The mechanics of treating chronic constipation.

The Mechanics Of Chronic Constipation – And How To Treat It.

Theoretically, it’s so simple! Get Clean and Stay Clean!

1) If there’s backed-up stool in the rectum or colon: clean it out.
2) If there’s an impaction that isn’t easily shifted: persevere and clean that out too.
3) Then don’t let it happen again!

In practice, it can be far from easy, so it’s good to understand why.

(This post explains the mechanism for clearing and treating chronic constipation. If you’ve noticed one of my early warning signs, please don’t panic!

Here I’m relating what I learned while treating my impacted child. It took us 4 doctors and 18 months to finally understand the severity of the problem and embark on a proper treatment plan. It then took months to get back to anything resembling normality, and years of vigilance to stay one step ahead of a relapse.

Staying ahead of the condition for my other children is a far cry from that experience. Paying attention to their poop schedule, adding laxative fruits to their diets as needed, knowing when to insist on more water, and flushing with a laxative if we stray into ‘worrying’ symptoms – these are all very quick fixes.)

Impaction

Chronic constipation is a build-up of stool in the rectum or colon. It’s something that happens gradually, so by the time you get ‘proper’ symptoms – like encopresis (leaking poo) or enuresis (wetting) or those awful sticky stinky poops I talk about here – the poop that started it all has been stuck in the bowel for a very long time. It’s been compacted into a dense ball with age-old poop in the middle and fresher poop stuck around the outside. And it can be bigger than you think possible (after 6 months of laxatives and cleanouts the impaction in my 4 year old’s rectum was still the size of a grapefruit).

The impaction is stuck; Wedged in a tube that doesn’t have the muscular strength to dislodge it. And it’s a compounding problem because the more the bowel stretches, the weaker the muscle tone becomes.

Backup

Then there’s the other problem caused by the impaction: the backup.

If you imagine your gut as a motorway, the impaction is an accident blocking all three lanes and the only way around is to creep along the hard shoulder. Just like traffic would pile up behind the accident, poop piles up behind the impaction – and that’s the backup.

Now, in the traffic analogy, police would clear the accident and traffic would flow again – but that’s not usually how bowel cleanouts work. Flushing from above (by taking oral laxatives) is like opening another lane. All the backed up cars can now maneuver past the accident, but those three lanes are still blocked.

It’s an easy mistake to clear the backup and think you’re done. But if your child is going to heal, it’s really important to completely clear the impaction too.

The After Effects

When both blockage and backup are cleared, you might think you can relax – but again it’s not that simple!

The muscle that once housed so much poop remains stretched and weak – like a balloon that has been inflated and then let down. It can take a long time to return to a tight, springy, healthy state – and it’s not something it can do by itself.

Without help, fresh poop that reaches the stretched section of the gut will get stuck – because the bowel is too saggy to move it along properly. And we all know where that leads..

If this has been going on a long time, all of the rectum and part of the colon will have been stretched to some degree – by either the impaction or the backup. So there might not be much ‘normal’ sized bowel left at the end of the digestive tract, to keep things moving.

That’s why phase two of the treatment “Stay Clean” is not as easy as it sounds.

This is where you’ll hear of long term laxative use, and perhaps be confused by it.

Stimulant and Osmotic Laxatives

You’re likely to come across two types of laxative when treating chronic constipation: Stimulant laxatives and osmotic laxatives. (See the NHS laxative pages for more information.)

Stimulant laxatives act on the wall of the gut and cause it to contract – pushing all the contents forward. This is how peristalsis works, but stimulant laxatives give a lot of extra oomph!

If you don’t have any experience of different types of laxatives, these are probably the kind that you think about- the stuff of cartoons and comedy scenes. (Don’t worry – if you use them to help your child, you won’t be aiming for anything like those extreme reactions!)

Simulant laxatives can be helpful when the muscle tone is so weak that you can’t clear the remains of a blockage, or can’t keep stool moving swiftly enough through the bowel to ensure a poo every day, or you don’t have any involuntary ‘push’ to get all the waiting stool out of the rectum.

Examples: Senna and bisacodyl are stimulant laxatives. Senna is sometimes used during the ‘maintenance’ phase of a cleanout (i.e. when you’re keeping the bowel moving and empty so that it has time to shrink back and heal) – often in conjunction with an osmotic laxative.

Osmotic laxatives cause your gut to retain water. That’s all they do.

