Let’s Talk About Constipation

Constipation can be a source of great discomfort and can be a source of self-injurious behaviors, teeth grinding, night-awakenings, bad gas, bloated or a big belly (the “pregnant belly” look), and just irritable and cranky behaviors.  It is NOT an option to ignore and MUST be addressed in every age child.

Constipation in our children can be simply defined as not completely emptying the bowels daily. We need to consider that having a bowel movement every other day or once a week is indeed constipation.  One can also be constipated even with a bowel movement every day. If the body makes for example, eight inches of poop a day, and six inches per day is removed with each bowel movement, then two inches of stool per day will keep accumulating. Parents will say, “There’s no way he can be constipated. He’s pooping once or twice a day.” The important question is, “Is he eliminating all of the waste material when he has a bowel movement?”

Constipated stools vary in their presentation from child to child.  Some can look like little rabbit pellets or can be huge grapefruit-sized poop that will not flush down the toilet.  All the while one wonders how a four year old was able get that huge mass of stool out of his or her little body.

Strange smelling stools including particularly foul smelling stools and unusual colors of stools  such as green, tan, white, yellow, and even orange are clues that digestion and bowel motility, the movement of the stool through the colon, are not working properly. Another problem here is that the stool material is decomposing organic material that is kept warm, moist, and dark.  It quickly becomes fertile growth material for bacteria and yeast.

Our children are not digesting and absorbing foods well, so even more proteins, fats, and sugars become available to be used as “fertilizer” in the stool.  The breakdown of proteins by bacterial organisms is called putrification, where we get our word, “putrid”.  The stools have a very putrid smell.  If the bowels are moved regularly and completely then the overgrowth of putrefying bacteria will be kept at a minimum.  If not, many untypical bacteria and yeast will proliferate inside your child’s colon, which creates a situation commonly referred to as dysbiosis.  Many parents will confess that they just want to take off all the clothes and the diapers and take them right out of the house and into the trash can. They do not even want to wash the clothes. There are other types of bad smelling stools that do not quite smell that bad.   Some stools can smell like a bakery, stale beer, or even have what has been described as a chemical smell.

What if my child has both, constipation and diarrhea that seem to alternate?
Actually, this can be a COMMON way of a child with constipation presents to the clinic.  The diarrhea merely represents fluid stool that goes around the large “rocks” of stool and leaks out the anus.

My child doesn’t have any problems with constipation, if anything, he poops too much:
Large amount of daily stools indicate one of two things. Either the child is consuming too much food daily or the child is not able to digest and absorb the food that is consumed.  Very often, these children are not growing well and not gaining weight.  The proteins, fats, and carbohydrates are not being broken down and absorbed and end up in the colon feeding the bacteria and yeast and waiting for elimination.   This too, can back up causing constipation.

Helpful Tools for Alleviating Constipation
Alleviating constipation is quite a long process and may take up to 6 months!  This time is required to allow the dilated colon to shrink back down to its normal size.
Methods to help a child overcome constipation vary and are best done with the input of a physician who recognizes the importance of normal working bowels.

Enemas: a first line intervention to help remove large amounts of stool in the later third of the colon.  They often are available in infant, children, and adult “sizes.”  Younger children are more tolerant of the insertion process than older.  I do not recommend using force in older children…this step may just have to be by-passed in favor of an oral approach.  Giving one enema daily for 5 days can really help with moving the bowels, especially when combined with an oral agent.

Glycolax (Miralax®): this is a terrific stool softener that is non-addictive.  It mixes well in drinks as it is colorless, odorless, and tasteless.  I will use a smaller dose twice daily as opposed to a larger dose once daily.  It is very gentle and does not seem to cause any significant cramping.  Your physician can help give you dosing guidelines (perhaps a call to the nurse and she can find out for you).  Note: this is a corn derived product, so if your child has corn sensitivities or allergies, it may be best to avoid this.

Pedialax Chewables: this is Magnesium Hydroxide and is a great alternative for a “chew” that some children will consider these watermelon flavored laxatives as candy.

Kartzinel Health Fiber®:  I always recommend adding fiber to our children’s diet.  This is a wonderful fiber that is colorless, odorless, and tasteless.  Fiber can promote better bowel movements.  Dosing ranges from ½ tsp twice daily to 2 tsp twice daily (maybe more for bigger kids).

Vitamin C:  High dose vitamin C will help to move the bowels as well.  Usually 2000mg or more are required to induce bowel movements.  This is a great way to keep bowels moving when a long term treatment plan is indicated.  Please keep in mind that when using large amounts of vitamin C, it is important to use one that is buffered, so as not to hurt the stomach.

Magnesium Oxide:  Magnesium is also of great benefit to help with bowel movements.  This too, can be given daily, usually in doses between 200mg – 600mg.

Oxypowder®:  This is a capsule and the typical dose ranges from ½ capsule daily to 2-3 caps daily.  This supplement is usually very successful for long term management of chronic constipation.

George’s Aloe®: 1-4 oz per day of this colorless, odorless, and tasteless product from the Aloe Vera plant.  It promotes healing to the gut membrane.

Kartzinel Health Enzymes®: If malabsorption is contributing to the large amount of stool being produced, it is important to consider using a Digestive Enzyme with each meal and snack.

And that’s my approach to the management of constipation.