Constipation

What is Constipation?

Constipation is often described as a decrease in frequency of bowel movements (BM’s). However the true definition of constipation is related to how much water is in your stool. For example, diarrhea is stool with too much water content as opposed to constipation which there is too little water in your stool. Often times when a person becomes constipated, their stools become hard and more difficult to pass.  In children, we find that they often do not want to go to the potty because it is difficult and sometimes painful to have a bowel movement. This only makes the issue worse and can lead to stooling accidents, often called fecal soiling or encopresis. (please see “Fecal Soiling” sheet regarding this condition).

How do I know if my child is constipated?

  • Hard stools- Often people will say that their child’s stools are very hard and sometimes small in the form of a ball.
  • Goes days without BM’s- A good rule of thumb is that your child should be having BM’s every1-2 days, if not daily.
  • Clogging the toilet- Many times parents complain that when their child goes to the potty they clog the toilet with large stools.
  • Stomach pain- sometimes when children are constipated, they will complain of increased stomach pain or cramping.
  • Poor Appetite- A child may actually have a decreased appetite after going several days without a BM. You sometimes notice that once the child has a BM their appetite improves.
  • Bleeding- sometimes blood will be seen on stools when a child with constipation is having to strain or push stools out. Usually these stools are very hard and can cause small tears (fissures) in the rectum.

How is Constipation Treated?

Constipation is treated in two basic ways, both with the goal of increasing the water content in your stool.
  1. Medication– The most commonly used medication is Miralax. This is a granular powder that is mixed into fluids and basically takes the fluid that you mix it in with and carries it to your colon, thus increasing the water content of your stools. In our office we often talk to you about titrating (adjusting) doses of Miralax to achieve a desired goal. The other medication that is commonly used is Kristalose. Kristalose is a synthetic sugar that is broken down in the colon and then pulls water from the body to the stool. Medication is considered the short term answer to your child’s constipation problems. In the long term, adequate fiber and fluid is essential to maintaining normal BM’s without medication.
  2. Fiber-Diet changes may seem difficult at first.  This will become easier once the medication begins to work and your child’s appetite improves with regular BM’s.  We have found through many years of experience that constipated children require about 1 gram of fiber per kg of body weight/day.  (Divide your child’s weight in pounds by 2.2 to get weight in kilograms)  In some cases, this may exceed the following Dietary Reference Intakes (DRI’s) for fiber:
Click here to view or print  a chart with Fiber Recommendations.
  • In our practice, you can expect to be given individual guidance to gradually improve your child’s fiber intake based on lifestyle and other factors.  In most cases fiber supplements are not necessary.  They also can be expensive for the amount of fiber they provide.
  • Fluids- In constipated young children, it is not uncommon to find that they are drinking more calories than they are eating from solid foods.  This problem makes it more difficult to get enough fiber.  Getting too little fluid can also be a problem.  In fact, increases in fiber intake without enough fluids can make constipation worse.  We will assist you in making sure your child receives the right types and amounts of fluid.
  • Record Keeping- you will be asked to complete a 3-day food record and a daily stooling record between visits.  Using these tools will greatly increase your child’s likelihood of success in our constipation program.