Every person’s bowel habits are unique; a daily bowel movement may not be the norm for everyone. Constipation refers to the character and consistency of the stool rather than the frequency of bowel movements. Stools that are small, hard, and dry characterize constipation. Children will withhold stools because of discomfort from hard stool. Stool collects in the rectum and makes it even more difficult to pass. As the rectum stretches, sensation will temporarily decrease. Thus, constipation becomes self-perpetuating and often more severe with time.

Things to Know about Children and Bathroom Time

  1. A busy child may not take the time to go to the bathroom.
  2. Make bathroom time relaxed and unhurried.
  3. Keep special books in the bathroom for relaxation.
  4. If away from home, a child may not use bathroom facilities because of unfamiliarity or lack of privacy.
  5. Make sure that the bathroom is available for the child when he/she needs it. Discuss it with the teacher at school.

Helping Your Child Overcome Constipation

  1. Dietary changes – increase water intake, high residue foods (green vegetables, fruits), whole grains and bran. Reduce intake of cheese and milk, which may be constipating. It has recently been suggested that changing to a soymilk may be helpful for severe constipation.
  2. Retrain bowels. Encourage the child to sit on the toilet for 5-20 minutes after meals. If your child is a toddler and not completely toilet trained, put him/her back in diapers and eliminate all pressures.
  3. Laxatives will alleviate the pain that the child associates with stooling and give the stretched rectum time to return to normal size. This type of laxative use will NOT cause laxative dependence.
    • Milk of Magnesia ______ tsp orally at bedtime
    • MiraLAX _____ capful in 6 ounces of fluid each day
  4. Stool softeners are not laxatives. They work by pulling water into the bowel, preventing excessive drying of stool. They help the laxative do its job.
    • Benafiber _____ Tablespoon each day
  5. The goal is 1-2 very soft bowel movements each day. You may need to increase or decrease the above interventions to achieve this goal.

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Clean Out Regimen (if recommended)

Goal: Complete Evacuation of the Colon and Rectum. It usually requires 2-5 days to minimize cramping and pain when passing a massive impacted stool. Here are 3 options:

Enemas. Administer enemas at home each evening until your child passes a massive stool indicating that the colon is empty. The advantage of enemas is quick response, minimal cramping and predictable stooling time. Do not use more than 5 days. Avoid tap water, herbal, or soap suds enemas; these have been shown to cause water intoxication, bowel perforation, and other complications.

  1. Begin with a mineral oil enema – instill approximately 15 ml into the rectum. This will soften the mass and lubricate the intestinal walls.
  2. Wait 30 minutes and then give a Fleets’ Enema – use 59ml (it is sold as an adult dose of 118mlmor pediatric 59ml. We suggest you buy the adult size and only use half. You will use the second half the next day).

Oral. Magnesium Citrate 5 ounces twice a day for 2 days AND Ex-Lax Regular Strength Chocolate Squares – 2 squares twice a day for 3 doses (morning, night, morning)

Combination. Recommend doing on a day when there is no school. On this day, follow a full liquid diet (milk or yogurt, shakes, soups, juices, jello, applesauce)

AM: Give Ex-Lax Regular Strength Chocolate Squares – 3 squares prior to breakfast. Dissolve 4 scoops of Miralax (Polyethylene Glycol) in 4 cups of Gatorade, wait for it to dissolve and let your child drink 1 cup over 5 minutes every half hour.
4 PM: Administer one Liquid Glycerine Suppository (sold in a pack containing 4 small containers – not the solid)

Expect your child to pass several liquid stools during that day. If cramping occurs, get your child to lay on
the left side with knees bent and apply a heating pad to the belly.

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