One of the functions of colon is to dry out the stool, i.e. extract water back into the body to be regulated and excreted as urine. Osmotic laxatives prevent water from leaving the gut and draw water from the surrounding tissue into the stool.

(They do this by changing the osmotic potential of the liquid in the poo. Essentially, the poopy water contains a high concentration of laxative, the body notices and water enters the bowel to dilute it. When the laxative is consumed with lots of water, the water stays in the bowel because it has a higher concentration of laxative than the surrounding tissue.)

This has two important effects:

1) It keeps the stool soft (and can be taken in different doses to vary the consistency from ‘soft but formed’ to ‘liquid’)

2) It bulks up the stool (i.e. makes it bigger)

PEG3350 (branded as movicol or miralax) is a very popular osmotic laxative – prescribed for both cleanouts and maintenance.

Lactulose is also an osmotic laxative, as is sorbitol – an indigestible sugar similar to lactulose that occurs naturally in apples, apricots, gooseberries, grapes (and raisins), peaches, pears, plums, prunes, raspberries and strawberries.

The role of laxatives in treatment

1) Cleaning out a soft backup.
High-ish doses of an osmotic laxative will turn fresh poo moving through the gut into poo soup. This soup has two functions:

a) To flush any loose stool along with it
b) To soften anything that’s too big to be swept along

For the laxative to do its job, you need to be flushing fluid through the colon. If you’re trying to clear a backup with a maintenance dose of laxative you’re not going to get very far! A maintenance dose is enough to bulk up the stool while keeping it soft – but it’s not going to dissolve or flush anything…

2) Clearing an impaction
This takes longer, because the impaction needs to dissolve in the poo soup. If the soup is too thick, rather than dissolving the impaction, it will coat the blockage with another layer of fresh poo. Not at all what we’re after!

The impaction has probably been around for months (or years) and will be very dense. It’s not going to dissolve easily. You need to flood it with fluid that’s as close to water as you can get and ideally you want it to sit there a soak for a bit. Even then it can take days to see the first breakdown products come out: dark gritty poop that stinks to high heaven.

I know what you’re thinking… “Wouldn’t it be better to use actual water, rather than poo soup?” And you’re right! That’s why enemas are so effective (and not nearly as scary as you probably imagine – especially if your only point of reference is the old Carry On films.)

A micro enema comes in a soft squirty bottle that is smaller than your smartphone. It takes a few seconds to administer and a few minutes to work. But it can only work on an impaction in the rectum – it won’t flush anything backed up in the colon.

3) Keeping the rectum and colon empty during the ‘saggy balloon’ period.

With the impaction and backup cleared you move into the maintenance phase: i.e. maintaining a clear bowel.

At this point, bulking the stool is just as important as keeping it soft.

If you’ve just completed a clean out, you’ll be anxiously looking for signs that the bowel is healing. Does your child poop every day? Are they responding to their body’s messages (i.e. do they seem to be holding or not noticing when they need to poop?)

Unfortunately, neither efficient peristalsis nor stimulation of the rectal nerves is likely to happen with just one day’s worth of poo if the gut is used to accommodating several weeks’ or months’ worth at a time…

A maintenance dose of osmotic laxative bulks the poop out enough for it to ‘touch the sides’ so the gut can practice working properly. Without that bulking agent, one day’s worth of poop might be too small to be moved properly by peristalsis, get stranded, and have to wait around until it’s big enough to be squeezed along. Any poop left stranded in the colon would get dehydrated (that’s the colon’s job) so you’d end up with smaller denser poop by the time it reached the rectum.

You want to avoid this!

Which is why long term laxatives are prescribed – and why you need to remember to keep taking them (even if the idea of being on long term medication fills you with horror). If it helps, try not to think of it as medication, so much as a crutch. You’re not altering the way the body works, just giving it a chance to work with what it’s got.

Don’t be fooled by the wrong type of fibre

It took me a long time to understand the fibre dilemma, so I’m going to outline it here. Hopefully you’re more clued up than I was and this is old news!

There are two types of fibre: insoluble and soluble. You want to focus on soluble fibre.

Until we were at least 6 months into treating the constipation, I equated ‘roughage’ (as my mum used to call it), with fibre.

Bran, brown bread, brown rice, fruit skins, vegetable skins – these things meant fibre to me and are often listed as helpful when treating constipation in adults.

