Physical (not behavioural) causes for constipation?

[MindfulSquirrel]

I honestly thought constipation and soiling was in our past but sadly it’s become an issue again for my 7 year old. 😕 My daughter’s movicol dose has rapidly doubled, we’re back to toilet sits after breakfast and dinner yet she’s started to soil again, and we just seem to be swinging between big piles of normal looking poo, mush and then nuggets again. There was no obvious period of constipation before this all started again, which makes it feel all the more unpredictable.

Thing is she’s NOT scared of pooing, and she says she’s not holding it in for other reasons and I believe her. She’s mostly happy to sit on the toilet after a meal at least once a day. She eats a good diet, takes a daily probiotic and whilst she has the odd day when she doesn’t drink enough at school, other kids drink much less and don’t have these issues. There’s a strong family history of chronic constipation and food intolerance - she’s lactose intolerant and had a brief period after COVID of having issues with dairy free chocolate. For years we’ve been told to keep her on the movicol and she’ll grow out of it as she had made great progress, but I’m increasingly wondering if something gastrointestinal has been missed.

Can anyone relate/has anyone been here? Fwiw I was chronically constipated as an adult, which only stopped after I started ADHD stimulant medication as an adult (I think it works as a motility agent) and now I have a similar normal>constipated>normal pattern and have just been told to go gluten and lactose free am waiting results on a SIBO breath test.

[ERIC-Charity Partner]

Hi, In terms of underlying causes, it is worth ensuring that your daughter has had a full examination to rule out any underlying causes of constipation. You can find more on this here: eric.org.uk/physical-examin.... You may need to consider disimpaction again, if she is constipated: eric.org.uk/talking-about-d... A good diet, fluid intake and exercise will help keep things moving and prevent constipation reoccurring. We recommend a child with a bladder or bowel issue to aim for the top of the fluid intake recommendations and this does not include that which is mixed with her laxatives. Children can also become constipated after illness or as a result of taking other medications. If you have any concerns about intolerances we would recommend speaking to a dietician. Children can also really benefit from a consistent toileting routine, if she is impacted again this affects the signals telling her when she needs to go for a poo, so she may not know/be consciously withholding. If problems are not being solved you may wish to check out these resources: eric.org.uk/poo-ladder/ and eric.org.uk/talking-more-ab...

[Helen36]

hello .. gosh… I can totally relate! My little girl is ten now and you are exactly where we were at 7. Like you I was on a mission to find something causing it.

We did all the things you are trying. However, we did food intolerance test from a hair sample that flagged up pork as a ‘red’ food and cutting it out was the start of things getting better for us. I think people can get mixed results from those tests (not sure how much real science is in it!) but it helped us. I still find now that if she eats pork for a couple of days in a row it will impact her.

I’m also interested that you don’t have a stimulant laxative with the movicol - e.g senna or bisacodyl. Really worth talking to a doctor about that. A bowel that has been constipated for a while can find it hard to know when it needs to go and this really helped us.

Keep your chin up - we came out the other side of this so have faith it is possible. We still need the medicine and I still monitor poo like a hawk… but there can be light at the end of the tunnel xx

[MindfulSquirrel in reply to Helen36]

Thank you - I am thinking of asking for food intolerance tests. Not sure they are available on the NHS but I’m going to start by asking GP. I’d like to limit blood tests as much as possible as she’s a bit scared of needle pain, but she did brilliantly with the numbing cream last time we tried so I’m definitely not adverse to it.

I imagine part of why we don’t have a stimulant as well is that she was doing really well until this current set back. Also aren’t stimulants the ones that you’re body can get used to and cause their own issues?

[mumbychoice]

Yes, neither of my children have ever been witholders, but both struggle (9 and 4 years old). We've been told by our consultant that she doubts it's anything to do with diet, it's just the way they are made. Most of it is likely due to them not emptying properly and indeed, if we increase the stimulants (still finding the right dose for my younger child), we see black tar-like poo coming out, implying that it's been stuck there for a while.We only take stimulants, as they also soften stool, are much easier to dose and easier for the kids to take. My 9 year old is on daily 30mL Senna and 15mL Pico, my younger is heading the same way. None of the consultants I've dealt with uses movicol, only stimulants and it's been a relief to us.

My eldest has now been accident free since the summer, where she wetted daily before, so I have absolute faith in our consultant. In terms of future she has suggested that we keep this dose for a while to allow the distended rectum to return to "normal", then may try to reduce the dose slowly. But we have to get the night's dry first. So still a way to go, but I guess ultimately the idea is that she will "grow out of it", but only with the help of the stimulants.

Good luck!

[MindfulSquirrel in reply to mumbychoice]

Glad that you’re seeing such improvements in your eldest!

I had assumed that this tendency towards constipation was just a genetic/an “us” thing (my daughters have it though only one really struggles with it, I had it, my mum had it). However, as I’ve recently been identified as having gastro and vitamin issue and there’s a family history of food intolerances and allergies, I’m increasingly less sure. I suspect such writing off of my own issues as normal variation has caused delays in my own diagnoses, and I guess it’s natural that I’m now questioning it with my kids 😕

[ERIC-Charity Partner in reply to mumbychoice]

Here you will find information on laxatives and how they work: nhs.uk/conditions/laxatives/ Stimulant laxatives do not soften stools but their are a range of laxatives that do which are shown on the above link. Stimulant laxatives get that squeezing going that pushes poo along. It is not advised to use stimulant laxatives until stools are reliably soft to prevent discomfort or pain through forcing along hard stools.

[Worriedmum222]

Hi - I was really interested in your question although I don’t have any good advice! I find it hard to accept that there are no underlying issues such as food intolerance or neurological/neurodiversity with chronic constipation- although of course ERIC’s advice relating to disimpaction, water intake and healthy eating can only be a good thing. Movicol and occasional stimulants have helped my younger child who is now 12.

Having had both children with long term encopresis and a history of food sensitivities and digestive problems myself, I am now saving to consult a private nutritional therapist for my youngest. BANT is the registering body for Nutritional therapists in the UK and have a directory.

Below your message was a v interesting thread about interoception which you might find helpful too. Good luck!