Sometimes constipation shows up as large hard stools that are painful to push out. Some children go days or even weeks between normal bowel movements. Some children with constipation have bowel movements every day. This can cause a lot of other symptoms in children especially abdominal pain nausea, poor appetite, soiling, poo accidents, blood in the stool and even bladder infections. Every child is different and not all children show obvious signs of constipation to their caregivers. This makes constipation a sneaky problem. Most often it has been going on a lot longer than we think, even for years.
In most cases the problem starts when a child is very young. Sometimes even less than one year old. What happens first is that a child passes the painful bowel movement. The child’s response is to hold the next poo in as long as possible to avoid any more pain. Since the colon is always sucking the water out of the poo inside, the longer a poo is held in the bigger and harder it gets. When the next poo finally comes out it hurts even worse. So the child holds the next poo in even longer. This makes the next poop even bigger and even more painful. This is the cycle of constipation.
Developing a habit of holding in poo creates a bad problem. Older children hold in poo to avoid using the school toilet or so they don’t have to stop playing. Some children show outward signs that they’re holding in their poop but others don’t. The problem with holding in poo too long is that the colon gets bigger and more floppy over time. It’s like blowing up a balloon and letting the air out over and over again. Some children pass very large poo that clogs the toilet. This is an outward sign of how big and stretched out things are on the inside. At this point children may not have a strong urge to go poo this is what makes constipation a sneaky problem. Your child can walk around all the time full of poo and ignore the feeling that the colon is full.
Constipation can get worse and worse over many years without the family even noticing. The colon is a muscle when it’s stretched too far it gets weaker. This makes it harder for a child to squeeze all the poo out. Some children may start to leak poo into their underwear without even noticing it. Small liquid poo can come out in between big hard poops. This is like water flowing around the rocks and a stream. Signs that the colon is full and overflowing include poo accidents or dirty underwear. So to summarise, chronic constipation happens when poo is held in over and over. The colon gets big and floppy. Your child walks around full of poo without feeling it and without a way to empty it.
The good news is that almost all of this can be fixed. It isn’t easy though and it takes a minimum of six months of treatment often longer. There are three important factors to treatment. Firstly, a colon clean-out, second, daily medicines to keep the poo soft, and third toilet time to retrain the body.
A colon clean-out is drinking large amounts of laxatives at home over as many days as it takes to flush out all of the food. The end result is liquid stool that is as clear as tea or urine. The other steps in constipation treatment won’t work if the colon isn’t clean. A child will need to be home from school because he will be using the toilet most of the day.
Many children have tried to clean out the colon in the past and failed. The biggest reasons why a clean-out fails are, not drinking enough laxatives, secondly, not taking laxatives for enough days in a row, and third, stopping laxatives before the poo is coming out clear. Do your best to take all the laxatives prescribed by your care team and keep going until the child is clean. Keeping the colon empty means taking medicine every single day to keep the poo very soft. When the colon stays empty for several months in a row, it can shrink back to normal size. Get it’s feeling back and get stronger. As this happens, other symptoms like poo accident, abdominal pain and blood in the stool will start to improve. This is the most important piece of treatment, Medicines for chronic constipation are only a short-term fix.
Your child needs to break any habit of holding in poo and relearn to feel when the colon is full and when it needs to be emptied. We do this with regular scheduled time sitting on the toilet. The body naturally wants to move things out of the colon after we eat a Meal. This is the best time to sit a child on the toilet. A child should sit for two to three minutes after every meal even if he does not feel the urge to go.
When a child passes a poo in the toilet we celebrate with him. The reward helps the brain rebuild normal feelings in the colon. Toilet time is a positive experience. A child should be praised just for sitting. A child should not be punished for not having a poo or for having poo accidents later. This only creates a negative experience and leads to more holding in. All the caregivers need to be on board with a plan. Nothing will work if one caregiver makes a child sit on the toilet after lunch while another always lets them go play instead. Remember there is no quick fix for constipation. A colon clean-out is an important first step. Without a strict long-term plan and a change in behaviour, the colon just keeps filling up and stretching out more and more.
Constipation can happen over years and can sneak up on families. It leads to a big and stretched out Colon that doesn’t work properly. It can cause abdominal pain, poo accidents and other symptoms. With a colon clean out over multiple days if it is necessary, daily laxative medicines to keep the poo soft and regular toilet time your child’s colon can shrink back to normal size and be healthy again.