How to treat at home and when to seek medical guidance

Posted May 2, 2017By Tania Haas, Staff Writer

To this health writer’s surprise, constipation is one of the most common issues that Dr. Joseph Wiley, a paeditrician at Medcan, addresses with the parents and children he sees. He explains that constipation can be underrecognized and undertreated leading to abdominal pain, appetite suppression, social isolation and family conflict. The longer children struggle with the problem, the more severe it can become, both behaviorally and physiologically.

It’s normal for a child to have irregular bowel movements – just don’t wait too long to address it. In extreme cases it can affect the functioning of the colon or the development of encopresis, when diarrhea escapes around the compacted colon, leading to “accidents”.

Below, Dr. Wiley answers common questions:

What is constipation?

Constipation involves infrequent, difficult, painful or incomplete bowel movements. Children have different patterns of passing stools from several times a day to once every few days. If your child’s pattern has changed or slowed, they may be constipated.

Functional constipation is when the child intentionally withholds feces to avoid going to the bathroom because of things like pain, distraction, embarrassment or a preference to use the toilet at home. Two key stages in a child’s life are particularly prone to functional constipation: toilet training and during the start of school.

What are the signs of constipation?

Parents of younger children can monitor bowel movements with diaper changes and trips to the potty. Less obvious symptoms including ​squatting, rocking, walking stiffly on their tiptoes, crossing their legs or sitting with their heels pressed against their perineum. Large, firm, or pellet-like bowel movements may indicate your child is constipated. Other cases may include severe intermittent abdominal pain and general discomfort.

How can constipation be resolved at home?

Talk about it

Dr. Wiley believes parents and older children benefit from a clear understanding of the mechanism of the digestive system. Dr. Wiley uses infographics to explain. For older kids, you want to create an environment where they can talk about it, or they won’t.

Establish, and monitor, a new routine

Behavioural intervention helps children get over their anxieties (i.e. a fear of public bathrooms or going to the bathroom at school) and learn new habits — parents and caregivers can use charts to monitor progress and practise positive reinforcement when children take medication or sit on toilet for a specific time everyday. A footstool may be necessary so the child can effectively apply intra-abdominal pressure. Scheduled toilet sitting after breakfast and dinner can take advantage of a normal body reflex and assist in developing a healthy bowel routine.

Follow food and drink recommendations

In most children, constipation is caused by issues with bowel routines or diet. Ensure your child is drinking enough fluids, eating enough fibre from whole grains or cereals, fruits and vegetables; and limit junk food or other foods that promote constipation. Some children experience intolerance to cow’s milk and may experience associated constipation.

Don’t avoid over-the-counter aids

While sorbitol found in prune, pear and apple juices can help, sometimes stool softeners are the best treatment to retrain the colon’s conditioned reflex. Stool softeners can be safely used as a preventive tool, and in some cases are more effective than behavioural changes alone. Dr. Wiley says PEG3350 without electrolytes (Lax-a-day or RestoraLax) is safe for daily use at recommended doses. The effects typically start within the first week of treatment.

Some parents are concerned that these aids are addictive or will make the bowel ‘lazy’. Dr. Wiley explains that stool softeners such as PEG3350, are largely unabsorbed by the body, do not make the bowel contract and are safe for long-term use.

When should parents seek medical guidance or treatment?

Constipation in infants should be discussed with your paediatrician. In older children, treat the constipation immediately with guidance from your doctor if diet and behavioural techniques do not work. Regular follow-ups to monitor ongoing laxative or stool softener use are usually necessary. In many cases, stool softeners need to be taken for months or years to promote soft daily stools.

The following signs or symptoms should prompt medical assessment: abdominal pain associated with fever or significant weight loss; blood in bowel movements; a distended, rigid, painful abdomen; episodes of bilious (dark green) or bloody vomiting.

Constipation is a common issue in children and many pharmacologic and non-medical interventions are available. Dr. Wiley recommends discussing your concerns with your paediatrician, who can offer support through education, treatment strategies, and follow up. They can also screen for less common causes of constipation that may relate to underlying conditions.