Common Problems – Constipation

Constipation is another very common problem. Someone is constipated when his or her stools are much larger, harder (very), more difficult to push out, and/ less frequent than is normal.  Some have defined constipation as having fewer than 3 bowel movements weekly.

Constipation may occur when the large intestine (colon) takes in (absorbs) too much water leaving very hard and dry stools behind. It can also occur is the colon’s muscle movements are too weak or slow to move the stools along the colon before too much water is absorbed. Sometimes this occurs when one is sick and laid up in bed for a while. If fiber intake is low the contents of the colon have less bulk so the colon muscles have no real structure to push along. 

Sometimes all it takes is one hard painful stool or a child being punished for having an accident for the child to avoid emptying his/her colon. This usually snowballs because the next bowel movement is larger, harder and even more painful so there is even more avoidance. Some kids with severe constipation and distended colons and rectums have leakage of liquid stools into their underwear as the anal sphincter cannot function effectively from the rectal distension. We called this encopresis. It usually takes  3 months of lifestyle adjustments including intentionally scheduled daily bowel movements,  dietary adjustments and medicines to allow for the distended colon and rectum to return to its normal size. Parents should resist the urge to use suppositories regularly as this external stimulation shuts down the normal internal urge to go triggered by internal distension of the rectal walls.

Some recommended diet and lifestyle adjustments  include:

• Have regular bowel movements: go when you have the urge, if convenient, especially after meals.
• Regular exercise helps: often it is easier to have a bowel movement after working out.
• Increase fiber intake. A good guide is Age + 5 up 25. Fruits and vegetables are a good source.
• Limiting foods that are high in fat and low in fiber (fast foods, junk foods, and soft drinks).
• Drinking the required amount of calorie free liquid (at least half weight in lbs). Limit drinks with caffeine as they promote urination reducing body fluid so the colon would reabsorb more water.
• Dairy milk and cheese may cause constipation in quite a few kids. You may need to substitute.

• Sorbitol containing foods like apple juice, prunes, raisins, and papaya promote regular bowel movements.

In rare cases, constipation can be caused by an underlying problem that cannot be addressed by the steps outlined above only. They include:

• Problems of the intestinal tract, rectum, or anus (muscle problem, short bowel). 
• Nervous system problems, such as cerebral palsy.
• Endocrine problems, such as hypothyroidism, diabetes.
• Certain medicines, such as iron supplements, some antidepressants, and narcotics such as codeine.