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Have You Seen the Movie on Constipation?

Kelly Ochoa, MD

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Mastering the Art of Passing Stool Is Not That Easy

Have you seen the movie on Constipation? Neither have I, it hasn’t come out yet. I asked the librarian for a book on constipation. She said: “It comes out in a week or two”. Ok, ok, that’s enough. In all seriousness constipation is really a common issue for so many children. I would venture to say that in my experience, it is the most common reason children complain of abdominal pain. Constipation is having hard, dense stools that are hard to pass – often the stools are described as small pebbles or balls. Your child may be constipated and still stool every day, or may go 4 or 5+ days without a bowel movement. This is especially true in infants. A baby’s stooling patterns constantly change, and I often remind parents that it is not necessarily how often their child has a bowel movement, but the consistency and difficulty of passing the stool that constitutes a diagnosis of constipation. Constipation is not common before introducing solid foods, especially in breast fed babies. They can go a week without stooling and this can be normal. They often will appear constipated to a caregiver – grunting, face reddening, the facial grimace of straining – this can also be normal. It takes a lot of coordination for babies to get that stool out, and this process takes a long time to learn and master!

The Vicious Cycle

In older children, often a stool will be so hard that it causes a small tear in the child’s bottom as it passes through. This tear bleeds a bit, resulting in blood on the toilet paper or in the toilet water. This can be really scary for a parent (and a child!), but is incredibly common with constipation. Luckily that bottom area heals fairly well and fast, but this problem can cause a vicious cycle. If it is painful one time, often the next time your child needs to go number 2, they will hold it in because they’re scared it will hurt. The more the stool stays in the gut, the drier, bigger, and harder it gets, and the worse the constipation gets.

Encoparesis – Enco what?

This is a fancy medical term for severe constipation. Basically, the stool inside the rectum (the last part of the intestine before stool is released) gets super hard and dry and big and stuck. The rectum gets stretched and liquid starts seeping past and around this hard stuck ball of stool, and then leaks out into the child’s underwear. This can look like watery diarrhea, but in fact is the exact opposite problem. This can be very embarrassing for the child, as they are not able to control this leakage.

What Goes In Must Come Out

The first treatment for constipation is changing what goes into the gut – the child’s diet. One of the most effective and easy(ish) fixes is to increase the amount of water your child drinks in a day. Drinking plenty of water makes the stool softer and easier to pass. And, as we all know, eating foods high in fiber can help prevent constipation – but, as we all know, that is easier said than done in a picky eater. Blueberries, mangos, and pears with the skin on them are all high in fiber and tasty for kids. You can make smoothies with frozen strawberries, maybe even a little chocolate to sweeten a bit, and then hide a burst of fiber in that blender with some kale and ground flax and chia seeds. An evening snack of popcorn with your weekend movie can add some fiber as well. Beans and veggies are of course full of fiber, and if your child will eat those, then more power to you!

Medication – The Next Step

Sometimes diet alone will not suffice, and we need to add some medication to get your child to have softer stools. If you think your child is to the point of needing medication for constipation, I recommend talking to his/her doctor before starting any medication regimen. MiraLax is a common medication prescribed for constipation in kids. It only works when taken with a ton of water, as it works by bringing all of that water into the intestines to soften the stool. Glycerin suppositories are also commonly used to start things moving from the other end – they’re not fun, but will do the trick. Laxatives and enemas are less often used, and need to be recommended by a physician before using in a child.

Well, I am finally done writing about constipation. This one was a real struggle to get out.

Health-e Tip:

Constipation is not how often a child goes number 2, but rather how hard the stool is to pass and how dense and dry it is. Drinking plenty of water, and eating fiber can help with constipation. Sometimes medicine is necessary, in which case you should speak with your child’s doctor.