Parenting children with constipation
Alex* is a dad of two children who presented with very different toilet troubles. But as it turns out, they were both experiencing the same problem. This is his story.
“People always say to you, 'all kids are different'. I thought it was a cliche until I had my daughter and she could not be more different from my older son," Alex tells Bridge. "My son was a fabulous sleeper, his favourite foods are cucumber, peas, edamame beans, blueberries and he will always be willing to try something new. When my daughter came along, she only slept for 40 minutes at a time until she was almost a year old. Now at 3, she mostly lives off yoghurt, rice and a very occasional bite of apple. We do everything the health professionals and books advise you to try. We keep putting the variety of food that the rest of the family has on her plate, but not only will she not try it she often won't even acknowledge it's there."
TOILET TIME
"Working from home means I am lucky enough to have a good routine with the kids. In the evening we always have dinner at 5pm, then I read stories and give them some yoghurt (usually because my youngest hasn't eaten dinner), then we sit on the toilet and read a few more books to make sure they both have a chance to do a poo before we get in the bath," Alex recounts.
"My son was the sort of baby that would poo in every single nappy and have 1-2 poo explosions a day. Now at 6 years old, he still does 2-3 poos a day which are a 4/5 on the Bristol Stool Chart. My daughter would go for 7-10 days without pooing from very early. She always did a humongous blow-out poo explosion when we were out somewhere busy in a public place—babies are delightful! Because of her self-imposed limited diet she is very constipated and often goes 1-2 days without pooing now and will say she has a sore tummy and that her bottom hurts. When she does poo it is small hard rocks. Sometimes with a large backed-up lump that comes out first and has been blocking everything up."
WHAT IS CONSTIPATION?
Constipation is when you struggle to empty your bowels regularly because the poo is hard to get out. You might need to strain or go back to the toilet a few times to get the whole poo out. It might be painful to poo or cause bloating if you become backed up.
We try to keep her as hydrated as possible and bribe her to eat things with fibre in them such as porridge, pear juice, or wholemeal toast. I have even started trying to hide fibre in sweet treats. She loves helping with baking and we often make cupcakes for her brother's school lunch. I have swapped out plain flour for wholemeal flour and started to add flaxseed meal, psyllium husk and hazelnut meal to the cakes. I find if I put enough chocolate chips in the cakes and add Milo (for some much-needed vitamins!) to the batter she can't tell it is in there. I'm not sure if it helps, but at least she is getting some nutrients and fibre. If she hasn't done a poo for a day I usually give her the children's Coloxyl chocolate flavoured drops to try to make sure she goes the next day.
GETTING ADVICE
"I went to our general practitioner (GP) to ask for help with managing the constipation. She listened carefully to my story and then felt my daughter's stomach. She said she was obviously very backed up because she could feel hard poo in her stomach. She explained that because my daughter had been doing type 1-2 poos on the Bristol Stool Chart for a long time, the rectum (where your poo is stored before it comes out of your bottom) becomes stretched and isn't as sensitive to the feeling of needing to go to the toilet, which in turn exacerbates the constipation. She explained we would need to give my daughter an over-the-counter medicine called Osmolax which would draw water into her bowel and make her poo softer so it would be easier for her to push out. We would need to keep upping her dose until her poos were a 5-6 on the Bristol Stool Chart (on the runnier/softer side) and then maintain that dose for 6-12 months to give her bowel and rectum a chance to heal. She said this was important because if you don't get it runny enough, there can still be a lot of poo trapped in the bowel and if you don't keep up the maintenance dose, the bowel can't recover and regain its elasticity and sensitivity to being full and telling your brain you need to go to the toilet."
CONSTIPATION DISGUISED AS INCONTINENCE
"I have been worrying about my son for a while, he often complains of tummy ache and his poo can be on the loose side. I was beginning to think perhaps it might be a food intolerance. But it was hard to tell because the stomach pain always seemed to be around bedtime or before school, so I wasn't sure if he was anxious or if it was digestion related. I took him to the same GP that we saw for my daughter and asked if it could be food related. She took a full history of his toilet habits, eating habits and general health and then said she thought he might be constipated. I was surprised because he does multiple poos a day. But she explained that sometimes constipated children do actually poo every day, but they just don't poo enough. Some poo gets left behind and can block the bowel meaning only thin sausages or more liquid poo can get past. My son often comes home with poo in his undies from school. I assumed he just forgot to wipe, but the GP said this is often 'soiling' rather than not wiping which means liquid poo leaks out unintentionally (faecal incontinence) because the rectum and bowel are so blocked full of hard poo. She sent us for an xray and an ultrasound of his stomach, just to make sure there were no abnormalities with his organs. After that was all clear we were asked to start him on the same medicine (Osmolax) as my daughter.
"With such different symptoms, I would never have guessed they were both constipated."
TREATING CONSTIPATION
We are a few months in to treating my daughter with the Osmolax, it has made a huge difference and she is now pooing once or twice a day and it is easy for her to pass. It has made bedtimes a lot easier because before the treatment she would often get out of bed 3-4 times saying she needed the toilet and it was hard to tell if she did need to go or she just didn't want to go to sleep. But often on the second or third go she would do a poo if we gave her enough time. This often meant she was going to bed 1-2 hours later than she needed to. With my son it is too soon to tell, we have been giving him the Osmolax for a few weeks and will continue for the next few months to see if it improves his stomach pain and reduces the soiling in his undies and the diameter of the poo he is able to pass.
ALEX'S HIDDEN FIBRE CUPCAKE RECIPE
- 2 eggs
- 120g wholemeal flour (12g fibre)
- 120g sugar
- 120g butter
- 4 tbsp Milo
- 1 tbsp flaxseed meal (3.5g fibre)
- 4 tbsp hazelnut meal (6g fibre)
- 1 tbsp psyllium husk (12g fibre)
- Dark chocolate chips (1g fibre)
Pop the cake mix in a silicone cupcake tin and bake in the air fryer for about 16-18 mins on 180 degrees. Can be frozen in an air-tight container.
SNEAKY HIGH-FIBRE FOODS FOR FUSSY EATERS
Recommended daily fibre intake: adults 25-30g a day, children their age+10g per day.
- Popcorn: comes in different flavours (1.5g per serve).
- Toast: pick bread with a smooth texture with hidden fibre and added vitamins and minerals such as iron (3g per slice).
- Pasta: switch out your pasta for a high fibre 'smart' pasta (around 3g per serve), or pulse pasta such as lentils or chickpeas.
- Smart sweets: most supermarkets now stock natural lollies and lollipops made of tapioca starch, which are sugar-free and high in fibre, around 5g per 4-5 lollies.
- Potato: although not thought of as a high-fibre food, does contain roughly 2g per potato. So don't count it out with fussy hot chip lovers.
*Not his real name.
If you need advice about diagnosing and treating constipation, call the National Continence Helpline for a free and confidential chat with a nurse continence specialist. 1800 33 00 66 Mon-Fri 8am-8pm.