So, when faced with chronic constipation, I assumed that kind of fibre was going to be a big part of the solution – even though we already ate everything in that list.

But it turns out, too much roughage isn’t helpful at all. You need some – yes – but keep an eye on it! Too much causes big poops and stretches the gut that you’re trying to shrink.

Everything I listed above contains insoluble fibre.

What you really need, in the aftermath of chronic constipation, is soluble fibre. Soluble fibre acts like an osmotic laxative, drawing water into the stool to bulk it up while keeping it soft.

For soluble fibre you need porridge (oatmeal), nuts, beans, apples…

So when I thought I was helping by giving my 5 year old shreddies for breakfast, I really wasn’t. Porridge would have been a much better idea.

(That’s one of the things I do now, actually. If I spot any warning signs, porridge becomes the breakfast staple for a while. Then, when things are ticking along, the kids get more choice again.)

Nerve Damage and Self Initiation

Unfortunately, it’s not only muscle tone that is affected by stretching the bowel. You also need to deal with nerve damage.

If your child was leaking poop, or had crumbly poop falling out of them, or completely stopped self initiating (taking themselves to the toilet without prompting from you) – it might have been due to nerve damage in the rectum.

Nerves in the rectum, near the sphincter, fire when the rectum stretches – to tell the brain that there’s a poo waiting to come out.

If the rectum is always stretched, those nerves stop firing. Your child might lose sensation altogether (be unable to feel when they need to go and not notice when a bit of soft body temperature poop leaks out). They might also lack the cues that help them ‘push’ to help their body poo (and their stretched impacted rectum can make pushing ineffectual anyway).

The nerves can take a long time to heal. So if you’re certain your child is clean but they’re not self initiating as you expect – consider the physical reasons for that before jumping to behavioural conclusions (hates the bathroom, is frightened of the potty, is too lazy to go etc).

Withholding Habits and Leaking Poo

If your child has a holding habit, it might be due to the type of poop that was always ‘knocking at the door’. The anal sphincter can tell the difference between solid, liquid and gas waiting in the rectum. Solids give you plenty of warning, liquids cause a clamping of the sphincter to keep them in, and gases can be released.

In some cases of chronic constipation, poop always arrives in the rectum very soft – because there was no space in the colon for it to be processed properly and it had to squeeze past the large blockage. The sphincter goes into ‘liquid panic’ mode and clamps shut. This should trigger your child to race to the toilet, but if it doesn’t… the sphincter muscle stays clamped tightly shut. If it’s clamped for long periods of time every day it can get tired – so tired that it doesn’t close properly in it’s default ‘relaxed but closed’ state.

A tired sphincter can cause problems long after the bowel is apparently back to normal – with small unexpected leaks at the first sign of soft poop for several months or years.

(This is one of the reasons that finding a good maintenance dose of laxative can be tricky. Too much and the soft poop leaks out, too little and there’s not enough bulk to trigger the daily bowel movement. Again, enemas and suppositories can really help with this.)

What if you’re in the early stages?

If you’ve experienced some of my early warning signs and are worried that you might be at risk of developing chronic constipation – don’t be alarmed by what you’ve read here. The difference between early warnings and the full blown condition are like chalk and cheese.

Clearing a large impaction and allowing the gut to recover – that takes time and treatment.

Clearing the beginnings of a backup that hasn’t had time to impact, or hasn’t reached a problematic size – that’s not nearly such a big deal. Cleaning out will be quick and easy. If the gut has only been stretched a little bit and not for very long, then staying clean will be more about monitoring your lifestyle and diet than anything else.

Diet and Food Intolerances

If your child has a problem with constipation and you know it, then you’ve probably already looked at their diet. Hopefully they’re eating plenty of fruit and vegetables and not too much processed food. You might also have added in a few extra sorbitol containing fruits and some soluble fibre foods for good measure.

But do you need to consider ‘special’ diets?

Should you go dairy free? Or gluten free? Or both?

You’ll find plenty of internet advice that recommends restricting your diet for good gut health, but when I took my daughter to the consultant and asked about this he couldn’t have been less interested.

So assess your situation on its own merits and do what you will. You can get tested for celiac disease (gluten intolerance) but read up on it first so that you know in what circumstances the test works best.

I know of parents who swear that taking probiotics or eating natural yogurt makes a daily-soft-but-formed poop massively more achievable. I know other parents who have tried this and not noticed any miracles.

