Bowel problems are common in childhood. Constipation can start at any age and is common at potty training. Understanding the issues will help you to support your child or young person.
Constipation can cause lots of different problems, these includes delay in toilet training, reluctance to use the toilet, withholding poos, lots of loose poos, infrequent hard poos, accidental soiling, pain when having a poo.
All children with a bowel problem, including those who have additional needs, should be offered an assessment and treatment, a childs additional need or disability should not be assumed to be the cause of difficulties with their bowels.
Two charities can support giving lots of additional resources and offer helplines in regards to bowel issues
Childhood Constipation is managed in Gateshead in the community, supported by family GP following Constipation Pathway for primary care
If there are no improvements in the child constipation symptoms after two weeks of macrogol disimpaction regime, bowel stimulant medication are prescribed.
Daily maintenance laxatives, which may include a combination of Macrogols and simulant laxatives continue to be used until regular bowel habit, toilet training is well established and child is symptom free.
Bowel medication is gradually reduced which may take weeks or months for chronic constipation.
However if the child has no improvement of their bowel symptoms after the disimpaction of the bowel and following 3 months their individual bowel medication plan the family GP will refer to Gateshead community nurse-led children’s bladder and bowel service for continued management in the community.
About the service
The service consists of a team of specialist children’s nurses who support individuals with bladder and bowel problems, where primary advice and intervention by GP, health visitor, school nurse or other health professional has not been successful.
We offer a confidential, friendly service, undertake a comprehensive assessment, which may include investigations such as stool samples, urinalysis, ultrasound scans, physical and abdominal examinations.
We provide a programme specific to your condition in order to promote continence. This may include self-help advice, medication, equipment or toileting aids.
Who do we see?
We see children 1-19 years old, who are registered with a Gateshead GP who commonly have concerns such as:
- Constipation
- Soiling
- Stool withholding
- Day time wetting (over 5 years old)
- Nocturnal enuresis (bedwetting)
- Overactive bladder (urine urgency/ frequency)
- Those needing specialist support to achieve their toilet training developmental skill
Our Team
Michelle Newton
Children’s Bladder and Bowel Specialist NurseRachel Doherty
Children’s Bladder and Bowel Specialist NurseHow to be referred to the Bladder and Bowel service
Each referral is triaged to ensure the child’s condition meets Children’s Bladder and Bowel Service criteria. If your child does not meet the service criteria the family and child’s GP will be copied into a letter which is sent to the referrer with information detailing alternate services and support.
If a child meets the service criteria the family are asked to attend a two hour ‘Adult Information session’ prior to being seen. Attendance at this session is essential in order to understand bladder and bowel health and conditions that can occur. If the family choose not to attend the session, then the child will be discharged from the service. A letter will be sent informing the GP / referrer that the family has chosen not to attend.
After attending the information session, the family and child are expected to follow all advice given in the session for a minimum of 8 weeks. If after 8 weeks the child continues to experience on-going bladder and bowel problems with no signs of improvement, then the family are required to contact the service to opt in and request an initial face to face appointment. If no contact is received from the family to request an appointment after 12 weeks, then the child will be discharged from the service. A letter will be sent informing the GP / referrer.
How to opt into this service after referral
Each referral is triaged to ensure child condition meets children Bladder and Bowel Specialist service criteria. If your child does not meet the specialist service criteria the family and child GP will be copied into a letter which is sent to the referrer with information of alternate services and support.
If child meets the service criteria the family are asked to opt into the service by attending a two hour ‘Adult Information session’. If family do not attend the session or contact Bladder and Bowel service the child will be discharged from service informing GP and referrer.
After attending the adult information session the family and child are expected to follow all advice given in the session for minimum of 8 weeks
If after 8 weeks the child continues to experience on-going bladder and bowel problems, with no signs of improvement, family are required to contact Bladder and Bowel service to opt into the service and request an initial face to face appointment.
If no contact from family to request an appointment within 12 weeks the child will be discharged from the service informing GP and referrer.
What you can expect at your appointment
A specialist nurse will take a medical history and comprehensive assessment of the child and the family. Information will be taken relating to fluid intake and toileting habits of both the bladder and bowels to give an accurate history. This will include daytime and night-time habits to give an accurate history. The assessment will give the nurse an insight into how best to manage the symptoms and develop a programme of care. It is essential that you bring your child’s assessment charts to every appointment.
The nurse:
- Will undertake physical examinations where appropriate. This may include abdominal examinations and bladder scans. Urine and stool specimens may be required to reach a diagnosis or explore differential diagnosis.
- Will provide health promotion advice and individualised information and update treatment plans and medications in order to achieve healthy bladder and bowel habits.
- May prescribe continence aids to assist the child’s condition or may prescribe disposable containment products for children who have a neuropathic bladder/bowel condition.
- May prescribe disposable containment products for children over 5 years old who have an underlying medical reason for not being able to attain continence. These children must have engaged with an individualised targeted toilet skill development programme for 6 months and not shown any improvements. Targeted toilet skill development programmes and disposable containment prescriptions are required to be reviewed annually as a minimum. This is to assess the child’s development and progress and ensure the appropriateness of disposable containment products before the prescription continues.
Review appointments can be either face to face or telephone appointments. Referral to other Health and Social Services can be supported if appropriate. The child may be referred on to a Paediatrician for further treatment or discharged back to the care of the Health Visitor / School Nurse for ongoing care.
Patient Information
- Children should NOT attend Accident and Emergency Department in hospital for treatment and management of constipation.
- Attend Accident and Emergency Department only if your child is acutely unwell.
- Bowel symptoms may include:
- increasing abdominal pain
- increasing abdominal distention
- vomiting and unable to tolerate oral fluids
- reduced urine output
Cancelling your appointment
- If need to cancel or rearrange a child’s appointment, please call the service as soon as possible. This service complies with the Gateshead NHS Foundation Trust Policy ‘Safeguarding Children’. Any nonattendance to a child’s appointment will result in a ‘Cause for Concern’ being completed and may result in a referral to social services being made.
Toilet Training
Support for Children at School
Continence Aids
Useful Resources
Useful Websites
- Bladder and Bowel UK
- The Children’s Bladder and Bowel Charity
- Growing Healthy
- Colostomy UK
- Mitrofanoff support
- Down Syndrome UK
- Shine Charity
- ERIC
How to contact the service
Monday to Friday 8:30am – 4:00pm excluding Bank Holidays
The Gateshead Local Offer brings together information for children and young people aged 0-25 years with special educational needs and disabilities (SEND) and their families.
This includes information about services and support, and advice and guidance on education, health, social care and transport.”
Gateshead Local Offer SEND 0 to 25 Years – Gateshead Local Offer SEND 0 to 25 years (gateshead-localoffer.org)