Advice by Pediatric Conditions: Constipation
What Is Constipation?
Constipation can be defined as having hard stools that come out round often causing pain. Note, constipation is not infrequent stools. Skipping days between bowel movements is not a problem as long as the stools are soft and easily passed.
Why Do Hard Stools Hurt?
Having round hard stools means the anus may be stretched beyond capacity and this stretching is painful.
Treatment
Appropriate treatment depends on the age of the child (or adult).
First, if you have a newborn that has never had a soft stool within the first 24 hours after birth, you should have your baby checked in the office.
For everyone else treatment is divided between infants and non-infants.
Infants (before solid foods introduced)
- If your baby is breastfed and having hard stools, call the
office. Remember skipping days between bowel movements is not a problem and is normal – especially in breast fed babies that are 3 months of age. - If your baby is formula fed, add a water feeding (about 4 ounces) to the daily diet. If your baby doesn’t like water, add just enough table sugar so your baby willing drinks this. If that doesn’t stop the hard stools, call the office. We may want to add some prune juice to the diet or change the formula.
Everyone Else Older Than Infants
- First, stop giving constipating foods (like bananas, apples or
applesauce, rice or rice cereal and fatty foods). - Next, give prunes, peaches, pears, apricots and plums or
those juices. Sometimes you have to be creative to get children to consume these. (Some parents mix prune juice with 7-up to make the prune juice more appealing.) - In addition to foods you can give 1 capful of over-the-counter Miralax powder in 8oz of (any) liquid. You can give as many times per day as needed to soften the stool.
How Long Should You Treat?
Constipation is usually not a short term problem. It will persist until the situation that caused the constipation changes. Since the cause is usually some change in your child’s appetite/diet, the tendency towards constipation is going to be present at least until your child’s appetite/diet changes again.
What Can Happen If Constipation Is Left Untreated?
The biggest problem occurs when a child has had enough painful stools to fear the passage of the next stool. Then your child may try and hold the stool inside (to prevent the painful experience). This starts a vicious cycle. The longer the child holds the stool, the harder and bigger (and more painful) the stool will be when passed. That more painful passage reinforces the fear and the child tries (with more determination) to hold the stool inside longer the next time resulting in the stool being even more painful.
Further, it’s not unusual for this fear of passing a painful stool to lead to inability to relax and pass even a soft stool.
Consequently, children will try to hold soft stools when the memory of painful stools is recent. You can estimate that the length of time it will take for a child to begin to relax at stool, once they start having soft stools, is about twice the length of time that they had hard stools.
In older children (and adults) the desire to pass the hard stool will usually result in excess pushing. This increased pushing can lead to dilated blood vessels (hemorrhoids) around the anus that cause further pain (and swelling with blood clot formation) and bleeding.
When Should You See The Doctor For Constipation Problems?
If you can’t quickly control constipation using the above information, please call for an appointment.
