Chronic Constipation.

Okay- this is long and detailed and it deals with poop. If you dont have a concern in this area it will probably not hold your attention -it will also be totally irrelevant to you

If you are dealing with this issue then I hope there is something here to help you as this is not something that is fixed overnight. Please be assured this is not an uncommon problem but people do not like to talk about it.

I have three children, two of them had no problems with toileting  and potty training and so on. The other one - well perhaps we tried to potty train too early- perhaps he is just contrary, but he didnt like the potty, was scared of the toilet and would hold on until he pooped his pants more often than not.

I didnt realise it was happening but thanks to all this - he developed chronic constipation. (Encopresis)

Almost from the time of toilet training he would soil his pants regularly- not necessarily a lot but it was often.

I tried to take him to the doctor but he was scared of that too (and hid under the chair), they assured me everything would be fine and he would 'grow out of it'.

He didn't grow out of it. He would have dirty pants most days. So i researched on the 'net and discovered that most likely he was in fact suffering from chronic constipation. This seemed odd as the problem was dirty pants- not lack of poop!

Now- if your child is going through this do not hesitate- get them to a doctor - dont wait for them to 'grow out of it- its a lot of dirty pants.

I am NOT offering an alternative to medical advice and your childs condition may not be the same as mine.

However I would like to share what I learned- some of the program I developed myself to help my child and then later what was suggested by the paediatrician.
Maybe there will be something in this to assist others with this distressing restrictive and long term condition.

Firstly when long term constipation occurs it causes the bowel to stretch and form a 'pocket' the waste then balls up in this area- forming a plug and encouraging more back up. The frequent soiling which then occurs is in fact the 'new' soft movement being squeezed past this hard blockage.
The plug often causes stomach pain as well.

I was very worried that there was something wrong with my sons sphincter muscle and he was unable to 'hold the poo in'. Researching on the web I found out about the 'anal wink'. This is a simple technique to discover if the muscles are in fact intact (and was later also carried out by a paediatrician - who confirmed that all was fine.) All you do - is have the child lie quiet- and then with a small safe object (eg a cotton bud) lightly touch the skin right beside the anus. If all is anatomically correct- the anus will 'wink' (the muscle will contract and then relax). Your doctor will be able to check this for you- so ask for this specifically if it is a concern.

So ; moving on from there it was logical to assume constipation and work with that.
The ingredients to deal with this are

1. water
2. fruit juice
3. high fibre diet
4. laxative of some type
5. encourage lots of toilet sitting (maybe girls have less problems due to the fact that they sit regardless)
6. Enema if necessary (please note- there are little mini enemas available at the chemist - they are like little plastic tubes which you break the end off - THESE ARE NOT SUITABLE _ THEY WILL NOT CLEAR THE PLUG. A saline enema (1.5 tsps salt to 500ml warm water; boiled water that has cooled) is necessary- please get advice from your chemist.
   

Unfortunately we found that my sons favourite foods were not helping- quite the contrary!
Namely (THINGS TO AVOID)

• Peanut butter
• Cheese
• Banana
• White bread

I wrote out a program based on what I had learned and totally changed his diet. There were diet and toilet items 5 times a day. I will share these details at the end combined with the information we later received from the paediatrician.

We had a lot of success but not completely better. Unfortunately at this point I lost faith in what I was doing and began to worry that there was a more serious physical problem so slowly I let it slide and things got worse. He developed frequent sore tummy problems and was grumpy. His pants were dirty often (sometimes we went through 4 pairs a day.) Obviously he couldnt go for sleepovers and just visiting a friend was a real worry. (it is a rather smelly problem)

At this point we secured an appointment with a paediatrician.

He confirmed that the muscles were fine and that there was indeed a large 'poo plug'.

He explained that we needed to clear the plug before starting a high fibre diet.
I will not go into details of this as it must be done under medical supervision and advice using laxatives and/or enemas. If it is not done properly it can be harmful or at least ineffective. The dose of the laxative will depend on the age and weight of the child and the severity and length of time the problem had been present. It is not correct to just buy a laxative and administer it- this is a problem which requires professional advice. The enema should be a saline one (you mix it yourself).

From there you need

• lots of water- we have 4 glasses on the 'program'
• apple or orange juice - 2 glasses a day
• anzac biscuits (or similar high fibre)
• fruit
• multigrain or high fibre bread (we use Wonder gold)
• Whole grain cereal (we go for Weet-bix)
• vegetables (he WONT eat them so we use V8 juice - one or two glasses a day)

Summary of the program (AFTER the poo plug is cleared)
Sit on toilet 4x a day
4 to 5 drinks of water
Fruit and vegie juice
2 serves of fruit
High fibre bread
saline enema in the evening if necessary
laxative at bedtime/

Our paediatrician explained that in our case the laxatives would need to be continued for a prolonged period of time (6 months) as the problem was so long standing and the bowel needed time to return to a normal shape. You must have advice on this as every case will be different, it is important to use the right laxative too- we use a very low dose of a gentle senna based one.
Just one warning though- if you use a laxative drink some of these need to be taken at least 2 hours before bedtime. Otherwise there could be problems with reflux of the liquid and some entering the lungs which is very dangerous. We use a small tablet.

I hope there is some hope and assistance for you in this advice if you are going through this with your own child. Please be assured this will eventually pass- but it is a very slow and long term process.
Good luck
x