Whatever you try to tinker with, keep in mind the aim of the game: Clear the backup, clear the impaction, don’t let it happen again.

Remember: Any change in diet only counts towards preventing a relapse.

Don’t use dietary changes to try to manage the chronic constipation you’re facing right now. Use a proper cleanout regimen. And if your child was impacted, don’t rely on diet to control the immediate aftermath of the cleanout. Make sure you have an alternative plan in place to keep the bowel clean and empty while it shrinks back to size.

Relapses

Unfortunately, relapses are very common.

In his book “It’s no accident” Dr Hodges says 50% of patients relapse. On the internet groups I’ve participated in, relapse is always under discussion.

Relapse can mean one of two things:

1) The cleanout wasn’t 100% effective so stool backed up again
2) You didn’t manage to stay clean even with a clean start

Take a deep breath and start again.

Get support from anywhere you can find it, but especially your doctor. Parents who have been through the same thing will have a huge amount of empathy – and also inspirational tales of what life is like on the other side.

Keep Going!

Your child needs your help.

Signing Off…

I know this blog needs better links to other resources. I’m publishing it now so that anyone following this series has my story to use as a springboard for more research. I’ll try to come back and update it over the next few weeks.

If you’re worried this is the beginning of a long road for you, spend an evening reading Dr Hodges blog over on www.bedwettingandaccidents.com. Bear in mind that all his patients come to him with urinary problems, but he treats them for constipation. You might not see any urinary symptoms but that doesn’t make his treatment plans any less helpful.

I hope this was purely of academic interest and you’re not actually dealing with chronic constipation (keep an eye out for these signs to keep it at bay).

But if you are, I wish your child all the very best for a speedy recovery.

Get in touch via the comments below, or email me: jenn@bornready.uk

Happy Pottying!

– Born Ready Jenn.

P.S. You might also be interested in the first two blogs in this series:

Part 1: Are there risks to ec / baby-led / early potty training?
Part 2: How to prevent chronic constipation in potty using toddlers

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The Comments: Your Turn!

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  1. Hi I have an issue related to this topic. My daughter has had chronic constipation for a while now and been through several clean outs. She started to see a gi specialist end of last year while the clean out was doing well at that time in April she started to have unexplainable symptoms started by spitting up small what looked like blood clots then chocking complaining of not being able to breath than legs giving out dosing off out of nowhere twitching of limbs head then to top it off slurring words. Not on specialist could find any reason for this. The only thing different in that I could think of was the amounts of miralax she was prescribed to take. Later looked an article on side effects and saw several of her symptoms. Asked doctors about it and they say it was unlikely to be the cause. Has anyone experienced anything similar?

    1. I’m sorry this has happened, Tracy. It must have been very worrying for you.

      I’m afraid I’ve not heard of symptoms like this related to constipation or miralax (but my experience is limited to my own personal experience and reading forums and social media posts from parents in a similar position). If the side effects are listed on a medication then someone has experienced them… but whether that’s the cause in your case would be up to the doctors to diagnose. I know there are facebook groups dedicated to miralax experiences and side effects so if you can get onto one of those it would be worth asking.

      You can carry on with clean-outs using micro enemas and very minimal doses or miralax (or another stool softener) – and should even have a higher chance of prolonged success (according to Dr Hodges research).

  2. ..Hi All,

    I want to say this is an awesome post. Thank you Jenn for this. I really thought I was clued up on this issue.

    My son (Tyler) is now 4 and has had this issue of faecal impactation from the time he was 3 days old! YES 3 DAYS.

    After numerous visits to the emergency rooms and paeds we finally consulted one of the top gastro specialists and she gaves us a strict routine to follow. We did a clean out and it happend only on the tenth day. What a relief.

    Unfortunately the maintenance was not fully explained and we have been giving him pegicol on a regular basis to keep his stools soft and moving along. Now Tyler has relapsed very badly and we are back to the clean out phase.

    After reading this post I now have a better understanding of how the rectum, colon works.
    Armed with this info I am sure we will be able to better treat and manage his condition.

    Thank you again.

    1. Hi Lee,

      I’m so sorry you’re going through this with your son. Maintenance can be so much more difficult than you’d think :( Unfortunately it’s easy (and demoralising!) to slip back into impaction, even when you know exactly what you’re looking for. Best of luck with your latest clean out – hopefully it won’t take 10 days this time!

