Bowel Health

What are some tips for general bowel health?

My 3.5 year old daughter has chronic constipation. Our pediatrician
recommended mineral oil to "clean her out" and Metamucil afterwards. He
says that she might be on the Metamucil for as long as six months. She also
has to have a bathroom break each day after finishing supper. Does anyone
else have any experience with chronic constipation in their children? Will
it ever end? She's been on one thing or another for the constipation ever
since October. Also, the bathroom breaks are a battle. Does anyone have any tips on what worked for you?

Response 1:

Chronic constipation can be the result of an unfortunate spiral in children.
It usually starts with the stools becoming a little hard at some point. This
may result in painful BM's possibly due to tears or fissures or just
irritation. The child then starts trying to hold it because moving is so
uncomfortable. Alternately, some kids just prefer to hold it and keep
playing rather than to stop and take a break.

What happens next is that the colon becomes chronically distended and the
normal signals to void are lost. At this point the child would have trouble
voiding normally even if they understood and wanted to do so. The
pediatrician's advice is pretty standard. The initial effort is to clean out
the colon and then the next step is to try to keep it empty while the
physical condition and reflexes return to normal (this is what takes about 6
months). Fiber, fiber, and more fiber are central to the maintenance phase.
If she refuses the Metamucil she may be willing to eat Fibercon wafers.
Dietary sources of fiber such as salads are also a good idea.

The final goal is to establish a more normal pattern of voiding. This
usually requires some type of prompted voiding since the whole problem is
that the child will not sense that they need to go and then go do it.
Usually, the voids are scheduled after meals as this takes advantage of a
natural reflex (the gastro-colic reflex) that stimulates the bowel to move
after the stomach has been filled with food.

The mineral oil is a pretty gentle way to go. It's nice if you can get away
with it. More aggressive laxatives or stool softeners may be needed of this
does not work. The current thinking is to try "to fix the problem from
above, rather than from below." Suppositories and enemas may be needed
occasionally but we usually try to avoid them if possible. It is likely that
we will hear from our resident chiropractic enema nut. My advice is to
ignore him.

As far as the behavioral issues, they are tough. Generally, you do not want
to get into a battle of wills with a toddler. No adult has ever won. It is
best to use praise and positive reinforcement rather than force and threats
of punishment. Calendars with stars and rewards are common. Many people use
M&M's as a prize but some scholars think it ill advised to use food as a
reward in children. The most successful ones seem to be the ones that can
turn it into a game or playtime.

Response 3:

Carrott juice if she will take it. Fruit.