Chronic constipation and hard poops in 6yo

[Ak Mom]

I have a 6yo son who has never been a regular pooper, generally every 2-3 days, but over the years it has gotten so that it is painful for him and sometimes he is crying when he goes. Not always, but sometimes. it also takes him a VERY long time to go-at least 1/2 hour to an hour. And they are "messy" in that he uses a lot of toilet paper to wipe. This last summer we took him off dairy, and for a couple weeks I thought that helped-no more crying. But unfortunately, it went right back to square one. We tried it a couple of times, and one time he had an extremely hard poop and was crying (milk in hot chocolate), and another time (ice cream and cheese), everything was fine. We had him allergy tested and took him off: gluten, corn, soy, peanuts, cranberries and is still off dairy. No difference. We have tried prunes, prune juice, lots of fruits, lots of veggies, and no bananas. We have added glutamine, probiotics, slippery elm. Chiropractic care. No difference. Kept a food journal, and couldn't figure particular foods.

So, any ideas? I think part of the problem is mental-he holds it too long and so it probably gets harder to come out. So what can I do to get his poops softer and easier to get out, so that he can overcome that mental block?

Thanks for any ideas!

[Llyra]

My DD1 (5 1/2) suffers from chronic constipation and stool withholding. She avoids going for days, and when she does go, it's either tiny hard rabbit droppings, or enormous toilet-plugging monsters. She cries because it hurts to pass them, and sometimes has tiny tears in her anus that are sore from trying to pass hard stools. So she avoids going next time, and the problem gets worse and worse. The longer you wait to go, the more fluid leaches back out of the fecal material, making it harder to pass when you do go.

What we wound up doing was a regimen that consisted of increasing fluids, using Miralax for a period of time to keep the stools soft, enforcing a ten-minute time on the toilet after breakfast and dinner each day, and offering rewards for successful stooling. She also soils, when the stool she's holding gets large and softer fecal material starts leaking around it. After awhile, if they withhold long enough or often enough, they start to lose some control over the ability to hold and pass stool. So it's worth dealing with early.

The Miralax softens it, and makes it impossible to withhold. That gets a child going regularly. After awhile of that, we weaned her from it. She now uses Metamucil every morning, to add some bulk to the stool, and she does well on that. But the Miralax got her over the hump of being afraid to go regularly.

As far as causes? She's suffered from this since she was 2, and after years of keeping journals and going through allergy testing and trying elimination diets, and putting her on the same gut healing regimen I used to heal my ulcerative colitis, I've never found anything. The Metamucil seems to be our solution-- she needs more bulk, plus I think there's a strong psychological element to it. She thinks it works, so it does. (For awhile, she was dependent on chewable laxatives. Then I found a candy that looked just like the laxative, and started giving her the candy placebo, and it still worked. That's how I know we ourselves were dealing with a psychological issue.)

I would encourage you to talk to a health care professional about this. It's very common for kids to deal with constipation and avoid pooping, and most professionals who work with kids are familiar with the problem.

[kjbrown92]

Even off a whole slew of foods, my DS was still only pooping once every 3-4 days, and it would take him 20-30 minutes in the bathroom.

His osteo ordered a Genova stool test. Found out he had putrefication from slow transit time, no beneficial bacteria (despite doing probiotics for 1.5 years) and something else I can't remember. Since switching probiotics to one that was more tailored for the specific strains he needed, and starting 2 enzymes, he's now pooping every day or at least every other day and he's in and out of the bathroom within 5 minutes. For us, the Genova stool test was not covered by insurance, but if you had certain types of insurance, you could pay $150 through their PayAssured program and that's the max it would cost (instead of over $1000). My DS also gets osteopathic manipulation, which has been helping. And now he's been adding foods back in right and left.

