Second repeat disimpaction?

[Beccaell]

Our 5 yo daughter was diagnosed with constipation in April this year, following incidents with poo and wee soiling. We disimpacted her successfully at the time using cosmocol (it took 11 days in total until we reached rusty water stage). We went to the highest maintenance dose. (4 sachets in line with Eric guidance) and then reduced down to 2 doses and then 1 dose over the course of 3 months. All seemed to be going great with no accidents for the first couple of months however over the past few weeks she has started having accidents again - poo in knickers frequently and today she wet herself for the first time since the disimpaction. We have in the last few days ramped her back up from 1 dose a day to 2 but it doesn’t seem to have helped.

We are at a loss as to where to go from here - is this normal? Did we reduce doses too fast? Do we need to start disimpaction again? Any advice gratefully received.

[Yaleamanda]

Sounds like you reduced too quickly. I would disimpact again. Work upto the maximum dose for their age until you reach watery stools with no lumps consistently for a few days before you start reducing the doses down extremely slowly ie one dose every few days until you reach a suitable maintenance dose to remain on. Also regular toilet sits after every meal. Ensure they are drinking plenty of fluids on top of the movicol as this does not count towards the daily allowance of fluids and fluids are key.

[Beccaell in reply to Yaleamanda]

thanks for your reply. We reduced doses over a couple of months from 4 to 1. Do you think we should be staying on the highest maintenance dose of 4 doses for say, a month and then going down to 3 doses for another month before reducing again etc? It’s so hard to know what timescales to go for. I was focusing on the consistency of her poo which was loose, hence why I thought best to drop the dose.

[Yaleamanda in reply to Beccaell]

I would stay on the high maintenance dose for a while, it's not a process to be rushed. Are you encouraging regular toilet sits after every meal? Do they drink enough fluids during the day?

[Beccaell in reply to Yaleamanda]

ok thanks. Yes we do. I think it’s tricky during school as she can be a bit shy and scared of interrupting the teacher to ask to go. We’ve tried speaking to the school numerous times and of course to our daughter but I do think her reluctance may have something to do with it.

[Yaleamanda in reply to Beccaell]

I would make an appointment with the senco as this is their remit. Get an intimate health care plan in place so they have to encourage her

[Beccaell]

ok - thank you. I hadn’t thought of that.