Struggling with disimpaction regime

[Lem14]

Hello, really hoping someone has some advice as I’m at the end of my tether! My son is 5, he has struggled with constipation since he was 6 months old. He went onto Movicol (just x1 sachet a day) which was working fine to keep his stools soft and passable however when he began potty training at 3y/o he started to have bad episodes of constipation. We upped his Movicol to x2 a day which was working, however he was still refusing to sit on the toilet and only wanted to poo in a nappy. He started school last September so we were really keen to try and get this sorted but he point blank refuses to sit on the toilet (we have tried reward charts, toilet toys etc). In December he started soiling in between movements and after going back and forth with the GP and a private paediatrician, I called ERIC who advised the impaction regime. I am struggling! I have been trying to do the regime since February but I cannot get more than 4/5 sachets in him per day, it’s just impossible. He won’t have it in his water, he doesn’t drink squash or juice so the only way I can disguise it is in milk but he only has that in the morning with his breakfast. How do you disguise such a large volume (8-12 sachets) in a day, has anyone else struggled with this and found a solution? His soiling has got so bad now. His bowel movements are currently type 6 I would say so very runny but I believe there is still a mass that needs to come out hence the soiling. Please help!

[CharlotteLig]

This sounds exactly like what my son went through about a year ago - it is so stressful. Small loose bowel motions all throughout the day and he was constantly trying to hide to keep his poo in. He was withholding bc he associated so much anxiety with pooping! We found a guide by Jaime Glowacki (toilet training consultant in the US) so SO helpful and it explained the difference between constipation and withholding. My son was very constipated as a baby too so I assume he always found pooping stressful. But never appreciated the difference between standard constipation and then the anxiety some kids get around withholding

[Lem14 in reply to CharlotteLig]

Thank you so much for replying. Was or is your son on stool softeners still and did you have to go through disimpaction?

[CharlotteLig in reply to Lem14]

Yes we did, but with the help of a stimulant too (senna). We were getting nowhere without it bc every-time we dropped the dose down of the stool softener down he went straight back to withholding and we got issues again. Now he is still on a stool softener (1x sachet per day) for maintenance dose, and he poops most days on the toilet now with no problem. I just realised your question was more about getting all the liquid into them, but the symptoms sounded very similar to what my son was doing just over a year ago! I wish I had understood withholding earlier though - it could be a piece of the puzzle for you.

When we disimpacted we mixed the sachet with water and then added a bit of chocolate milk and my son seemed to drink it quite happily. Now we just add a bit of milk to it and he is used to the taste - I think drinking through a special straw or bottle helps too (from my experience).

Good luck you will get through it and don’t beat yourself up about it - you are doing all the right things getting it sorted

[Lem14 in reply to CharlotteLig]

Did you find the disimpaction worked? We’ve done it once before and felt it cleared him out but the soiling slowly started again. Trying not to beat myself up but it’s hard isn’t it. Being on here makes you realise how common it is though and makes you feel like you’re not alone which is nice.

[CharlotteLig]

Yea the disimpaction did work, but not for that long! And that’s when we discovered it had a lot to do with him simply not wanting to poo (bc of it hurting previously). So anytime he could hold it in (like when it wasn’t super watery), he would try to keep it in and sometimes spend all day trying not to poo and would end up soiling again. It was a vicious cycle for us and only with the addition of senna (and some glycerol suppositories when needed) did we really address the issue in my opinion. You are absolutely not alone - it’s so common (and yet so stressful!). We also had a Dr guide us and she requested we get an x ray to confirm he needed disimpaction before we started

[TealandMustard]

It is a bit of a nightmare, I hear you! We’ve had similar with my 4 year old daughter and honestly going through disimpaction felt like a full time job just getting the drinks down her. We tried all sorts. For us chocolate milk and lollies worked the best (but can only get about half a sachet in a lolly….). We did explain the whole thing to her (in simple terms) and showed her child friendly YouTube clips of what is happening in the bowel so she had a basic understanding. We’d also had a bad episode where she was in a lot of pain but we could use that to explain and justify why she needed the drinks (I think getting her ‘buy in’ helped to some degree). We also tried bribery (ie one minute of Bluey then pause it while she had a drink) and made games out of it ie pushing her down the corridor in her baby’s buggy and having a ‘pit stop’ for a drink. We honestly tried EVERYTHING and some things worked sometimes…good luck. You’re not alone xx

[Lem14 in reply to TealandMustard]

Thank you! It’s so hard isn’t it. I have tried explaining the reason we are trying to get him to have his drinks, he’s still very reluctant (he’s a very stubborn child!). I managed to get him to have 6 sachets yesterday which is the most we’ve managed and that was hard, so unsure what tricks I can use today! I will keep persisting as the impaction soiling has got so bad, we can’t even leave the house

[TealandMustard]

Yes, my daughter didn’t go to nursery for 3 weeks and we barely left the house in that time too. We were all going a bit mad by the end of it. It was 100% worth it though as things have been so much better post disimpaction in many ways. I hadn’t understood how much chronic constipation had been ruling our lives, and how uncomfortable/in pain she must have been for so long. Her pre disimpaction soiling was terrible too and affected what we did as a family - so difficult to get out the house. I had no idea it was as a result of constipation and was so grateful for the support given by ERIC (website and helpline), GP not much help….

Well done for getting the 6 down him, and good luck for today. We found putting it in different cups/bottles/straws helped (I’m sure you’ve tried this but we’ve found changing things up has helped, recently putting it in a miniature glass bottle is working for her maintenance dose atm, less daunting?).

We also added in Senna after two weeks of disimpaction regime which definitely moved things along (started with 5mls but quickly went up to 20mls for a few days) x