Chronic constipation - A review of the long term medication.

This article doesnot in any way recommend the medications listed. It serves to reassue parents with similar medical problems.Families must seek medical advice from their own Doctor in cases of chronic constipation.

There has already been a super article written on the site regarding chronic constipation. It is

an awful condition for your child to suffer from. My child suffered from this condition from the age of three years and I am not sure that it is a condition that ever entirely goes away. Here is in part the story of my sons treatment in case it helps others in a similar position.

Each family with a chronic constipation history has a life filled with toliet anxiety; when will it happen? Have I got clean pants. Can I go out if the laxative was given x hours ago? How far am I from a toliet? If I go out and he wants to go will he refuse if it is a strange public toliet. Then there is trying to stay calm, trying to calm the child, trying not to let it affect other siblings. The list goes on.

Initially as a parent I failed to understand the pschological problems attached with passing a stool. My son would do anything under the son to stop himself passing a bowel movement. At his worst he was often going for nine or twelve days without any movement. I have photographs of him then and he looks really sick, thin, drawn and very very grey. As you can imagine twelve  days without a BM would make you cranky, sore, and in desperate need to clear out your system. 

What is amazing at this stage is the lack of understanding even by close family members. It is not a case of adding more fibre to the diet, drinking coke, eating figs. It is not a mothers fault for not feeding her son correctly, (it is much more common in boys) or for not being relaxed over potty training. The amazing antics every parent has been through with their child who suffers from this condition would astound many. Chairs set up next to toliets to reassure, tables with sticker books to try and relax the child, bribes, threats, pleading all again to no avail. Often following laxatives the child will then hide and have to try and pass a hard plug of impacted poo followed by very runny laxative treated waste. Not the ideal solution. This is very painful and very messy and reinforces that pooing hurts, is messy and the child really wants to avoid doing it again...ever. Sometimes the opening of the anus can tear causing additonal pain discomfort and anxiety.

childhood constipation can quickly develop into a serious chronic medical problem that is not uncommon but which seems to fathum some GP's. I would suggest that any parent who has a child suffering from chronic constipation to get to their GP straight away. If there is no improvement within a short space of time go back and get a referral to a specialist.

The treatment in my sons case did not consist of any unplugging, this was viewed to be even more damaging for someone so freaked out by the idea of waste. Instead we started him on lactulose which alone was ineffective so began on a mixture of laxoberal (sodium picosulphate) and lactulose. The lactulose is a sugar based medicine which works by sucking moisture from the body into the bowel thus making the stool softer and easier to pass. Vast quantities of this can be required to have any effect on a chronically constipated child (20mls to begin within my sons case). This also provides a massive sugar hit just before bed time (it needs to work overnight). However this alone did not work in my sons case. The next medication is the heavyweight. The laxoberal says it is not suitable for children under ten years of age and should not be used long-term. (My son started on it at three years of age and took it for nearly four years, its not an ideal medicine but the condition without medication is far far worse). The sodium picosulphate (laxoberal) purpose is as a muscle stimulant in the anus. When chronic constipation has been left too long patients can loose all feeling and sensation of needing to empty their bowels. This medicine slowly restores that feeling by stimulating the muscles. The theory follows that slowly the patient learns to feel the need to go to the toliet again and one can slowly reduce the dosage required. This can (and did in our case) take over three years.

As you progress through the treatment you think you are getting an improvement only for a bout of illness or a renal tear to set back the routine and the dosage needs to be raised again. The idea is through trial and error to keep the bowels emptied once a day. Ideally the child should be feeling the need and taking him/herself off when required. However this can be a little ambitious. It seems many (including my son) even when medicine free still need to be encouraged to use the toliet daily. It is not an easy condition to manage and gets harder as they get older to control. What eight year old boy wants to discuss his toliet habits in great detail with his mother?

So in conclusion, chronic constipation is not linked to diet. Your child will almost certainly need supervision and medicine to improve slowly. It is advised to see a specialist who will discuss treatment and monitor progress. Do not be alarmed by the medicines discussed here with correct medical recommendation they have proved themselves in the household as effective. I wish you the best of luck.