Ok, so this is quite a niche blog post! But I thought it might be useful to anyone with a constipated child, considering Movicol, using Movicol, about to use Movicol… I’m certainly not an expert or medical professional, but this is our poo story… or rather Audrey’s (age 7).
I think Audrey started to experience constipation around age 4/5 ish. She had been through a short fussy eating stage, but on the whole, her eating habits had become pretty good – she now happily eats a variety of vegetables and lots of fruit, but our problem is: fluids.
Audrey will sip a little water in the morning with her toast, a little bit more later and then throughout the day (with encouragement) drink a bit more. There are days when I could see she had pretty much only had a small cup’s worth of water the entire day! Using a straw seems to help her drink more and she does enjoy a juice box, but literally the only liquid I have ever seen her “down in one” is a 60ml portion of chocolate flavour Movicol!!
But back to the start of our journey. Audrey’s constipation presented itself very traditionally as several days without pooing. She would be in a very bad mood and 99.9% of her poos were in her night time nappy. To be completely honest, not worrying about poos in the daytime (being out and about and finding a toilet etc) was convenient. She progressed to pants age 5 and it was nice that we didn’t get those kind of accidents. We just gave her a spoonful of Califig most days and hoped for the best, she generally had a bowel movement every other day and we would find a poo in her nappy at night (that we would discover before we went to bed and change as she slept) or a poo greeting us in her nappy in the morning.
Once we entered lockdown, we ran out of Califig and our local pharmacy didn’t have it. I made a special trip to the big Tesco to get it, but we realised that if we were going to tackle things properly and get her on a daytime poo on the toilet schedule, now was the time to do it. So at her annual review, I discussed it with the GP (over Zoom) and we received the prescription for Movicol. I had been reluctant to “medicate” before, simply because she is on no other medication and Califig is “natural”, but I regret that now. I am the sort of person who suffers a headache for a couple of hours to avoid the use of paracetamol, but I am learning to just take the meds when needed!
With Movicol everyone warned us the dosage had to be right. It’s all anyone said when the mere mention of Movicol came up. We were advised to start on one sachet a day and scale up or down, depending on her reaction. My expectation was: it will have no affect (and the dose should be increased) or it she’ll have diarrhea (and the dose will be decreased). It was much more complicated than that.
Within a couple of days of taking it (just one sachet a day), we had seen two poos on the toilet and were doing happy dancing and thinking all was solved. How simple! [Side note: thank god I use local charity Amaze for advice on Audrey’s disability living allowance claim, as I was filling in the form that week and made it sound like the Movicol had magically cured her constipation and that was that, but I was advised by their guru it was too soon to make any such declaration and I downgraded the info to “she suffers from constipation and has recently started Movicol for this”]. How right they were… within days Audrey was wriggling and grumpy and doing “micro poos” (basically: sharts) in her knickers throughout the day. I was suddenly in a world of six or more pairs of pants a day and a constant washing cycle! And our happy Audrey was now a grump most days and not pooing other than the strange small amounts! Naturally, we lowered the dose (thinking it was causing her to soil herself) to half a sachet. But no, nothing changed. So we took a break and the night time poos returned. Then the gaps between poos returned (up to 5 days!), so we went back to half a sachet, but nothing changed.
I considered morning and evening – did the timing affect things?
We went back up to a sachet a day…. but after another 4 day gap of no movement, I remembered something mentioned on a toileting forum (yes, I’d been on a toileting forum!!) and went to trusty Dr Google to find more info on disimpaction. It basically described Audrey’s symptoms (the discomfort she seemed to be in, fidgeting, the micro poos in her pants all day, the lack of any real bowel movements) and advised we needed to “flush out” a blockage from her bowel with high amounts of Movicol. It also said to not to leave the house as you’ll have to deal with watery poos for days in order to get this sorted! Yikes. As the UK was gripped by a heatwave (and we do not handle heat), I figured this was the time to get things going and started the regime. 2 sachets a day, then 3, then 4… by day 8 we were on 7 sachets of Movicol with pantyliners in her knickers to help with minor accidents (she hated being told to wear nappies again!). I am pleased to say that aside from a couple of absolute corker accidents (I threw some pants away), she was doing really well and going to the toilet when needed. I was analysing her bowel movements waiting for the “brown watery” stage and once I felt we had reached that (this was day 9 I believe), we went back down to 1 sachet a day.
Audrey’s stomach changed. The round hard bloat she often had really went down. I feel so bad for leaving it untreated for so long. She has now, for the last 3 days, achieved “normal” stools on the toilet with no soiling in her pants and no night time nappy poos! (Though she has woken me at midnight and 1am to go for a poo!).
We will keep the one sachet a day routine for now and see how we go, I just really wanted to write this to remember what we went through and also to help anyone else in a similar situation as I am a little baffled the GP didn’t warn us about the disimpaction to be honest.
I am so very proud of her because it has been a strange journey to reach age 7 and rarely have actually pooed on a toilet. I know part of that was through fear (pain passing the stools) because she told me as much. It feels like a big milestone to be here with her in pants, able to tell me she needs to go (and don’t get me wrong, I still have to be very strict making her have toilet visits for wees otherwise she would just hold it in all day!). Children with Down syndrome may find that through the low muscle tone they don’t feel the signals for toileting like others and also, the constipation will have caused her a lot of confusion over the years too.
School return is just weeks away and luckily she has 1:1s who will help with her personal care, as the next stage is to teach her to clean herself safely and successfully!