Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|kami - Sat Sep 20, 2008 7:44 pm||
I 'm a very worried father, my 27 months old daughter has had chronic constipation for four months now. It started four months ago when she started having less frequent stools (before this she had always been very regular with one to two stools a day), she started having one every two days then three days and some of them needed alot of expulsive effort she cried a couple of times and regurgetated once or twice so we eventually (two months ago) started her on stool softeners (colace) wich had no marked effect then progressed to mineral oil (lansoyl), and also used lactulose wich all had no marked effect, as time went the stools got furtther and further apart. She gets frequent urges to go and actually puts alot of effort into it (and no she is not trying to keep it in) she does an exhaling moan while trying. We started using glycerin supositories and they seemed very!! painful but worked at first, after about 3 or 4 times with about 4 days between the treatments it stoped working so we had to go to the hospital for a peadiatric fleet. that didn't work the first time a second one was attempted 2 weeks after and was succesful she then had about 8 days of doing one stool a day she was also on lansoyl at that time. After 10 consecutive days of lansoyl she started getting stomach cramps so we stoped the lansoyl. She constipated for 4 days after then di 2 stools on her own, the second one she regurgitated while doing it. Now she hasn't done a stool in 6 days, we tried a fleet on day 4 and it did not work, she cramped and pushed for one hour, just a small stool came out and she vomitted 3 times in the process. Tonight on day 6 we tried a glycerin supository, and she could not keep it in it seemed very!!! painful and expuled it in a matter of a couple of minutes. I am very worried that this is something very serious as it seems to be getting worse week after week.
Please somebody give me an opinion on this!
Kami (I am a dentist so I have minimal medical knowledge)
|Debbie Miller, RN - Tue Sep 30, 2008 3:40 pm||
You haven't mentioned whether or not your daughter has been evaluated by a physician to see if there is any underlying physical problem. I also don't know if she has actually been potty trained at this point. Assuming you have ruled out physical concerns and she does use the toilet, it would be good to do basic bowel training for her. The laxative use itself can actually contribute to the problem as the bowel comes to rely on artificial stimulation in order to move but these can be used for a time and then gradually withdrawn until they are no longer needed. Continue to use stool softeners as they are not associated with dependency. It is also possible your child just isn't quite ready
Begin with dietary changes. You want to incorporate lots of fiber foods into her diet, including whole grains, fruits and vegetables with skins, nuts and cereals. Get rid of refined flours and starches. Avoid fast food and junk food. You may need to be creative in adding these foods to her diet.
She should also increase her water intake. Give her a sipping cup or bottle with a straw and take it everywhere you go; encouraging constant sips. The addition of prune juice is also important and children do drink this if the adults don't turn up their noses at it. The water can be flavored but avoid carbonation or caffeine. If she gets dehydrated the stool will be hard and dry.
Find a time 20 to 40 minutes after a meal to establish as allotted time for a bowel movement - the same time each day is best. The child should have plenty of time there but she should feel in control if she gives it a good effort but is not successful. It is important to do this but not something you are pressuring her about. It should be a relaxing atmosphere without pressure where she sits to allow the bowel movement even though she is not feeling the urge. She can "read" books or you can read to her or other relaxing diversions to make the time pleasant. Special books kept in the bathroom can be appealing. Books about potty activity can also be helpful. Stimulation with a lubricated child-size glycerine suppository is perfectly OK.
Consistency is the most important aspect of this activity. The child must know that every day at the designated time, there will be this chore. It should not be punitive since you want her to learn to relax her sphincter and evacuate the bowel. Anything that causes a tensing of muscles will not be helpful. Give her a small stool to rest her feet on during this time.
Exercise should be a regular activity. If you feel she is not playing outside enough to do lots of running and walking, find a way to do this every day.
These things should help her to be able to do this job but there may be psychological factors at play as well. It would be good to talk with her about her "poop" and how it wants to go to the toilet. It is her job to help push it out. When she complains of stomach pain, remind her gently that "it's the poop trying to get out - you can help." Her body is talking to her. Let her know that's what it is so she will recognize it. When she is successful, reward and praise her. Also, let her know that the other important people in her life also take time to use the toilet every day.
Keep in mind that it is perfectly normal for her to have a movement only 3 or 4 times a week, but she should practice this time daily anyway. It need not be a daily bowel movement to be healthy. However, the stool should not be hard and dry, difficult and painful to pass. If your efforts don't result in improvement over time, take her back to see her health care provider but it does take time to reverse this kind of problem.
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