Movicol - should I start again?

[dipsymum]

The last three weeks with DD1 have been a cycle of constipation followed by dihorea, she is 3.6 and has been potty trained for around four months with the occasional accident but had no problems with poos in the toilet. When constipation first started the doctor proscribed lactulose which didn't seem to do anything, a few days later she was screaming in agony sitting on the toilet trying to go, so took her back to the doctor who referred her to the childrens ward at the hospital for an enima, they didn't give her one but instead gave her movicol, after being on this a couple of days she started to do really water poos and then just had dihorea, so I stopped the movicol and went back to GP, he said she didn't appear to be constipated any more and just continue as normal. That was a week ago, dihorea continued for a few more days and now she's just getting traces of poo in her pants which was one of the first indications that she was constipated in the first place, do I go back on the movicol? Or is this likely to lead to dihorea again? Am taking her to pre-school in a few minutes although putting her in pull-ups which she's not keen on but would appreciate any advice that you can give. Sorry it's so long!

[meltedmarsbars]

Are you sure the original blockage/lump came out when you had the movicol? Two days doesn't sound very long to be on movicol.

If she hasn't done normal stools for a while then it can be hard to tell if she is clear.

Ime the lactulose softens the stool, the movicol acts like an electrolyte and carries water to the gut. I'd say go back to the GP.

[MummyElk]

yes agree with meltedmars about GP but:
you can play around with the movicol dosage a lot more than you can with, say lactulose (which might cause wind) - so could you try a lesser dosage more often? (i don't know what dosage he's put for her). if its watery poos then i would suggest easing back on the movicol but not stopping it.
also have you tried the usual sneak a raisin into anything you are cooking marlarchy.... i'm sure you've done all this but I've found that prunes, apricots and raisins actually improve most recipes (savoury and sweet) and if chopped/blitzed up small my DD doesn't even notice...

[dipsymum]

Thanks, to be honest I wasn't convinced that the original blockage had been cleared but the GP feeled her stomach and didn't seem to think that there was any build up left, she was on movicol for a week in total, after a couple of days she started to get very small watery poos but the dihorea really kicked in on about day five when I stopped it. The hospital prescribed an incremental dosage, 2 sachets on day 1, 4 on 2 and 3, up to 8 for the rest of the week.

Have tried to increase the amount of dried fruit she has, prunes aren't a problems cos she has them with her wheatbex every morning (always has which is why her being constipated came out of the blue), but have increased her intake of raisins etc

Think I may try her on a couple of sachets a day for the next few days and see how things progress, just really hard as I think that she has been so upset by everything over the last few weeks that there is a real chance that she'll start holding it in even when things return to normal which'll just be another problem. Thanks for the advice and if anyone else has any more will be appreciated.

[meltedmarsbars]

You can't always tell by feeling the stomach, if the blockage is at the rectum.

We have had the same thing - a week of incremental movicol, followed by a micro-enema, and this week she'll have a phosphate enema. We know its still there because it shows itself momentarily at the rear end! tmi!!!

If there is a lump in the way, the movicol might just make todays food go straight past it without dissolving the lump.

Get on the phone to the gp - they may be happy to do a telephone-consultation rather than go in for an appointment. Just check out what you're doing with them.

[MummyElk]

dipsy 8 sachets is a lot for ME and i'm 32!! I know you can go up to something like 10 sachets per day if needed but it does sound like your DD doesn't need so much - at my worst I think I was averaging about 2-3 sachets a day which kept things ticking along quite nicely...
Fiddle around with the dosage - if it's too watery one day then less the next, if she doesn't go for 24 hours, then up the dosage.
The way movicol works, is it softens the stool as well as drawing water into the bowel to keep it all moving, without over stimulating the bowel...so it sort of does all three of the three different types of laxative out there (that's how I understand it). So hopefully, if there is a blockage, that will also be softened incrementally by the Movicol, even if the daily stuff is passing it by...

Who knew poo could be so interesting

good luck

[meltedmarsbars]

MummyElk - the incremental amounts is the pattern to move a faecal impaction, only for a week to move the blockage.

