’t, reward for trying and say okay can we try again in a little bit?

This has helped us massively, after fighting our daughter to toilet sit for 2 years and trying everything!

Hope that helps. 😊

[Le15]

Hello! We have a similar age boy at home and have had a really similar experience over the last 3 years.

My advice would be to definitely give ERIC a call initially. The gps and health visitors, I’m my experience, don’t give as good advice. I would also do a disimpactation asap - it’s not something that can wait. It doesn’t always take as long as 7-10 days. We have done a number of them over the years (so be prepared this is a journey!!) but we will typically give 2 sachets on a Thursday, 3 on a Friday, 5 on a Saturday and 7 on a Sunday then once the watery stools are really watery (it’s a mess!) we go to maintainanace. - we also add 5ml of Liquid senna on the Friday night to get things going. we then maintain at 2 sachets a day. So maybe 1-2 days off school but typically, we only have ever done one day off school.

When the soiling starts again, we don’t hesitate. We up the movicol and disimpactation again if necessary.

The toileting regime is the thing that’s going to get this back on track. This is what works for us… we do ‘toilet time’ for 20 mins after breakfast with an iPad and because of the movicol, this typically will clear our son out enough so he can get through school without an accident. When we get home, my son is naked from waist down. I don’t know why this works - but it does! Almost like we repotty train after every disimpactation with a sticker chart but we hand the power to him. We never nag, we don’t do more than one toilet time a day and we try to give him the power to make the right choice. We blame the ‘naughty poo’ that comes out in the wrong place and we don’t make a big deal out of anything. We don’t really even prompt, our son gets so aggressive when we even mention the toilet so we just wait for him to make the right decision and then give some praise. But not too much - that can also make it a big deal. We’re just like - ‘great job, that was a great decision’ and try to not make poo the focus of our lives (it was for a REALLY long time)

When we had some success, you will find that the emotions calm down around the whole thing. Try taking the pressure off completely and for the next month at least, just do your best to ignore the accidents. We don’t say things like ‘that’s ok, don’t worry’ because it’s not ok, but we just sort him out, and then keep him naked for the rest of the day. You will be amazed how quickly you will make progress after a disimpactation! I promise, it works a dream.

I’ve attached a book that I found amazing. It really helped so worth a read!

Best of luck x

Constipation

[14crosstitch14]

Maybe put a book/fidget toy for only the toilet area, music to calm and relax the anziety of sitting for so long. This helped my child.