[deditus]

My dd is off grains, dairy, soy, corn, and eggs. She takes digestive enzymes, high bifidus probiotics, magnesium, clo, zinc, sodium ascorbate, and a bit of a high quality b complex. Poops every day for the first time in her life. It took me about a year and half to figure this all out. It's different for all kids, so there's lots of trial and error.

[manchestermafia]

DS is on generic Miralax but still has problems. Just came from the gastro. dr. today. He said to add 2 Tbl. of mineral oil to the diet. It can be mixed in yogurt, sauce, or anything he said. He said it will help things "move along."

[Ak Mom]

Ok, I will try Miralax to see if it gets him over the psychological hump. Wonder if other oils besides mineral oil would be the same? I put either flax or coconut oil in something every day, but that hasn't done anything.

Kathy, what are the probiotics and enzymes you use?

[Marsupialmom]

It most likely isn't mental, even though there can be mental aspects.

You can get to much fiber! We were told to ad fiber and my son got worse. I would eliminate anything that is on the BRAT diet.

Water him!

Also encourage him to sit on the toliet after meals when his body is naturally moving.

[Ak Mom]

I will try having him sit on the potty after meals, when we can.

He does drink a lot of water-5-6 cups a day.

What is an appropriate fiber count for a 6yo? I don't count things-I just serve fruits and veggies with meals and for snacks, so I think he is getting enough. We do not do a lot of grains/carbs since I eat pretty much paleo, but I do serve rice a couple times a week and he loves it...

BTW, we have seen two NP's about this.

Ahh!!! So confusing and frustrating. I feel so bad for him when it hurts him...

[lindsayjean]

Originally Posted by deditus

My dd is off grains, dairy, soy, corn, and eggs. She takes digestive enzymes, high bifidus probiotics, magnesium, clo, zinc, sodium ascorbate, and a bit of a high quality b complex. Poops every day for the first time in her life. It took me about a year and half to figure this all out. It's different for all kids, so there's lots of trial and error.

Hey Em- I've been meaning to ask you about digestive enzymes.... what kind does she take? I'm looking for a good one for R.

[lindsayjean]

Also, I personally wouldn't do miralax... that's what our doctor recommended and I did NOT listen to her... it really can mess with their system and I know kids dependent on it to poop. Magnesium works in much the same way as miralax, but it's natural. Try epsom salt baths and supplementing some magnesium. I mix DDs mag in yogurt and it really helped her pooping, also when she'd go (and it's be easier) I'd say "wow, that seems so much easier!" and then every time she'd feel like she had to poop for a while she'd go "Mommy, it's going to be SOOO much easier!!!" all excited like, and then go poop. She used to say NO NO NO I don't have to poop while curling up and whining and doing her I have to poop cry. So, I know some of it was psychological for her as well.

Now we are dealing with a host of other issues... I think constipation was just the tip of the iceberg for us
Good luck!

[kjbrown92]

Originally Posted by manchestermafia

DS is on generic Miralax but still has problems. Just came from the gastro. dr. today. He said to add 2 Tbl. of mineral oil to the diet. It can be mixed in yogurt, sauce, or anything he said. He said it will help things "move along."

My brother was on 1 c. mineral oil a day back in the 70s to get him to poop. He was on it for a couple years. He's in his 40s now and he still has trouble with constipation. I don't think the mineral oil is going to fix anything. It's just a short term help. You need to find out WHY they are constipated.

Originally Posted by Ak Mom

Ok, I will try Miralax to see if it gets him over the psychological hump. Wonder if other oils besides mineral oil would be the same? I put either flax or coconut oil in something every day, but that hasn't done anything.

Kathy, what are the probiotics and enzymes you use?

Theralac is the probiotic, and the enzymes are Xymogen's PanXyme pH, and Calcium D-Glucarate. But we wouldn't have known he needed those particular things without the Genova stool test. It told us which probiotics were needed in his system. And how much. He was on probiotics for 18 months previous to the test, and he still had NO lactobacillus in his intestines. Every body is different, so there are different needs for different probiotics. You can ask the same question to 10 people and you may have 10 different answers. What's right for my DS, might not be right for yours. We also have him on 120 mg of Magnesium in the morning and at night.

