CONSTIPATION

We frequently receive calls regarding constipation.  Constipation is painful, hard stools, inability to pass stools or very infrequent stools (more than 4-6 days apart).

Infants may often seem to be in pain while attempting to pass stools.  They may grunt, pull up their legs and become red in the face.  This is because their abdominal muscles are not very strong and it takes more effort to push out a stool than it does for an older child.  It is also more difficult to pass stool lying down than sitting or squatting.  These signs do not mean the baby is in pain or constipated.

Constipation is often caused by a diet without enough fiber or fluids.  Excessive milk intake can also cause constipation.  In an older child, especially during toilet training, it can be caused by holding in the stools.  This leads to hard painful stools, which can then create a vicious cycle of holding even more.  There may then be leaking of stool, called encopresis.

The initial treatment for constipation should be dietary management.  Try increasing fiber and fluids and decreasing constipating foods (bananas, rice, excess milk).  For infants who are not yet on solid foods, you may add extra water.  For older infants and children, add fruits, vegetables and juices.  For even older children, add bran or wheat products.

If your child is stool-holding, try to establish a regular pattern of sitting on the toilet and call us if there are still difficulties.  If this occurs during toilet training, you may need to stop the toilet training for a while.

Sometimes the constipation may be severe enough to cause an anal fissure, which is a small tear in the anal area, canal or skin.  You might then see streaking of blood on the stool or on the toilet paper.  Usually resolving the constipation and using a healing ointment such as A & D will resolve this.  However, if it continues or if there is a lot of blood, you should call the office.

If dietary measures do not help, we might suggest that you use a medication called Miralax.  This recently became available over-the-counter, but you should call us for instructions. Often an enema or suppository will be necessary first.



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