  3. This has been very helpful. I have a handicapped son, wheelchair bound….constipated all the time. I think this last time was a doozy though. I believe we achieved clean out with magnesium citrate. Four days ago, lots of diarrhea and a day prior to that, golf ball sized compacted stool. But since then, only a couple of smears in his diaper. In your experience, after a clean out has there been a couple days with no significant stool production? I am continuing with Miralax once a day, but maybe I will try a laxative today. We have an appointment with GI on Tuesday.

  4. My sister, age 76 has chronic constipation. The impacted bowel pushed on her stomach which pushed on her diaphragm made a hernia her stomach got caught in and strangled then went up and pushe’d on her lung and deflated it. Major surgery!! Lost half of her stomach in surgery. Now she is struggling to eat and to keep pooping. Has had one emergency visit to hospitalk since coming home for constipation. Is Miralax the best thing for her to take? What foods?

  5. Such a helpful blog. Thank you. My 5 year old son has suffered for ages. GPs just told us he was withholding, and a specialist said he was allergic to dairy. He was put on lactulose when he was 3 which was awful, didn’t help at all but made him very tired. Movicol really helped and he was put on a maintenance level. I slowly took him off, and I keep his diet very healthy (he loves fruit and vegetables). I’ve been trying to work out why he lapses every couple of months. I now realise he’s just never really got over it and he needs a maintenance programme.

    1. Hi Beverley,

      Yes, there’s such a high relapse rate that a some sort of maintenance program can be helpful – even if that’s just you checking that he does a poo every day, and stepping in to help him if he doesn’t (with a suppository, or a dose of something to keep him moving).

      I like supps when you feel like you *ought* to be out of the maintenance phase because they’re so instant. If you use an oral dose of something, then the bowel is stretching until the bulked up poo reaches the rectum, but with a suppository you’re clear in 5 minutes and still follow up with a oral laxative if you like.

      Good luck – and well done for keeping an eye on it. It’s wonderful that he has such a healthy diet, but unfortunately it’s not always enough when the bowel hasn’t fully recovered its elasticity.

  6. I have been having the exact same problem with my son he was regular until the age of 3/4 and then it all stopped we took him straight to the doctors who assured me that it was his diet and that once a week or longer could be normal for his body.

    At the age of 6 he became very ill (not related to the constipation) after 3 trips to A&E they finally gave him an X-ray after we got upto the room they said his lungs were all fine but that his bowel loops were higher than normal and they were twisted and to go back in 3 days to see the surgeon finally I thought we had a breakthrough and things would be sorted ( oh how wrong I was) within those 3 days he was slowly deteriorating finally the day came to see the surgeon we arrived at the hospital the surgeon wasn’t there and had cancelled our appointment but when he was checked over they finally could see he was getting worse and took him for another X-ray still the problem with bowel loops but they found he had pneumonia in his left lung and immediately admitted.

    After 2 long weeks he was finally well enough to go home and we was to wait for our next appointment with the surgeon which was 4 months later. He sat me down and said it was his diet and no further action would be taken and he would not X-ray him again as bowel loops tend to move around and they were probably in the right place now!!!!!

    So we changed all his diet and still we had the same problem it didn’t help at all. Another few months later we went back to doctors and was told same thing change his diet and that was it no tests or anything. After another change in diet and a year later he was still the same still blocking the toilet and going once a week/ fortnightly.

    I made another appointment and refused to take no for an answer we got referred to hospital and was given movicol 2 sachets a day and keep going back every few months.

    After a year of this and still hardly any change I asked for another X-ray which showed a large amount in there so upped his dose to 3 a day. Another 6 months passed and they stayed again still showning he’s very full and feeling that it’s very large when they press down.

    A few months ago he started vomiting no signs of illness just random sickness sometimes straight after food sometimes a few hours after and anything from all day to once a week it’s all very random.

    He turned 12 2 weeks ago and yesterday we were finally given some hope. They said after years of him having chronic constipation and the movicol not helping at all he’s now developed faecal impaction been told to give him 8 sachets yesterday 12 today and 16 tomorrow fingers crossed this works but how long should I leave it if it doesn’t work and it still won’t clear??

    What are the next steps to take After this weekend and the 36 sachets he then has to have between 2/6 a day until we see her again in may. And also could this be the cause of the vomiting too?? He also had his bloods done yesterday mainly for thyroid and cealiac disease and tested for glucose in intone which came back clear

    1. Hi Kelly,

      I’m so sorry this has been going on for so long. Your poor lad.

