Constipation
Constipation Basics
- Constipation is a very common pediatric condition characterized by changes in stool frequency and character that may cause abdominal pain, pain with bowel movements, changes in appetite, blood streaked stool, stool accidents, withholding behaviors and other symptoms.
- There are numerous interconnected causes of constipation. Some of the most typical causes include: diet, hydration status, recent gastrointestinal infections, stool withholding behaviors, muscle tone, and many more.
- Constipation tends to be a recurring condition. It is important to build in preventative treatments to break the cycle.
- There are several medications options for treatment of constipation:
- Natural treatments - Certain fruits and fruit juices like prune and pear have a high natural sugar content which pulls water into the colon and acts as a natural stool softener.
- Osmotic Laxatives- Medications like Polyethylene Glycol (Miralax) or Magnesium Citrate (Milk of Magnesia) work just like prune juice by pulling water into the colon and softening stools. This tends to be a safe and gentle way to relieve constipation with the only notable side effect being diarrhea.
- Stimulants - Medications derived from the Sennakot plant (Senna, Ex-Lax) stimulate muscle contraction in the colon to help push poop through. These can cause cramping so they are often used in conjunction with stool softeners.
Constipation Treatment:
- Clean-out regimen: If your child has symptomatic constipation, the first goal of treatment is to clear the colon of the large bulky stools that are causing symptoms. Your provider will outline a high-dose regimen of one or a combination of the medications above. This regimen will vary from child to child, but the end result should be frequent liquidy stools indicating a clear colon and a fresh start.
- Maintenance regimen: Once the colon is clear, the next goal is to prevent constipation from recurring. This is done through daily, preventative treatment with one or more of the medications above. The regimen will again vary from child to child, but the goal is to produce a soft, easy to pass stool every day. This regimen is important to give the colon a chance to heal and reset to its normal function. This ‘reset’ can take up to three months and your maintenance regimen should be continued at least that long.
- Prevention:
- Diet: There are no specific foods that cause constipation but maximizing natural fruit sugars and fiber
- Hydration: The MOST IMPORTANT thing to prevent constipation is to stay hydrated. More water = softer stools which are easier and less painful to pass
- Toilet posture: Potty stools can help relax the muscles in the bottom and allow for easier passage of stool.
- Consistency: Constipation is a recurring condition and prevention is the best medicine. Be consistent with your 'Maintenance Regimen' and the tips above to prevent constipation before it starts.
- Behaviors:
- Limit 'withholding behaviors:' Encourage your child to use the bathroom with the first urge to poop... even if it is at school! Withholding makes stools harder and bulkier and can start a problematic cycle.
- Scheduled bathroom time: For young children or children who don't recognize the urge to stool, scheduled potty time can help. Your colon is most active about 20-30 minutes following a meal. Put your child on the potty during this window to give their colon a chance to clear and give them a chance to learn their body’s signals.
When to seek care:
- If your child develops bloody stools, cannot pass a bowel movement, or has severe abdominal pain, seek care right away.
- If your constipation regimen is ineffective after 2 weeks of consistent use, make an appointment with your pediatrician for evaluation
- Constipation is often a chronic condition. It is important to keep any recommended follow-ups to stay on top of your medication regimen
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