Constipation in kids
In a perfect world we would have time to pass stools after every meal. We let the old food out to make room for the new food to be processed and digested. In the real world we make time for a bowel movement once a day and the process is easy and painless. Anyone though who has had problems with constipation knows it is a miserable feeling, and that it is far worse seeing your own child suffer. In children the problem can quickly escalate because if constipation is causing pain they become fearful of having to go to the bathroom. This makes them want to withhold which of course just makes matters worse and commonly results in anal fissures.
Whilst there are strategies available through specialised clinics in overcoming the fear associated with going to the bathroom, in practice I find that it is more important to deal with the cause of the constipation in the first place. Once stools become softer and less painful, other behavioural strategies are able to work or may not even be needed.
What about laxatives?
Many parents are dubious about the use of laxatives for longer than a couple of months, and for good reason. Although long term use of laxatives is considered safe as they are technically not addictive, they do encourage a ‘lazy bowel’. When a person becomes used to having assistance for every bowel movement there is no reason to train the muscles to do their job. If you are concerned about the use of laxatives, it is best to wean off use rather than stopping suddenly, whilst rebuilding and strengthening these internal muscles. One way to do this is slowly building up fibre in the diet to firm up stools and so stimulate the muscles into action.
Despite this inherent problem with laxatives, there is one that is actually beneficial. Lactulose syrup (Actilax and Duphalac are among some of the products with just lactulose syrup) is used as a laxative but has the interesting ability to encourage the growth of healthy bacteria in the gut, specifically Bifidobacterium strains.
Common causes for chronic constipation:
- Lack of fibre or water– Fibre creates bulk in the stools so that the muscles feel the mass and are triggered to push. Water in turn keeps the stool relatively soft so it is not painful to pass.
- Low levels of beneficial microflora– use of antibiotics reduces all bacteria, including beneficial and useful bacteria. Unless beneficial bacteria are actively restored through excellent food sources or supplements, they will remain at low levels. If constipation began at infancy or toddlerhood, then that is a big clue that beneficial microflora levels were low from birth.
- Low muscle tone– more specifically in the trunk or abdominal area means difficulty in pushing out bowel movements. In theory, simply increasing fibre should help because it makes the stool big enough that muscles are triggered into passing it. But a dramatic increase in fibre will not help a person with low muscle tone- much like asking a weak person to suddenly lift heavy weights won’t help them. It needs to be done gradually and the use of a supplemental amino acid may also be needed to improve muscle tone.
Although a lack of fibre or water is definitely a common cause, I am more likely to see little patients whose parents have already addressed this area but with little to no effect. The prime cause in such cases frequently ends up being a food intolerance. With certain food intolerances, food is unable to be properly broken down leaving a fair amount left in the small intestine. Eventually this unabsorbed food is dumped into the large intestine which will slow down the rate of transit of stools, causing blockage and constipation.
The most likely food culprits for constipation in a child will be dairy (cows milk) with gluten being a close second. Research has been more heavily weighted in proving dairy to be a root cause for chronic idiopathic constipation in children but I have found that gluten can be just as problematic, and sometimes it is both.
The bottom line!
The easiest thing to do is a trial elimination of all dairy produce from your child’s diet for up to 4 weeks and see if you notice a difference. You may not see remarkable changes but if you allow dairy back in, you may then see a worsening of symptoms which will be a clue that dairy is something of a problem. If this is unsuccessful keep investigating the other causes of chronic constipation including the possibility of food intolerances in your child. You will be happy to see how your efforts bring a lot of relief to your little one.