Macrogol sachets, known by brand names like Movicol, CosmoCol, or Laxido, are frequently recommended to manage constipation in children. It’s crucial to prepare macrogols accurately, and you can refer to the detailed advice sheet: How to use macrogol laxatives. Remember, you don’t need to administer the entire dose at once; you can spread it throughout the day. Some parents find it helpful to mix the day’s full dose in advance and store the macrogol solution in a jug in the refrigerator. This allows for easy addition to drinks and suitable foods throughout the day. Ensure the prepared solution is consumed within 12 hours for optimal effectiveness.
Dosage adjustments are essential to effectively clear impacted stools. Increase the dose as instructed until your child is consistently passing watery stools, indicating the backlog of poo is resolving. While the dosage schedule is often structured over 7 days, it’s important to understand that disimpaction may take longer than a week. The duration depends on the extent of stool accumulation, which varies based on how long your child has been constipated. For further guidance on prolonged disimpaction, listen to the ERIC helpline podcast, Episode 6 – Disimpaction explained by a Paediatric Specialist Continence Nurse. This resource offers valuable insights and support.
The definitive sign of successful disimpaction is when your child passes watery poo, often described as brown water with fecal particles. It’s understandable to feel concerned about administering high doses of laxatives. However, rest assured that following the prescribed regime is safe for your child. Macrogol laxatives work by drawing water into the bowel, softening the stool and promoting bowel movements without being absorbed into the bloodstream. They essentially ‘bind with’ water, delivering it directly to the large bowel to effectively soften and lubricate the hardened stool.
NICE Guidelines suggest incorporating a stimulant laxative if disimpaction isn’t achieved after two weeks of macrogol treatment. Some healthcare providers may recommend adding a stimulant sooner. Stimulant laxatives enhance bowel contractions, accelerating stool evacuation. Due to their mechanism of action, stimulant laxatives might cause abdominal cramps. Commonly prescribed stimulant laxatives include Senna, Sodium Picosulphate, or Bisacodyl, among others. Your doctor or nurse will provide specific instructions on dosage and usage.
What to Anticipate During Disimpaction: A Parent’s Guide
Whether using macrogols alone or in combination with stimulant laxatives, preparing yourself and your child for the disimpaction process is key. Here’s what you can expect:
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Increased Bowel Movements: Disimpaction aims to eliminate the accumulated stool, so expect frequent and substantial bowel movements. Your child may pass a large amount of stool at once or experience several smaller bowel movements. As the treatment starts with a lower dose, it might take a few days to see significant results. If your child wears diapers, ensure you have an ample supply of diapers and wipes. For toilet-trained children, inform family members that bathroom access will be frequent and stock up on toilet paper and moist wipes.
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Changes in Stool Consistency: Expect soft or loose stools. You might observe some formed stool initially, but as macrogols introduce water into the large bowel, any hard stools will break down. The stool will likely become increasingly soft and eventually watery.
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Potential for Soiling: If your child has experienced soiling (stool leakage) before treatment, understand that this might temporarily worsen. Initially, the stool will soften, making leakage more likely before the bowel is fully emptied. Reassure your child that this is a normal part of the process and will improve.
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Possible Abdominal Discomfort: If your child’s bowel is full of stool, some abdominal discomfort is expected as the stool starts to move. This discomfort is a sign that the laxatives are working. Provide plenty of reassurance and consider age-appropriate pain relief like paracetamol if needed.
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Challenges with Macrogol Palatability: Some children may resist drinking the macrogol solution due to taste or texture. Before starting high doses, experiment with different flavoring options to find what your child prefers. Consult the tips in How to Use Macrogol Laxatives for creative ways to improve palatability. Make drinking more engaging with a special cup or straw. Consider using a reward system to encourage compliance and make the process more positive.
Alt Text: A worried parent attempts to give medication to a reluctant child, illustrating the common challenge of administering medicine to children.
Managing School and Nursery During Disimpaction
Due to the increased frequency of bowel movements and potential discomfort, attending nursery or school might be challenging during disimpaction. If possible, consider starting the disimpaction process during a school holiday. If this isn’t feasible, you may need to request a temporary absence from school. You can ask your doctor or nurse for a letter to explain your child’s absence to the school. This letter will help the school understand the medical reason for your child’s absence and ensure appropriate support upon their return.
Transitioning to Maintenance After Watery Stools
Once your child has passed watery stools resembling brown bitty water on at least two occasions, the disimpaction phase can be concluded. If you are uncertain whether the stool is sufficiently watery, continue the high-dose regime for another day to be sure. You can use toilet paper in the toilet bowl to help visualize the stool consistency more clearly. Stopping disimpaction prematurely might necessitate restarting the entire process.
Following disimpaction, ongoing laxative treatment is essential to prevent constipation recurrence and allow the bowel to regain its normal function. Your child should transition to a maintenance dose of laxatives. NICE guidelines recommend macrogol laxatives as the first-line treatment for maintenance. Your healthcare provider will advise on the appropriate maintenance dose for your child to ensure continuedRegular bowel movements and prevent future stool impaction.
