PYAM offices will be closed from 10AM to 1PM on Wednesday November 15th for the funeral of Dr Terence Coyne.

Constipation

Definition

Constipation is often due to a diet that does not include enough fiber.  Drinking or eating too many milk products can cause constipation.  It’s also caused by repeatedly waiting too long to go to the bathroom.

If constipation begins during toilet training, the parent may be applying too much pressure.  Changes in the diet usually relieve constipation.  Sometimes trauma to the anal canal during constipation causes an anal fissure.  This is confirmed by finding small amounts of blood on the toilet tissue or on the stool surface.  Symptoms include:

  • Painful passage of stools:  The most reliable sign of constipation is discomfort with the passage of a bowel movement (BM).
  • Inability to pass stools:  These children feel a desperate urge to have a BM, have discomfort in the anal area, but are unable to pass a BM after straining and pushing for more than 10 minutes.
  • Infrequent movements:  Going 3 or more days without a BM can be considered constipation, even though this may cause no pain in some children and even be normal for a few.  (Exception:  After the second month or so of life, many breast-fed babies pass normal, large, soft BMs at infrequent intervals without pain.)

Common Misconceptions.  Large or hard BMs unaccompanied by any of the conditions just described are usually normal variations in BMs.  Some normal people have hard BMs daily without any pain.  Children who eat large quantities of food pass extremely large BMs.  Babies less than 6 months of age commonly grunt, push, strain, draw up the legs and become flushed during BMs.  However, they don’t cry.
Home Treatment 

Diet Treatment for Infants. 

  • If your baby is under 2 months of age, try 1 teaspoon of dark Karo syrup or 1 tablespoon of pear or prune juice twice a day.
  • If over 2 months old, give 1 ounce of fruit juices twice each day (pear, prune).
  • If over 4 months old, add strained foods with a high fiber content, such as cereals, apricots, prunes, peaches, plums, beans, peas or spinach twice each day.

Diet Treatment for Older Children 

  • Make sure that your child eats fruits or vegetables at least three times each day.  Some examples are prunes, figs, dates, raisins, peaches, pears, apricots, beans, celery, peas, cauliflower, broccoli, and cabbage.  Legumes like baked beans or black beans are also quite high in fiber.
  • Increase bran, because it is an excellent natural stool softener because it has a high fiber content.  Make sure that your child’s daily diet includes a source of bran, such as unmilled bran, bran flakes, shredded wheat, graham crackers, oatmeal, whole wheat bread or popcorn.  Other sources of fiber include benefiber and fibercon.
  • Decrease consumption of constipating foods, such as milk, ice cream, yogurt, cheese, bananas, applesauce, and cooked carrots.  High fat foods such as fast-food is also very constipating.
  • Increase the amount of fruit juices your child drinks.  Orange juice is not as helpful as the others, like pear and prune.

Sitting on the Toilet.  Encourage your child to establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.  Some children and adults repeatedly get constipated if they don’t do this.  If your child is resisting toilet training by withholding stool, stop the toilet training for awhile and put them back in diapers or pull-ups.

Gentle Laxative.  If a change in diet doesn’t relieve the constipation, give your child a gentle laxative, like 1 tablespoon of Miralax, with dinner every night for a week.  Miralax is not habit forming.  It typicalls produces results within 8 to 12 hours after it’s taken.

Measures for Acute Rectal Pain.  If your child has acute rectal pain needing immediate relief, one of the following will usually provide quick relief:  sitting in a warm bath to relax the anal sphincter, a glycerine suppository, gentle rectal stimulation for 10 seconds with a thermometer, or gentle rectal dilation with a lubricated finger.

Call our Office IMMEDIATELY if . . . 

  • Your child develops severe rectal or abdominal pain.

Call our office during regular hours if . . . 

  • Your child does not have a BM after 3 days on the new diet.
  • You have other questions or concerns.