      Hopefully you’ll make some progress now that you’re treating the impaction. I would stay in weekly or fortnightly contact with your GP if you can. As you know, it’s a very lonely time and it’s so so so easy to slip back towards impaction without realising it.

      After such a long time, you might need a strict maintenance routine to ensure your son ends every day with an empty bowel. Can you ask him to help track how much he produces each day? (How big the poo was – use playdoh to help visualise so you both know what you’re talking about, and what consistency – use the pictures on the Bristol stool chart.) It’s going to seem weird to start with, but having a record will help both of you track what’s going on.

      You need a full day’s worth of poo to come out of him every day. It’s tough to monitor, but getting a feel for it will help in the long run – and I’m afraid he might be in it for the long run, now.

      If you’ve never considered ‘bottom-up’ treatments to help with maintenance, they can make everyone’s lives easier – especially as he’s old enough to handle them himself.

      I hope he’s feeling better very soon, and you get some insight from the doctors on his other issues too.

  7. Hi there so glad to have found this blog post as feel I’m going insane with constipation in my 18month old son. A couple of key questions. How can I tell for sure he is impacted? What are the definite signs. He only goes about twice a week and spends most of the time in between trying to go and suffering. When he does go it’s with huge pain and crying and calling mama for help. It’s awful to watch. The stools are always hard and compacted. Of course I do use wipes but you hardly need to as the stool is so hard and clean it leaves no marks. How do you advisee to get the meds into a child so young. With lactulose we needed to give up to 30ml to see any difference. It was impossible to get that much into him. He is still a baby and just refuses to.open his.mouth or spits out. Then we were advised to try movicol but I can’t get him to take that either. He doesn’t like juice of any kind as I never gave it for tooth related reasons so I can’t disguise the taste. I’ve tried different cups and kids water bottles but no avail. I’m getting so worried I won’t be to fix this without being able to give him.meds. thanks

    1. Hi Anne Marie,

      I’m so sorry to hear you’re going through this, and apologies for missing your comment when you posted.

      I think the lactulose having such a little effect is a sign that something isn’t quite right. Lactulose is a stool softener, it’s never going to shift any kind of backup – especially if you can’t get your son to drink it (I know how hard this is :-( ). Hopefully you’ve been back to your GP for other ideas?

      One thing you can do is increase your son’s fluid intake alongside the medication. Sometimes a straw, or a new sippy cup work well as incentive to keep drinking. Watermelon (or any kind of melon!) is a good way to get water into him. Some toddlers like ice cubes or ice lollies.

      Some kids will copy you, so if you drink they’ll drink – out of toy cups, or big mugs or anything different where they’re joining in. Rituals work well – so every time you sit down to eat, you both get a cup of water to drink first (for example). Some kids drink *loads* in the bath if they’re given a tea set to play with…

      It’s so hard… I hope your doctor has been helping you. I do wish you all the best.

      Jenn.

      1. My son was the same I couldn’t get him to drink water or juice one day he got the hold of his sister small bottle of Robinson fruit shoot he started drinking it so he likes sports bottle type

  8. My son is 9 and is a cancer survivor. He was born with a neuroblastoma. When he was five he began catheterizing and then had a bladder augmentation at age 6. He has always had problems with constipation, though doctors don’t know if this resulted from the cancer (location of tumor and surgery) or a separate issue. We saw GI for two years but nothing came of it. We are back to seeing GI again to try and find some help.
    Jenn, if you get this message I sure could use some more advice and would love to know more about Dr. Hodge’s and where he is located. I live in the US. I will be reading the links you sent on him next. Thanks for all of the information. Prayers for all of you who struggle or who’s children struggle with this problem.

  9. Wow what an insightful read after months of suffering. I have just been told my 8months son has no faecal movemenet through xrays. I have been breastfeeding for six months nothing else and my son has never had a daily pooping routine. Going forth and backwards with doctors telling me its normal for an exclusive breastfed baby. At 6months appointment and at start of solids , i screamed at my doc to demand why is my breadtfed baby pooping pellets. Only then he authorised for xrays. He is on pegicol and have it was going soo well was giving him 2sachets a day for 7days upped the dose to 3sachets for one day then back to 1sachets. At one sachet i can see the stool getting a bit hard again. He has also not been able to self initiate (partly) although i could notice that he tries but once i insert a cotton bud to trigger he would go within seconds. I assist him daily either with supposites or ear bud to get him to a regular state.He is promising but in not sure how i can manage this condition with un clued doctors. Im not even sure when i will stop giving him the pegicol as he is soo young. I would also like to prepare food and maintenance plan please help.

