Natural Constipation Management

Constipation is considered to be the passage of hard or infrequent poops.  I also consider kids that are having poops that are rocks or pebbles (even if daily) to be constipated. I believe that kids are constipated if they have Bristol type 1-2 or large diameter type 3.

If you think about how close the rectal vault and they bladder are in a small child’s pelvis it’s important to recognize how much their poops are affecting their bladder.  If a child is pooping 1-2 times a week, I typically recommend a Miralax cleanout.  This should be done under the advisement of your provider and then they should be started on daily Miralax. The cleanout helps reduce cramping while starting on Miralax and reduces poop accidents.

Often times, I have families very resistant to Miralax. They have concerns about toxicity. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) put out a position statement answering many common questions. (See here.) I find Miralax very effective in treating constipation, which then effectively will treat some forms of bladder dysfunction and wetting.  My typical plan is to have a patient on Miralax for 6 months and then transition to healthy bowel habits through diet, hydration and sit times. If you would like to bypass medication it may take longer for your child’s bowel patterns to improve but it’s definitely a reasonable option.  If a child is wetting during the day, I tend to be more aggressive with their treatment because of the social and emotional ramifications.

Overall, there is very low evidence to support non-pharmacological (non-medicine) treatment of pediatric constipation.  However, I see these methods works when the child is on board and very compliant.

Fiber

Goal fiber: To calculate your child’s goal fiber in grams take your child’s age plus 5. 

Example: If your child is 7 years old, they should have a minimum of 12 grams a day. 7 + 5 = 12 grams.

Hydration

Child’s Weight Hydration goal before 4 pm Total Hydration for the Day
44-66 pounds ~ 40 ounces ~ 53 ounces of fluids a day
66-88 pounds ~ 45 ounces ~ 60 ounces of fluids a day
88-110 pounds ~ 49 ounces ~ 65 ounces of fluids a day
110-132 pounds ~ 54 ounces ~ 72 ounces of fluids a day
132-154 pounds ~ 58 ounces ~ 78 ounces of fluids a day

These are minimum requirements, if your child is active they may need more.

Behavioral Therapy

It’s very common to find busy children holding their bowel movements.  They will try sitting on their shoe, sitting, or squeezing their bottoms to reduce the pressure felt when they need to poop so they can continue to play.  Many times they don’t know they are doing these behaviors so it’s hard to get them to stop.  The best way to treat these unknown habits is to set scheduled times to poop.  It’s amazing how many kids can poop on command once they start having soft poops. The best time to poop is after stimulating the “gastrocolic reflex” this is when food hits the stomach and the colon starts to wiggle to empty. I have my patients eat breakfast with a big glass of water and then sit on the toilet with a step stool for 5 minutes to have a poop.  This is without electronic so they can focus on the feelings of their body.

Treatment I do NOT Recommend

  • I do not recommend probiotics because they are not FDA regulated.  You could be buying something that is labeled incorrectly. NASPGHAN showed low clinical evidence that probiotics are helpful. To me, it’s not worth the risk.
  • I do not recommend chiropractic care.  I have not found any supporting evidence and it can be time-consuming costly for the family.  Again, not worth the risk.
  • I do not recommend weekly enemas unless they are having poop accidents that can’t be managed by oral laxatives.  Any child that is having poop accidents should be seen by their provider and started on the above Behavioral Therapy to reduce their accidents.

For more information click here and here. For more information about fiber options, click here.