The macrogol sachets might be called Movicol, CosmoCol or Laxido. Ensure macrogols are prepared correctly – see advice sheet How to use macrogol laxatives. You don’t have to give all the sachets at once – you can spread them out across the day. Some people mix the whole day’s sachets in advance and keep the macrogol water in a jug in the fridge, adding a bit to every drink and every suitable food. Just make sure it is all drunk within 12 hours.
The dose needs to be increased as above until all the backlog of poo is cleared. Although the dosing regime is written out over 7 days, that does NOT mean that disimpaction will only take one week. It will take as long as it takes to clear all the accumulated poo – and that depends how much there is, which depends on how long your child has been constipated! Listen to our helpline podcast Episode 6 - Disimpaction explained by a Paediatric Specialist Continence Nurse to hear what to do when it continues for a long time.
The only way to be sure disimpaction is achieved is to continue until your child is passing watery poo - i.e. brown water with bits in. You may feel worried about giving such large doses, but as long as you follow the regime you will not hurt your child. Macrogol laxatives are not absorbed into the bloodstream but simply ‘bind with’ the water and deliver it to the large bowel, where it will soften and lubricate the poo and stimulate a bowel action.
NICE Guidelines recommend adding a stimulant if disimpaction is not achieved after two weeks on macrogols; some doctors prefer to add the stimulant earlier. Stimulant laxatives increase the muscular squeezing of the bowel, speeding up evacuation. Because of the way they work, stimulant laxatives can cause abdominal cramps. The medicine prescribed might be called Senna, or Sodium Picosulphate, or Bisacodyl – or there are others. Your doctor or nurse will tell you how much to use.
What to expect:
Whatever laxative(s) is/are used, it is important to prepare yourself and your child.
- Lots of poo! The purpose of disimpaction is to clear out the backlog of poo; the child may poo a large quantity all at once, or several small poos. Because the dose is small to start with, it might take a few days to get going. If your child is still wearing nappies buy LOTS of nappies and wipes. If they use the toilet, warn other members of the family that the bathroom is going to be busy and stock up on toilet paper and moist toilet tissue.
- Soft/loose stools. You might see some lumps of poo, but don’t be surprised if it is all soft/loose – as macrogols deliver water to the large bowel any hard lumps will be broken down.
- More soiling. If your child is experiencing soiling (leaking poo into their pants) explain that this may well get worse to start with as first of all the poo will be softened, then evacuated.
- Possibly some abdominal discomfort. If your child has a tummy full of poo, then whatever laxative is used they should expect some discomfort as the poo starts to move along the bowel. Plenty of reassurance will help, and maybe a dose of paracetamol.
- Difficulty getting your child to drink all the macrogol. Some children do struggle, so before you start on the big doses do some experiments with your child to work out their preferred flavourings – and check the tips on How to Use Macrogol Laxatives. Make drinking it more fun with a new cup and/or a straw. Plan some rewards before you start!
What about school/nursery?
Because of all the pooing and the possible discomfort, your child won’t really be able to go to nursery or school during disimpaction. It may be that you can wait for the next school holiday. If not, you may like to ask your doctor or nurse for a letter to explain your child’s absence.
What to do once watery poo has been achieved
When your child’s poo has the appearance of brown bitty water on at least two occasions, the disimpaction regime can be stopped. If you are not sure if the poo is watery enough just keep going until you’re certain – you could try putting toilet paper down the toilet before they poo, so you can catch it and see it better. Another day of big doses won’t hurt your child at all. Stopping too soon means you might have to start all over again…
Laxative treatment does need to continue to prevent recurrence of constipation, and to allow the stretched bowel to regain its tone. Your child should therefore be given a maintenance dose of their laxative. NICE recommends macrogol laxatives: