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Macrogols
What are Macrogols?
Macrogols are essentially laxatives. Your child will have been prescribed them for constipation. Large doses are required when your child has become impacted with poo, then a smaller maintenance dose will be needed to manage the constipation. Your child will remain on this maintenance dose of Macrogol for a minimum of 6 months, and then is decreased at a very slow pace.
Macrogols usually go by their brand names, including: Movicol, Cosmocol and Laxido.
How do they Work?
The active ingredient is actually the water you mix it with. This water cannot be absorbed through the bowel wall, so it stays inside the bowel essentially making the poo inside wetter and, in turn, softer.
Macrogols come in sachet form and must be mixed with PLAIN water before being taken. Macrogols work as a "binding with" medicine and will only work if mixed with plain water. (62.5mls for every sachet.) After this, they may be added to any other liquid your child may like.
How Long Will My Child Take Macrogols?
Each child is different and therefore the time they need to take Macrogol sachet will vary. Most children need to take them for many months or years. A minimum of 6 months is required of "type 5" stools passed every day will be required before decreasing the sachets.
We generally say that your child's constipation history will likely mirror the length of time Macrogol sachets will be required.
Please bear in mind that every child is unique and it is important to go at their pace and confortability.
Your child's dose will likely change a lot over their constipation journey. If their stools are too dry and hard, then the Macrogol sachets will increase. Too wet and runny will result in a decrease of Macrogols. Continued observation of your child's stools is extremely important so that you can adapt their medication as soon as a change occurs.
Stimulants
What are Stimulants?
Stimulants are medications that encourage peristalsis to stimulate the gut to have a bowel movement. Stimulants essentially encourage the bowel muscles to contract, moving the poo along the large intestine and towards the anus.
Stimulants are used alongside laxatives, which will have made the poo soft prior to beginning the stimulant.
The ideal time stimulants are introduced are when your child already has been on a Macrogol and their stools are soft, but they are still not reliably pooing, or are still actively with-holding.
Stimulants we use within our service include Sodium Picosulphate, Senna and Lactulose.
What Time Should You Give Stimulants?
Stimulants take approximately 6-12 hours to work, therefore the time of day your child takes their stimulant will depend on how their bodies react to the timeframe required for the stimulant to work.
We generally advise parents / carers to give their child a stimulant before bed time. This will hopefully ensure they will not poo during the night, but will likely open their bowels in the morning.
As with Macrogols, Stimulants largely depend on your child's reaction to them and how long it takes to become effective for them.
How Much Should My Child Take?
Our nurses will have provided you with a tailored stimulant regime as part of the treatment for your child's constipation.
Unlike Macrogols that are mixed with water, stimulants are given directly from the bottle in small liquid volumes. Typically, doses are as follows:
Sodium Picosulphate
Children aged 1-4 years: 2.5 - 10mls per day
Children aged 4-18 years: 2.5 - 20mls per day
Senna
Children aged 1 month-4 years: 2.5 - 10mls per day
Children aged 4-18 years: 2.5 - 20mls per day
Lactulose
Children aged 1 month-1 year: 2.5mls twice per day
Children aged 1-5 years: 2.5 - 10mls twice per day
Children aged 5-18 years: 5 - 20mls twice per day
Disguising Macrogol Sachets
At a Glance...
Macrogols Work By:
Adding water to the child's bowel. The medicine cannot penetrate the bowel wall, so it stays inside, making the hard stools softer and wetter therefore easier for the child to pass.
Stimulants Work By:
Making the muscles of the bowel wall work more effectively, t]so that the stools are moved along the bowel quicker. This also helps to keep the stools soft.
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