  10. Hi there, I have a 3 year old who has been having ongoing problems since turning 1. only going for what I’d call a ‘normal’ poo every month, if that. The rest of the time there is constant smearing. She is on lax sachets from pediatrician, but we are struggling to find the perfect dose. Is this type of laxative a stimulant which will help pass the blockage also? We just feel like we are in a viscous cycle and feel so much for our little girl!
    This article was great, the most I have understood the issue, even after two years of pediatrician visits!

  11. Hi There, fantastic article, very informative! My 22y/o son who has severe Autism, constipation begun at 13y/o&ongoing, severe faecal loading epis every yr, currently dealing with one atm, GI increased his Movicol (similar to Mirilax) from 2 sachets to 4 & Lactulose from 15ml to 30ml daily, this isn’t working so a new GI suggested we do a bowel prep b/c he’s seriously backed up. What did you mean by “(It’s not going to dissolve easily. You need to flood it with fluid that’s as close to water as you can get and ideally you want it to sit there a soak for a bit)”. Much appreciated

  12. The way that you explained things was very helpful. My 11 yr old became ill 2 and 1/2 months ago and was having severe right abdominal cramping. After lots of tests his GI says he is chronically constipated in the right bowel. We just finished our 3rd clean out in 2 weeks. He does great for a couple of days and then the severe pain reoccurs. My GI office has been great and keeping close follow up. I am waiting on a call back and was told they may add Senna to his maintenance dose of miralax. I have made an appt with behavioral help to help him learn techniques to deal with the pain but couldn’t get in for 2 weeks. This has been a long process and has been stressful for us all. Missing school and work. I just need someone that has been there to tell me there is an end in sight…

    1. Hi Trisha, my 8 year old was diagnosed with bowel impaction 6 weeks ago after severe abdominal cramping. He is on a daily dose of parachoc & movicol & usually clears his bowels daily now. Problem is that he’s still in lots of pain, particularly at night. we keep getting told that it can take months for the pain to go. Did your son experience ongoing pain even after he started clearing the impaction?? Thanks

  13. Hi wow this us informative my 13yr old gas suffered constipation on and off for 2 yrs after visit to consultant found impacted all over bowel… So started oral massive doses of laxatives but just hot diarrhoea overflow about 5 times a day for 7 days then admitted to ward for klean prep via nasal tube poop was in the stomach and on her breath… Now 7 days of klean prep later nil by mouth other than flavoured water for glucose and 2 enemas still no movement only yellow water….. I’m loosing the plot doctors are liaising with gi surgeons at another hospital but u wouldn’t put ur dog thru this I’m not sure what to do next tbh!!

  14. Sincere thanks and appreciation for an informative and plain language blog! My 3 year old daughter has suffered from constipation since she was an infant. I consider it to be hereditary, with my mother’s side of the family always having struggled with digestive issues, including longer than normal colon and thus the stool having a longer journey to travel and associated increase in transit time. I had my daughter on 250mls prune juice daily from age 2 1/2 to age 3. When she finally potty trained when she turned 3 a few months ago, it became apparent I had to do more from her. Seeing her bm sitting in the potty, I realized how incredibly (and overly) large a stool she was having to pass (upwards of 5 or 6 centimetres in diameter). Even though the prune juice made it quite soft, it was still an incredible amount of stool for a small girl. I tried a daily dose of PEG the past few weeks, only to realize I was being too conservative with it (the PEG was basically having the same result as the prune juice, where she would have a soft BM, but a very large amount, and only every 3 or 4 days). So I am now in full-on “clean out” mode. I’ve achieved the soup-like consistency you speak of above on a daily basis for the past 5 days. Not fun. My question is: how do I know when we can start to back off… I don’t believe she is impacted. I am thankfully on maternity leave with a younger babe right now, meaning I can keep my daughter home from daycare until she has her daily blow-out, at which point I put her in the tub, put her underwear on and allow her to start her day fresh. It definitely interferes with “life” and activities, though…at what point can I start to back off with the high dose of PEG (I would say I’m giving her an 11 gram dose each morning with apple juice)? What am I ideally seeking?

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