4 year old having more accidents than ever

[Specklescat]

Our 4.5 year old began having poo accidents around August last year. They started as dry smears, but have gotten worse over time. When we saw a GP, they put us her Lactulos twice daily. We did this for 6 months with ups and downs. Then it got worse, so the GP has put her on Movicol, one sachet a day. For the first 10 days she had no accidents, but since then it's got worse and worse. She now has several a day, wetter and bigger than ever.

She tries for a poo after meals, sitting for 10 minutes +, but only managed one every 2-3 days. She also does sometimes indicate that she feels one coming and gets it in the toilet, but it's fairly rare. When she poos they are pretty soft and unformed.

I feel like the Movicol is making things worse, but don't know whether I should try reducing the dose, or up it to try and clear her out. The GP did feel her tummy and couldn't feel any blockages.

Advice needed!

[Yaleamanda]

Have a look at the Eric website there is a wealth of information on this subject there.

[sosie16]

Most people would advise that you start with a disimpaction because soiling often means impacted and the soiling is overflow poo. This might take a few weeks to clear out all the old poo. Then you would be advised to slowly make your way down to a maintenance dose to help the bowel recover for a while and shrink back down to a normal size. Personally Movicol didn't work for us for maintenance and the soiling just continued, but after disimpaction we switched back to lactulose (and senna stimulant) and we've found a happy maintenance since then with daily poos and no soiling. If you're going to use movicol then I would recommend a course of probiotics too after as it can strip all of the good bacteria from the gut. The ERIC helpline are amazing, there's also a Facebook group called 'movical mummies' which is fantastic.

[ERIC-Charity Partner]

As per NICE guidelines Macrogol laxatives are the first line treatment for constipation. These are safe to use long term. If you are looking to support your child's gut biomes you can ensure they are having a healthy balanced diet containing foods such as live yoghurt, fermented foods, fruit and veg and limit ultra processed foods. They should also be consuming their daily fluid intake of water, diluted fruit juice/squash or milk (in moderation.) Diet changes cannot treat childhood constipation.

[14crosstitch14]

Toilet routine , needs inputting. Lots or fibre, prunes/juice if she'll have them. They'll really help. Put with cereal 3/4 is enough. Grapes or raisins. Fig biscuits will help. Small bag of nuts. Plenty fluids.