"My son has chronic constipation. He’s 15 now and we’ve tried everything. Is there anything you can recommend to contain the soiling? I worry about him getting bullied because of the smell." Parent's email to ERIC's helpline.   

Why does this bother me so much? It is, unfortunately something we hear all too often. But ‘chronic constipation’ should not be a diagnosis of childhood…what does it mean? I’m afraid to me it can be interpreted as constipation that has not been properly managed – in other words we have failed this young person.

Effective treatment protocol

Since the NICE Guideline Constipation in children and young people: diagnosis and management (CG99) was published in 2010, there has been a clear treatment protocol which is completely effective for the majority of children. ERIC’s generic Children’s Continence Pathway maps the child’s journey through continence care, showing how to implement the NICE guidance through a series of flowcharts with all the necessary assessment forms, factsheets, charts and diaries available at your fingertips as free downloads. So why do we continue to hear these stories of teenagers enduring endless soiling at such a crucial time in their lives?

Consequences of undertreated constipation

Hopefully in the future we’ll hear this less and less. ERIC’s drive to promote early intervention into childhood continence problems and to raise awareness of healthy bladders and bowels will hopefully have an impact. But in the meantime, there are young people out there who missed out on that, whose constipation has been undertreated for so long that their bowel is almost permanently stretched. That means their sensation of a full bowel can’t work properly, and the floppy bowel allows poo to accumulate, only to leak out at just the wrong time…

What else can be done?

There are a whole range of interventions that can be offered, delivering either medication or water directly into the back passage. Sound scary? Maybe it does, but given a choice of pooing in your pants or learning to use a suppository or a bowel washout what would you choose? We are often much more squeamish than our kids!

ERIC's step by step approach

Choosing the right intervention can be really difficult for practitioners who don’t specialise in the field. Knowing what to ask for can be a real challenge for parents. Looking at frightening equipment can put everyone off! So ERIC has devised a step-by-step approach using the analogy of a ladder, and Macgregor Healthcare has helped us by putting it into this fantastic graphic:

Poo ladderPoo ladderPoo ladder

ERIC's poo ladder

Just like climbing up a normal ladder, the child and family can start at the bottom and climb one rung at a time until they reach the goal of clean pants. It’s a big thing agreeing to something being put into your bottom – much easier if at first this is just a little suppository. That may be effective, but if not it’s not such a big step to a mini or compact washout.

How healthcare professionals can learn more?

"I have already started sharing my learning. Need Brenda's poo ladder to be available asap! I would like to get everyone getting our patients who are not improving, moving up that ladder!!" Feedback from attendee at ERIC's 2018 paediatric continence care conference. 

ERIC’s poo ladder will be explained in detail at our regional roadshow event in Powys on 6th June, in an interactive session drawing together the resources on the website and the products themselves. We listened to the feedback from the 2018 conference and have created another opportunity to see all the different equipment, and how the ladder fits into the Children’s Continence Pathway.