Constipation in children can be tough to treat. By the time parents are aware their child is constipated, the problem may have been present for weeks or even months. Then, after home remedies fail, additional months can pass before help is sought from the child's doctor. Often it's years before the problem is properly dealt with.
What Is Constipation?
One definition of constipation is at least two weeks of hard, pebble-like, infrequent stools. It's usually, but not always, painful.
The Causes of Constipation
Over 95% of constipation is idiopathic. This means there's no definable medical cause for it. According to Vita Goei, M.D., a pediatric gastroenterologist at the Medical College of Georgia, there's a psychological component to most cases of childhood constipation.
"The kids may be anxious, have poor self-esteem, and be less able to cope with stress," said Dr. Goei. "But we really don't know which comes first, the behaviors or the condition. Behavioral abnormalities usually improve when the condition does."
There are many possible events that may start the cycle of reluctance to deficate that leads to constipation: physical illness, a stressful life event, prolonged defecation avoidance due to unfamiliar toilets found, for example, during traveling, or a scary experience or event related to toilet use. A frightening cartoon or movie showing monsters coming from a toilet can do it for some children. For others, using a loud automatic-flushing toilet may be the initiating event that leads to stool withholding and constipation.
Treating Constipation
The first step in treating constipation is exploring with the child any possible unpleasant or negative events that lead to a fear of using the toilet.
If none are found or, if found, they don't help alleviate the problem, then treatment begins with stool softeners and laxatives. Dr. Goei recommends an effective clean-out "from the top." She stays away from enemas. She recommends MiraLax, a osmotic agent that draws water into the stool, thus softening it. It's available only by prescription. Once the child is cleaned out, she recommends maintenance therapy with either MiraLax, mineral oil, or senna-containing products.
The first goal is attaining regularity. It may require up to six months of treatment with one of these products. The second goal is to increase the amount of fiber in the child's diet. She recommends 10 grams per day plus the age of the child. So an 8-year-old children should consume 18 grams of fiber per day.
Children can usually reach this goal with fruits, vegetables, and whole grain foods. There are many good fiber supplements (Citrucel, Metamucil, etc.,) that children can use. Another product Dr. Goei recommends is Juice+Fibre. It comes in 8-ounce juice boxes that look like regular juice.
Other Tips
Dr. Goei recommends the child's teacher be informed of the problem. During the treatment, children need fairly quick access to a toilet. Delaying will only add to the problems.
She also recommends good posture when on the toilet. This is feet flat on the floor and thighs parallel to the floor. Balancing on the toilet leads to tightening of the muscles that must be relaxed to have a bowel movement.
Enemas should be avoided. They provide a temporary solution to the blockage, but don't help soften the stool. The short-term results they offer are frequently offset by the trauma and pain they cause a child.
Successfully treating constipation takes time and patience. No child wants to be constipated nor suffer the associated pain or embarrassment.
Family Practice News, 11/1/03.
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