[MummyElk]

But forgive me, we aren't sure it is faecal impaction are we? Or are we... And would movicol soften the lump gradually anyway? That is what happened with us - which is why i'm a big advocate of it, saves a lot of added side effects.
Anyway, all I can add is agreement to zapostrophe - long term it's pretty good and worth sticking to if you want to avoid added problems like anal fissures (which would bring a whole other realm of issues with pooing into it, IME)

[dipsymum]

Have spoken to the doctor this morning who has advised to try 2 sachets a day for the rest of the week, cutting back to 1 if it gets really watery again and make an appointment in a weeks time if she still doesn't seem to have settled. At least I can always get a same day appointment with my GP if things start going really down hill again. It's amazing how common this seems to be!

[PanicMode]

Sorry to hijack; I came looking for advice on how to train a toddler who freaks out if I take his nappy off and encourage him to use the potty. He is on Movicol but I can't see that it's making a huge difference to him - he still needs to strain until he's screaming in pain, even when he's passing soft stools. The GP doesn't seem to take it seriously at all - even though I've pushed for a referral to a paed....surely it's not 'normal' for a child to be screaming in pain even though the stools are soft? His diet is excellent, although I'm not sure he's drinking enough.

(As an aside, I was advised NOT to give dried fruit because it absorbs water in the gut in order to rehydrate, which isn't what you want if you're trying to reduce constipation.)

[PanicMode]

zapostrophe I don't think so - the GP did check - and he doesn't always scream in pain. I just don't know what to do next - I don't think Movicol is making a massive difference, his diet is very good - he eats loads of fruit, veg, fibre etc but the GP keeps telling me he's constipated and to keep on with the Movicol.

[MummyElk]

agree with zapostrophe - sounds like a small fissure, it would HURT him whatever he passed...poor little mite. if there is fresh red blood when you wipe his bottom then i'd say almost certainly, but that's not the only sign.
interesting about the dried fruit - does that apply if you cook with it too? I shove it in stews and casseroles etc...cakes and stuff i soak it in tea overnight first (my dad did, so i do...?!! )...
dipsy glad the gp listened. fingers crossed this week it sorts itself out

[PanicMode]

no red blood, no. I have been told by the GP to give Movicol another week and then to go back - so I will do that, and then return!

re the dried fruit - I think it's only if you eat it 'raw' - not if you rehydrate it in stews etc.

[dipsymum]

Just another quick question, have cut back to one sachet as although poos aren't watery yesterday she had a total of 14 'accidents' in her knickers which was small amounts of very soft poo, which she said she couldn't feel coming, is this normal? My understanding from what the Gp said was that she should just have very soft poo, but didn't get the impression that it should be in such small and frequent amounts.

[Mummy2LZ]

We are having the same problem at the moment with DD1 who will be 6 in Dec.
I was told she was constipated with overflow and she was pooing in her knickers several times a day sometimes.
We tried Parachoc and a Microlax enema to no avail, so she was prescribed Movical Half which at first didnt do any good as our GP told us the wrong dosage.
When I spoke to the peadiatric Murse at the hospital she explained to me that if DD was constipted it could take several months for her bowel to shrink back to normal size after being stretched by the large stools.
She told me to start on the incremental dose of movical then when things got a bit more regular cut back to one or two sachets as needed a day.
We recently flew home to Londan (from Aus) for my brothers wedding and while we were home she was so much improved and didnt have a single accident that I stopped giving her the drinks altogether and she was absolutely fine for 3 1/2 weeks until on the last few days before we flew back she was unable to go again now we are back to square one.
I have her in Pull Ups and she has pooed herself 7 times today.
Initially I thought it must have been a stress related thing for her but after typing this and then re reading it I am starting to think maybe stopping the movical was not such a good Idea even though she seemed to be doing so well.
This whole thing is so frustrating and upsetting for her and all of us. She has done it at school a few times now and I am worried that she will get picked on for it!
It is really hard to know what the right thing to do is, she eats a healthy varied diet although it is Dairy free due to a medical condition that she has.
With the Movical she goes from one extreme to the next.
We have a dd2 who is nearly 3 and she is absolutely fine with her Poo (far to interested in it but ok) which is also hard for dd1.
Any helpful advice would be greatly appreciated Please.
At least I now know that its not just her though which is a small comfort as noone else I know has the same problem.

Thanks for reading

[dipsymum]

Zap, will take a look at that book sounds interesting, it wouldn't surprise me if DD1 is withholding, the last few weeks have been so stressful for her that I think she's very confused about everything. Will keep up the one sachet a day and hope that she finally gets it.

[Mummy2LZ]

I just ordered the book.
Thanks for the link. Hope it gives us some help and understanding.