Stories & News Blogs The difference disimpaction can make Sophie's son Theo only stopped soiling and his constipation became more manageable once they followed a 'clear out' regime guided by ERIC's helpline advisors. If a child is struggling with a 'faecal impaction' (large build up of poo in the bowel and rectum) disimpaction using macrogol laxatives such as Movicol, Cosmocol and Laxido is the first line treatment recommended by the evidence-based clinical NICE guidelines on Constipation in children and young people. Read on to find out how Sophie's contact with ERIC's advisors helped her to understand the difference this could make to her son's poo problems. Sophie and Theo's story We started potty training Theo when he was nearly two and a half and to begin with, he got on quite well. He still did a lot of poos in his pants but everyone reassured us that he was young, that boys take longer and that he would get there in his own time. Continuous accidents By his third birthday, things had gone downhill and he was soiling and wetting continuously. Over the next year we tried everything; stickers, rewards charts, character pants, returning to nappies, trips to the GP, dairy free diets, endless meeting with nursery...We even had an appointment with a paediatrician at our local hospital and the diagnosis was always the same “it’s behavioural/he’s lazy/he will grow out of it.” Could constipation be the cause? Deep down I knew this wasn’t the case. Theo clearly wanted to get it right. He would get very angry when he had an accident, often kicking, screaming and refusing to be cleaned up. In desperation I spent hours googling “reasons for child soiling” and the answer was always constipation. His poos were usually very soft (which I now know was a warning sign!) and it never caused him any pain. But Theo wasn’t constipated (I thought!). The GP had checked his tummy and said he was fine, he pooed daily (often several times). His poos were usually very soft (which I now know was a warning sign!) and it never caused him any pain. To our knowledge he had never suffered with constipation, with the exception of once as a young toddler, following a nasty tummy bug. Getting answers So if constipation wasn’t the issue then why was our bright, confident, sociable four year old choosing to soil his pants every day!?! I just knew something wasn’t right and I continued to push for answers. Finally, when he was four and a half, I got Theo an appointment with our local continence team. Much to our surprise the nurse explained that it was highly likely Theo was suffering from “faecal loading”, probably due to his bowel having been stretched during the brief episode of constipation when he was younger. I just knew something wasn’t right and I continued to push for answers. She explained that constipation can present in many ways and that Theo's soft poos and soiling were big clues that this was the problem. She prescribed Senna (a stimulant laxative) to clear the backlog and we all got our hopes up that we finally had an answer. However it soon became clear it wasn’t as simple as that; the soiling was as bad as ever and Theo was also starting to complain of tummy pain. Desperation point By this point the situation was taking its toll on the whole family. However calm we were able to remain, Theo was now of an age where he was aware that his friends didn’t have this problem and he was getting increasingly upset with himself. With him due to start school in few months I called the ERIC helpline in desperation. The lady I spoke to was so helpful, explaining that a stimulant laxative alone wouldn’t solve the problem and that what he probably needed was a disimpaction to fully clear the backlog of poo. Seeking help She talked me through the process in detail and, when I explained I was reluctant to undergo a disimpaction without knowing for sure what the problem was, she encouraged me to push to see a gastro specialist. I did (with help from family we paid to go privately as time was of the essence) and the results of an x-ray and transit study confirmed what was suspected - Theo’s bowel was loaded and stretched, meaning he had absolutely no control over his soiling accidents! Clear out regime Using ERIC's parent's guide to disimpaction, we started the process immediately. The first time wasn’t as successful as we had hoped and the soiling continued. With advice from ERIC and the mums on the brilliant Facebook group “Movicol Mummies”, I realised we had stopped too soon and hadn’t kept Theo on a high enough maintenance dose after the disimpaction. In control and independent The second time we did things differently and we have never looked back. Just a month before starting reception and shortly before his fifth birthday, Theo finally knew when he needed the toilet and was able to take himself! School were brilliant when we met with them in advance of him starting and they were ready to support him in any way needed. Theo finally knew when he needed the toilet and was able to take himself! However I’m delighted that we have come so far over the last six months that he is able to manage his toileting independently and he has now been accident free at home and school for almost two months. He still takes two sachets of Movicol and a small dose of Senna daily, and will continue to do so for quite a while, but it’s such a relief that things are now under control. Trust your instincts My main message to other parents in a similar situation is to trust your instincts. If you know something is wrong then don’t let the professionals tell you it’s behavioural or, as one GP told me, that you’re being an over anxious parent. Also, be aware that children don’t always display the classic signs but that constipation it is almost always the reason for childhood soiling. Don’t give up. There is light at the end of the tunnel! If a child who is otherwise developing as expected hasn’t “grown out of soiling” by age four then it needs to be investigated. GPs don’t always know what to look for and can’t always feel if a child is impacted. Push for referrals, call the ERIC helpline, join support groups, educate yourselves and most importantly, don’t give up. There is light at the end of the tunnel! Resources and support: A list of peer to peer support groups can be found here. ERIC's parent's guide to disimpaction. Advice for children with constipation How to use macrogol laxatives NICE Guidelines on Constipation in Children and Young People (National Institute for Health and Care Excellence Constipation in children and young people: diagnosis and management - Guidance to support the early identification, positive diagnosis and timely, effective management of constipation in children and young people.) Stock images have been used for this blog.