Children and Constipation

Constipation is one of the more frequent reasons for children to see a pediatrician.  This article will focus only on toilet trained children and adolescents with this problem

First, we need to start with a definition.  Normal bowel habits vary from child to child.  However, if more than three days pass between bowel movements and the stools are large, hard, and painful to pass,  you should consider your child constipated.  Most everyone will have brief periods of constipation often related to a change in diet, but if constipation becomes chronic and associated with abdominal pain, irritability, and poor appetite, consulting your physician is a good idea.

Second, it helps to understand normal bowel functions.  After we eat, our stomach liquefies food for the small intestine to better absorb the nutrients.  After about eight hours, what remains enters the large intestine, which compacts this liquid back into solid form (bowel movement) and stores the waste.  The last portion of the large intestine is the rectum.  When stool enters the rectum, it stretches this cavity giving us the urge to have a bowel movement.

This past point is very important because constipated children have persistent fullness in their rectum and, if chronic, no longer feel the urge to have a regular bowel movement (FUNCTIONAL MEGACOLON).  Sometimes a child will even leak stool around an impaction (soiling his underwear) giving the appearance of diarrhea.

Then why do things go wrong?  There are medical conditions that can cause chronic constipation. After discussing medical history and a physical examination, often including a rectal exam, your physician may wish to do some testing to look for thyroid problems, celiac disease, neuromuscular problems, perianal strep infections, or Hirschspung’s Disease.  These are all important but rare.  Usually chronic constipation is the result of the child holding stool.  This can be a manifestation of having a hard time with toilet training or fear of going in public, especially in school.

Now that we have some information about the how and why’s, what can we do to treat this problem?  The single most important factor for successful treatment is to understand that FUNCTIONAL MEGACOLON does not start overnight and it will take some time to improve.  Frequent contact after your visit with the doctor will be necessary to achieve successful resolution (most over the phone) and strict adherence to the treatment plan which will include three phrases: stool removal, stool softening for 6+ months, and re-training.

Let’s go through these three steps though every physician may do things slightly differently.

1)      Stool removal—Historically, pediatricians used enemas and suppositories for this phase.  Though that is occasionally still necessary, most of the time we will use Miralax at doses based on your child’s age and size.

2)      Stool softening—Stool softeners add water to the stool.  Again, we will likely use Miralax but in reduced doses.  In addition, dietary manipulations will be important:  increasing fluids, decreasing dairy and constipating solids like starchy foods, bananas, and apples, and increasing fiber (other fruits, veggies, bran).  This phase will last six to nine months.

3)      Re-training—It is time to re-train when your child can appreciate the urge to have a stool all the time and act on that urge.  Ask the child to sit on the toilet twice a day for 5-10 minutes and try to have a bowel movement.  They may go the bathroom additional times throughout the day when feeling the urge.  It is often necessary to practice in public.  We recommend taking your child back up to school after school hours and check out the bathrooms.  If there are problems with cleanliness, locks on the stall doors, or rules in the classroom to limit use of the bathroom, it is best to discuss this with your child’s teacher or principal.

Constipation is an example of a BIG problem for children that can be solved with a little knowledge about normal body functions and strict adherence to an agreed upon treatment regimen.  It does not start overnight and you will need to stay in contact with your physician to see it through.  All are glad when  this problem is put behind us.

By Dr. Richard Lazaroff, Esse Health Pediatrician
11630 Studt Avenue, Suite 200
Creve Coeur, MO 63141
Phone: 314-567-7337