Disimpaction regime

[BabT]

Hi, my 6 year old son has been on Cosmocol and Senna coming up to 2 years. He has 2 daily Cosmocol sachets but for the past month has been having lots of overflow accidents.

We decided to follow a disimpaction regime to clear out the old poo and establish how much Cosmocol he needs as a maintenance dose. We’re on day 6 and his poo is very loose but not the rusty water colour they describe on the ERIC website. Just gave him 9 sachets and he’s had a massive accident so not sure whether to stop this now or continue!! I don’t want to stop too soon and have to start all over again. Please help!

[Yaleamanda]

Keep going. 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.

[BabT in reply to Yaleamanda]

Thank you. He’s got to 9 sachets with watery stools so I’m not going to increase this as he started with soft not hard stools. Sometimes he feels like he needs to go but yesterday there was lots of loose accidents he had no control over. Does that mean it’s still old poo coming out?

[Yaleamanda in reply to BabT]

No you need to increase, you need to complete the disimpaction and the doses are as such for that reason. The sachets are breaking down and softening the old stools. Accidents are common, ensure that he has regular toilet sits. After two weeks you can add a stimulant to the regime this will help things along. But carry on.

[BabT in reply to Yaleamanda]

Ok thanks. He’s been on a stimulant (Senna) since I started the regime which is why I think it’s cleared out so quickly.

[Yaleamanda in reply to BabT]

How much senna is he on? The senna will definitely be helping. Keep working up with sachets. Disimpacting is not the nicest thing but it will help and dont be tempted to reduce down too quickly once you do achieve the watery stools, slowly wins the race here.

[ERIC-Charity Partner in reply to Yaleamanda]

Just to clarify, you only need to see rusty water with bits in on 2 occasions, then you can reduce down to find the correct maintenance dose for your child, see our eric.org.uk/childrens-bowel...

You can also check out our podcast, disimpaction is explained by ERIC's continence nurse eric.org.uk/podcast/episode...

[BabT in reply to ERIC-Charity]

My son has done this on at least 2 occasions when he reached 9 sachets with 7.5mg Senna. I did not continue over a few days as mentioned in previous comments. So many conflicting answers it’s difficult to know what to do! I’m now slowly lowering his sachets to a maintenance dose that will hopefully enable him to go regularly.

[BabT]

7.5mg Senna. He’s had lots of watery/soft stools over the past 24 hours so I’m going to reduce slowly

[Yaleamanda in reply to BabT]

Do they look like clear tea with no dark flecks or melted chocolate?

[BabT]

Yes just bits of food. One was a huge explosion

[Yaleamanda in reply to BabT]

You are not there yet, keep going.

[BabT in reply to Yaleamanda]

Thank you for the advice. You were right I wasn’t quite there with the disimpaction and he’s still having overflow accidents so going to try again. Once disimpaction is complete did you notice a lot less accidents?

[Yaleamanda in reply to BabT]

If they are fully disimpacted the accidents should lessen as the stools start to form into type 4 on the Bristol stool chart.

[BabT in reply to Yaleamanda]

Although not fully disimpacted he is starting to feel the large amounts of poo and is taking himself to the toilet. Do you think this is a positive sign?

[Yaleamanda in reply to BabT]

Yes of course. Keep going with it, it is heading in the right direction.

[BabT in reply to Yaleamanda]

One last question….once disimpaction is achieved how slowly do you reduce the sachets back to the maintenance dose? The Poo Doctors suggested reducing by 2 sachets per day

[Yaleamanda in reply to BabT]

One sachet every few days i.e. 12,12,12,11,11,11 and so on until you reach a suitable maintenance dose to remain on.

[BabT in reply to Yaleamanda]

Only ask as I’ve got 2 weeks to do this until my son returns to school so I’m worried about him being on too high a dose and having accidents

[Yaleamanda in reply to BabT]

You dont want to reduce down too quickly, you will only end up back to square one and run the risk of not finding the correct maintenance dose. Slowly wins the race.

[BabT in reply to Yaleamanda]

Will it not work if I reduce by 2 sachets down to 6 and then very slowly from then on?

[Yaleamanda in reply to BabT]

I wouldnt reduce down like that no.

[BabT in reply to Yaleamanda]

Ok this was the info I received from the ERIC website and the poo doctors suggest this too. So difficult to know what to do!

[Yaleamanda in reply to BabT]

You do what you feel is best, I am just going by our experiences and what worked effectively for us.

[14crosstitch14]

You might be best getting some diralight to help and then stop the poo meds while he drinks 2/3 of that. Then do a toilet routine before and after meals, in morning and bed time. He's needs to do this 2xs as much as an adult for body to get back to normal. Plenty fluids/fibre and exercise. Thats what i'd be doing, to get him ready for school.

[Yaleamanda in reply to 14crosstitch14]

This isn't a case of diarrhea and meds shouldn't just be stopped.

[14crosstitch14 in reply to Yaleamanda]

Maybe your right. I gad good advice from you when needed. Was such hard work. Thank you for your help. I didn't have all that. Was bad though when back to school. Thats what i would of done. Clear them straight without the meds, if wel'd of had her full time. Still constipated when we get her back from school. Anyway your advice yalemanda is always good.

[Lambtrack]

You could try the ‘seeetcorn test’? Give him some sweetcorn this evening (assuming he hasn’t had any in the last couple of days) then see if he passes it tomorrow - if he does, then you can probably start to reduce the macrogol. This is what Eric and the local Bowel/bladder team advised us; it meant we didn’t have to go quite as far as the rusty water stage. Hope this helps. X

[BabT in reply to Lambtrack]

Thanks for the advice. So would you recommend doing this test near the end of the disimpaction?

[Yaleamanda in reply to BabT]

The sweetcorn test can be unreliable as it can bypass the blockage, so dont rely on it to tell you they are cleared.

[ERIC-Charity Partner]

Dear BabT

We see you've had lots of advice from our lovely members. Do contact our Helpline via our web enquiry form eric.org.uk/helpline/ and the team will be happy to help you. You can usually expect a reply within 5-7 days if not before.

In our Disimpaction podcasts, Brenda our Continence Nurse explains how to get to the maintenance dose. There's no need to reduce down gradually, have a look at the Guide to Disimpaction and you'll find guidance on this. The rule generally is that if you had to get to the highest dose for disimpaction, you stay on the highest maintenance dose. It can take the bowel a couple of weeks to settle down after a disimpaction. and remember that the rectum can take much longer to regain its stretch, so it's not unusual to still see soiling for a while after. If you do use a stimulant laxative this can be helpful in terms of getting into a toileting routine. Also working with the body so toileting 20-30 minutes after eating, a relaxed toilet sit, is helpful. The bowel squeezes most strongly 20-30 minutes after eating. best wishes ERIC