constipation (maybe TMI) - please help

[Siar]

DS (5 going on 6) is really suffering. He has been complaining of bleeding when he wipes, so I checked him and the water in the toilet is pink-tinged and there is quite a bit of blood and a couple of clots on the paper and sometimes some mucus. He has always taken forever to poo (45 mins isn't unusual) and he only goes once every 2-4 days (so not brilliantly regular). I went to the doctors about it and she says he has anal fissures and she prescribed lactulose and said that he needs to drink a whole lot more, which is difficult when he's at school all day. He has never been one to drink much anyhow, we've always had to encourage him, he would never ask for a drink. Anyhow, I'm looking for any tips or suggestions as to what foods might help or hinder the process! (we are vegatarian) Someone told me today to stop giving him bananas as they can clog you up (nearly all the children in his class take a banana for their afternoon snack at school. I'm thinking of giving him a pear or a smoothie drink instead, what do you think?) Also, would it help position-wise if he sat on the potty to poo instead of the toilet? - I understand that more of a squatting position might help i.e. it might involve less effort and pushing. He is so sore and of course he has probably been with-holding because it is painful - a vicious circle unfortunately. I would be so grateful for any help anyone can give. Thanks.

[Llyra]

My five year old is chronically constipated. She doesn't go at all for days and days, until the stool is so stuck in there that softer stool leaks around it involuntarily. Then she does these giant toilet-pluggers that are bigger than some dogs I've seen. She often has anal-fissures, and they cause her to avoid going and withhold her poop, which only exaggerates the problem.

At least that's what happens when it's bad. These days, she's doing much better. Our regimen consists of:
1. limiting dairy to three or fewer servings a day (one yogurt, one cheese, one liquid milk)
2. dried fruit, like raisins, or berries-- blueberries, raspberries, blackberries
3. no white flour foods and no white rice or white pasta-- stick with whole grains
4. Metamucil with breakfast
5. Probiotics-- she gets Culturelle in her yogurt every morning
6. Fish oil supplements
7. ground flaxseed on her yogurt
8. LOTS of good dietary fats-- coconut oil, coconut milk, meat, butter, olive oil, avocado and avocado oil, palm oil, etc.
9. increasing hydration

The idea is to limit the dairy and refined grains, which we know decrease her appetite for more fiber-rich foods. The fat seems to help her digest the high-fiber stuff better. The probiotics improve her intestinal environment. The flaxseed and fish oil add healthy fats, and the flaxseed adds fiber, and the fruit, Metamucil, and whole grains add fiber too. The water keeps things moving in general. We're working on weaning from the Metamucil.

In extreme cases, it can be helpful to use a laxative like Miralax to start things moving regularly again. There are side effects to consider, though, and the possibility of dependence, so you maybe don't want to do that without the advice of a health care provider who knows your child.

Then we have a scheduled toilet break after breakfast and dinner. She stays there for ten minutes, with a timer, and a pile of books or her hand-held video game. We have a chart where we keep track of bowel movements, so she can see how often she's going and when, and start to understand her own patterns better. She enjoys getting out the notebook it's in and putting little stars in the appropriate places.

And yeah, I think a knees-up position is easier to poop in. If he doesn't want to use a potty, a nice high step stool to plant his feet on might help. It's hard for them to go if they're perched precariously on the toilet seat.

Getting the school staff on-board with the problem can help a lot, too. DD's preschool teachers were very helpful-- they put in a scheduled potty break after lunch for her, too, and watched her hydration very carefully. Now that she'd in kindy, the school nurse has taken over this role, and it's been wonderful to have advice from that end. People who work with little kids are often very familiar with the problem-- it's very common.

[lonegirl]

My son has been to a pediatric gastroenterologist because of rectal prolapses due to constipation (from about a year). She told us that a child should have a BM every single day and that it should be soft formed not hard and pellet-like. At a year we didn't know that since when he was EBF it was normal to go a few days....but as soon as you add regular food to the diet she said it is important to go daily.
This is what she has us do to deal with it and we haven't had an issue now since October.
-Increase water/fluids
-Increase berries, pears, high fibre altenatives (whole grain fibre added bread, high fibre pasta etc)
-decrease constipating foods (bananas, rice, peanut butter, apples, corn, dairy, oils)
-if he has constipating food it should be with high fibre food (peanut butter on whole grain bread/banana in smoothy with flax powder)
-I buy Oasis brand Fibre juice that has added inulin and add it to smoothies or he has a small glass daily
-Daily take 1tsp of of Lansoyl (mineral oil based stool softener)
-She did not want him to have laxatives as they irritate the gut and can make the body reliant on them
-The Lansoyl basically lubes everything up. We now only give it if he has very dry pellet-like bms

AS for position....My son is potty-trained....but still occassionally asks for a pull-up to have a bm....he says it doesn't come out when he is sitting. So a more natural squatting position is better. There are actually squatting platforms/toilets specifically for this reason. We have thought about it for him.

[jillmamma]

Poor kid.

As far as water at school goes, my DS is in first grade, and his teacher allows the kids to keep a water bottle in the classroom to take a drink from whenever they get thirsty, so that kids are not constantly leaving to get a drink from the water fountain. Would your child's teacher allow that to help him with the hydration part?

I hope he can heal soon and have less issues with it!

[columbusmomma]

I hope he heals soon too
We've had GREAT luck with flaxseed oil. A couple tsps a day.

[omelette]

My ds has had very similar problems. We've been to 2 specialists and worked with a naturopath, none of which helped much with the situation.
My sons bm's are very large around and often plug the toilet. We were told that his colon is stretched out and therefore it has to fill up all the way before his brain gets the message that he needs to poop. And that results in hard, large poops. The solution is to shrink his colon back down to normal size so that he poops more frequently and they should not be so compacted. I was told to give him a laxative to give him very soft/runny poops for up to 6 weeks so that his colon would have the chance to shrink down. I did not want to give him a laxative for that length of time though. So we've tried many things, the best thing has been aloe vera juice (2 tbsp) mixed with juice. He's also taking a new calcium supplement that is mixed with a bunch of other goodies and that seems to be helping too. We also have the rule that the water in his class has to be finished before leaving the table. It's the only way we can get him to drink liquid.
A note on fibre - It's great to increase fibre but if not enough liquid is being ingested along with it the fibre will bulk up in the colon and will not do it's job of helping move things along.
Hope you find something that works.

[minkleaf]

I'm sorry for your DS's pain. When DD2 hasn't gone for a couple days I give her free reign on the dried apricots. She'll eat 6 or 7 and a poop seems to follow. We don't drink much juice, but when she has apple juice it loosens her up too. I know there is alot of sugar in the juice, but it may help with the liquid consumption too. Especially watered down.