[lia_joy]

We are far from having this thing figured out, but my 4yo is taking 500-2000mg of Vitamin C every day & I give him reminders & times to sit and try to poop. He isn't pooping as regularly as I'd like to see,but it's helped more than the miralax (which i hated giving him) and, though he's had a few small accidents, he hasn't gotten backed up to the point of leaking since we started the Vit C... Plus he likes them and is more of an active participant in his treatment.... I think there are more pieces to the puzzle for us to find, but we're not completely overwhelmed either so it's a start.

[Ak Mom]

Thanks for the ideas everyone, we'll keep trying new things to figure it all out.

[newmum35]

Originally Posted by Ak Mom

What is an appropriate fiber count for a 6yo? I don't count things-I just serve fruits and veggies with meals and for snacks, so I think he is getting enough. We do not do a lot of grains/carbs since I eat pretty much paleo, but I do serve rice a couple times a week and he loves it...

BTW, we have seen two NP's about this.

Ahh!!! So confusing and frustrating. I feel so bad for him when it hurts him...

I would completely eliminate rice from the diet. This is what you give when he has issues with diarrhea (it is very binding)

[babygirlie]

fiber causes bulk. Sounds like he's got enough bulk going and he needs it OUT. It is not mental. No one should strain to poop. Anal tears which I have are the most excruciatingly painful thing ever. Birth is cake to a fissure. Pushing and straining causes this (also chronic diareah I have heard).

After taking 5 stool softeners a day they just weren't working (not to mention every gluten free fiber) and miralax has been that.. a MIRACLE. I must say the generic made me ill and didn't work. I had to get the real stuff and it took like 3-4 days to start to work. I've been on it for months and if I miss a day goes right back to sticky butt (ugh) and praying to God as I can feel it tear open yet again. Once you have fissures they rarely fix themselves and it will be a common problem. I will feel healed and boom ONE bad day and I'm torn right back open. And there's not a whole lot a dr can do but give you a numbing agent which does virtually nothing.

So tell him DON'T push. Get softeners or miralax into him every single day.

My baby also only went once every 5 days and i thought it was normal until i saw blood. Got rid of the milk. Now that I've added rice cereal and purees were back to a horrible cycle of more fruits more rice more fruits.. we just can't find the right balance and i can see her turn beet red pushing so hard for 10 minutes and only getting a drop out *sigh*.

Laxatives aren't good to use over a year but miralax does not work the same way so it's different.

I say do what you gotta do to not push. fissures on a baby would make me cry. You have no idea how seriously painful they are unless you had them. Glycerin suppositories for the days he needs to get it out and to not push. It's either going to leave or not. I will try to sneak a push in there by pushing out my belly which actually works sometimes and feels safer to me. (tmi)

I am trying to wean off my miralax but just isn't happening. I didn't take it for 2 or 3 days and tore today and I was gasping it was so bad. You really should go every single day (heck even dr. oz says so :P )

[MountainMamaGC]

My DD had a couple painful poops and now she witholds her stool for up to 3 days. I find that benefiber helps. She still witholds but it doesnt hurt to poop anymore. I give her 1 tsp in her drink 1-2 times a day. It does make her gassy, but she is able to get it out so its not uncomfortable. It takes a long time for them to not fear pooping once its hurt them a few times. Benefiber is a water soluble fiber so it doesnt bulk up the poop it just hold more water in it.

For toddlers I suggest you start out with 1/4 tsp and work your way up as when we first gave it to DD it worked a little too well. My DD shows no other signs of allergy so I know that it wasnt that, she just does not drink enough fluids and its difficult to get her to drink them.

I have a morning and evening ritual we do to get her to drink. Its almost like a tea party. lol.