A Nutrition Thing: The Manufacturing of Movicol Mum Guilt

A few weeks ago, Jennifer and I were planning topics to write about in the newsletter. She asked me if I’d noticed that there seemed to be a lot of kids on laxatives, and yes, I had noticed that. I’d noticed in WhatsApp parent groups and overheard other parents discuss it in the queue for pickup and heard friends discuss their kids’ disimpaction schedules. Jennifer and I weren’t the only ones to notice this. The Guardian reported last year that there has been a 60% increase in children admitted to hospital with constipation over the previous decade. That sounds bad. But when you dig into the numbers, these cases of constipation are incidental findings, meaning they’re secondary to the reason for admission. Still, that didn’t stop The Guardian wading in with their trademark brand of sanctimonious hand-wringing. ‘While constipation is known to be a common problem in children’, writes education correspondent Sally Weale, ‘teachers say they are being asked to administer more laxatives like Movicol which have been prescribed by GPs to their pupils’. The article goes on to speculate as to why this could be. Changes to diet, exercise, and lack of water were offered by one primary school headteacher as explanations for the increase in constipation and therefore laxative use in schools. Lack of health visiting appointments, food poverty, and dirty school toilets were also cited in Weale’s piece. As was the statistic from the children’s bowel and bladder charity, ERIC, revealing that in a survey of 900 secondary schools, 48% of children did not have free access to the toilet; aside from anything else this is a children’s rights issue. 

ERIC also states medication use, stomach bugs, neurodivergence, pain, psychological distress, toilet training, and changes in routine as possible contributing factors for constipation. When I asked for people’s experiences on Instagram, I was offered lots of theories. ‘Isn’t it because they aren’t eating enough fibre and too much ‘beige’ carb heavy foods?’, ‘really common when potty training – is it fear of the toilet?’, ‘I think early potty training and pressuring to use the toilet can be a big factor’.

I checked in with CIHAS Medical Correspondent and bona fide GP, Dr. Hammad. ‘Anecdotally, I have noticed that parents are consulting more often about constipation, perhaps due to greater awareness that laxatives need to be prescribed first-line, and doctors are prescribing macrogols such as Movicol more consistently as a first-line treatment.’ Macrogols belong to a group of laxatives known as osmotic laxatives; they work by drawing water into the bowel, making stools softer and easier to pass. The most well-known of these is the brand Movicol. The vast majority of constipation is functional, meaning there’s no underlying pathology and we don’t always know why it happens. 

‘I almost never see laxatives such as Lactulose or Senna being prescribed as the first-line anymore, or parents just given diet and lifestyle advice, whereas this used to be a lot more common 10 years ago.’ Dr. Hammad tells me. ‘This may represent a lag in clinical practice catching up to the guidelines/evidence base.’ He also has a theory about how there has been a shift in how we access health information, with most people having already looked up their child’s symptoms on the NHS website and more awareness that they need to speak to a GP and ask for a laxative prescription. Parenting WhatsApp groups and social media might also contribute to this.

But this left Jennifer and I both floored. It seems obvious and intuitive that diet and hydration should be first-line treatment, right? Get them a cute water bottle to take to school, switch to wholemeal bread for some fibre, bung some prunes on their porridge to get the bowels moving. That could help, right? Why are we going straight to medication without first of all trying to manage through lifestyle changes? Surely that’s outrageous?

The thing is, it turns out that prunes are not the one.

Dr. Hammad pointed me to NHS guidelines for managing constipation in primary care. ‘Diet and fluid adjustments do not break down hard faeces and there is evidence that constipation is unrelated to diet and fluid intake in about 59% of affected children’ (emphasis mine).

The reasons why children develop constipation are multifactorial, therefore it stands that changes to diet might not be the only, or even best solution. 

Yet, there’s a perception that parents are being fobbed off by their GPs: ‘My experience of GPs is that they don’t know what to do BUT prescribe laxatives. Nothing else’, read one comment. ‘GPs less than zero help’ read another. This was my impression too; I was somewhat belligerent to Hammad when he told me he didn't really look at diet changes. But I’m starting to change my mind.  

Laxatives are safe and effective, yet, from what I’ve gleaned from Instagram and various WhatsApp groups, there seems to be a reticence to use them, even after parents have gone to the trouble of getting them prescribed. ‘There is no evidence, as far as I know, that the appropriate long-term use of laxatives causes harm to proper bowel function. But delaying or not starting treatment can and does cause harm,’ Dr. Hammad told me.

Ok, say more…

‘If left untreated, constipation can lead to abdominal pain, anal fissures, haemorrhoids, faecal impaction, soiling, stool withholding and difficulties in toilet training, megarectum (exactly what it sounds like), amongst other short and long term complications.’  Yikes.

As I was initially thinking about writing this piece, I figured it would be a straightforward download of how we can support children with constipation using gentle nutrition and hydration. And honestly, that would be the easier road to take. But it occurred to me that there’s something more interesting going on here that’s worth unpacking: Movicol Mum Guilt.

Of course, mum guilt is ubiquitous. It’s a byproduct of intensive mothering culture; an ideology that demands mothers are the primary carers of their children and stipulates that mothers must consider their children priceless. It dictates that mothers must ‘utilize child-centred, expert-guided, emotionally absorbing, labor-intensive, and financially expensive childrearing methods’. Sounds familiar, right?Intensive mothering culture creates the avatar of a ‘perfect’ mother; an impossible ideal that no human could ever live up to. But that doesn’t stop us trying; most of us, whether consciously or not, are striving to achieve the unachievable. And it’s in the gap between what we perceive a ‘good’ mother to be, and what we are actually capable of, that mum guilt manifests.