overflow or too high laxido dose?

[Belleanna]

Hello! I have a 3.5 year old girl. I started potty training her a year ago and she started to experience what I know now is constipation. She began soiling with the sticky grainy poo. I abandoned ship for a few months and put her back in nappy pants but come May I had to try again because playschool started in September and a baby sister was due in June. So I started training again in earnest and we would still have issues off and on with soiling. I did not know that that was constipation. About a month ago at the start of December I realised that she needed to see the gp about this. She was prescribed a macogol and we went ahead with the disimpaction. I thought she was disimpacted, so I reduced the dose too quickly and we were back to soiling again so the gp recommended the disimpaction regime again. Again I thought we were finished and I reduced slowly this time, from 8 sachets gradually down to 2. She has not had a formed poo since reducing the dose and the last few days has had soiling but this time it’s a greyish brown loose stool. I’d say 1 or 2 on the Bristol chart. Is this overflow or is her dose too high? Should I disimpact again? This just seems like a never ending story.

[Le15]

It sounds like you’ve done exactly the right thing disimpacting again and unfortunately, it is often a much longer journey when children have these withholding issues than you first anticipate. My son is six and still has issues although it has got much better! What we have been advised (through reading and ERIC, rather than the GP who’s knowledge seems to be quite limited) is that the once the bowel is impacted it stretches and can take up to a year to go back to normal. So my advice would be to firstly,

Make sure you have FULLY disimpacted. If in doubt, do another day. Then get down to / keep on 2 movicol a day for at least a month then maybe go down to one. And not to worry about them becoming dependant on the movicol because it just draws fluid to the bowel rather than stimulate the bowel so they can be on it for years without it having any long term implications. We’ve tried cutting out dairy, bread etc. but it’s usually the withholding (for reasons you may never fully understand) that causes the build up. We have done lot of disimpactations over the years and it can feel never ending but it does get more controllable!

What has worked most for us in improving the overall situation is a ‘toilet time’ regime. Every morning, 15 mins after breakfast, our son sits on the toilet or potty with his ipad and a stool to support his legs. Watching a program helps him to release the poo. When they get a few ‘wins’ and the soiling stops, they build their confidence with using the toilet for poos and will eventually start to identify when they need a poo and follow their body signs. We also slowed down our lifestyle a lot - so giving him time to poo in his own home when we know he needs to go, even if that means being late for school. Not ideal, I know! We just prioritise the poo and try to take the pressure off. We also do a lot of pants off time. We found that a lot of naked time from the waist down really reduced the soiling incidents and helped to build the ‘wins’.

Apologies for the long response but your story is so similar to our own and all I can say is that although we haven’t fixed the issue, we have got it under control and eventually I feel it’s something our son will grow out of. Soft poos for the foreseeable is the key - it really helps in the long run to go more with the movicol than less for a period of time. I hope that helps.

I’ve attached a photo of some books that I really recommend reading x

[Le15 in reply to Le15]

Books

Books

[Belleanna in reply to Le15]

Thank you so much for your reply! It’s so encouraging to hear other people’s experiences. So glad things are going better with your son. I’m definitely going to take your advice of putting something on for her while she tries to go. We’re disimpaction again now. I’ll do more days of it than before just to be sure. So any time she’s soiling 3-5 times a day does that mean she needs disimpacted? And to know the disimpaction is done properly, is the poo supposed to be muddy looking with food bits, or like clearish liquid? Sometimes she does have smaller liquidy poos while disimpacting, and sometimes it seems to be leaking like the soiling. Is that a sign we have more poo to disimpact?

[Le15 in reply to Belleanna]

Yes I would say so, you want one really watery, almost wee like poo and then you can reduce. All kids are different but for us, when the soiling starts we sometimes wait until the weekend and disimpact. If you catch it early it doesn’t take as long as the first - we can usually do it over a weekend and don’t always go all the way to water because our son has started to recognise the importance of this issue (it’s taken years!). Once we see soiling we nip it in the bud quickly - step up the toilet time to twice a day, naked time (without making a big deal of it - we just sort of say ‘time to get dressed’ and don’t put out any pants or trousers for a few hours!) And we will do something to motivate him. Stars, haribo etc. but it has to be a self initiated poo for him to get the prize- that’s just what works for us at the moment. These extra steps are the things that almost reset his mindset to focus back of listening to his body… without trying to put too much pressure on it. Then we get back into a rhythm of toilet time before school and wait for the next time he soils (which is usually the end of the next school holiday when the routine is out) and start the process again. But the length between the soiling stages is getting longer so I have hope it won’t last forever. Sorry, that’s another long answer but put simply, yes, when we see poo in the pants we up the movicol as required and sometimes add a stimulant (5-10ml senna a few days in a row) which we’ve been told is ok for withholding issues. Worth checking with your GP on that one though. Hope that helps x

[ERIC-Charity Partner]

When disimpacting ensure that you reach the stage where 2 consecutive brown bitty watery stools are passed. Ensure that these are large in volume so that you know the bowel is completely cleared. After disimpaction, if finishing on 8 sachets, start the maintenance dose on 4 and continue for a week to allow the body to settle down and adjust. After this time, you can reduce the sachets every few days or more. Remember, to make sure they are mixed correctly and additional fluid intake is given on top throughout. This gradual time, allows you to see the effect the change has had on her bowel habits. She should be pooing daily soft stools - aiming to reduce down to a type 4 stool (smooth sausage, no cracks, easy to pass). Signs of old poo still remaining would be dark stools, offensive smells, bad wind/breath etc. See our constipation advice sheet for the full list of constipation symptoms. A sweetcorn test can also help determine transit time although this is not fool proof: eric.org.uk/how-fast-are-yo...