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You might be wondering why I’ve decided to talk about the subject of poop here on the blog. Many parents and especially many special needs parents have kids who struggle with episodes of chronic constipation.

Both my kids have had significant issues with constipation and we’ve had to go through a lot of struggles and a lot of doctors to figure it out! I’m hoping to help share what we’ve learned along the way and make it easier for other parents dealing with the same thing.

If you see the typical doctor for this issue, he is probably going to tell you to start off with Miralax. Miralax can be good for mild to moderate constipation issues and for a short time, but what a lot of doctors will tell you to do over time is to keep going up and up and up on the Miralax.

This does not address the actual problem: the ultimate cause of the chronic constipation. The Miralax may work for awhile, but eventually, it may mask other problems.

So let’s get to the nitty-gritty of chronic constipation, how it happens, and what happens if we let it go too long:

So Your Child Has Chronic Constipation…

NOTE: This article should not take the place of talking to your child’s doctor. This article is full of tips and advice for parents to work on solutions for constipation at home, however, if you have any doubt about what’s happening with your child, take them to see a doctor immediately.

How to Know if Your Child is Constipated:

You probably already know that the first sign of constipation is not having enough bowel movements. The Mayo Clinic states that the first sign of constipation is if your child has pooped less than three times per week.

Now, I’m not going to tell you the Mayo Clinic is wrong per se, BUT children with healthy bowels should be going at least once per day. Every child will be different so if your child does not follow this rule don’t panic, I will get more into the reason why later.

Other signs of constipation are

• Hard or pebble-like poop.
• If your child is grunting, pushing, or in pain and having difficulty passing stool.
• Stomach aches.
• Stomach distention.
• Trace amounts of blood in the toilet (usually from pushing so hard).

Some children will eat less or refuse to eat when constipated. Others may have mild to severe behavioral problems when constipated. We dealt with that with my son and once he wasn’t constipated anymore he was like a different kid as far as food intake and behavior.

What May Cause My Child’s Constipation?

There can be many causes of constipation and these will vary depending on the severity.

• Dehydration – It may seem like your child is getting enough water, but you’d be surprised at how much upping water intake can and will make a difference for kids who are constipated.
• Diet – If your child has a limited diet (picky eater, food allergies, etc), this may cause constipation. Talk with your child’s doctor to see what other ways you can get more fiber into their diet.
• Food allergies – If your child is allergic or has an intolerance to dairy, gluten, or other things, this can cause constipation. Talk with your child’s doctor or allergist about getting testing down or trying an elimination diet to see what food(s) are the cause.
• Certain medications – Sometimes medications like antibiotics can cause diarrhea, likewise, certain medications can also cause constipation. Talk with your child’s doctor if you think this could be the cause.
• Potty Training Issues – The Mayo Clinic says, “If you begin toilet training too soon, your child may rebel and hold in stool. If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that’s tough to change.” This can be especially difficult if your child has autism or other special needs.
• Behavioral Issues – Sometimes a child will withhold their poop for various reasons. This can cause constipation and can be hard to figure out why your child is doing this.
  • One reason may be because they need or want something to control. They can control, when and where they poop if they withhold so if they feel like they are out of control and want to take back control, they can refuse to poop.
  • Another reason is your child could be caught in a cycle. A cycle goes something like this: A child is constipated, they try to poop and it hurts. They hold their poop because they are afraid it will hurt. Because they hold their poop, when they do actually go, it hurts even more, causing more distress, more fear, and more withholding. If your child is caught in this cycle, talk with your doctor or keep on reading below for ideas on how to fix this!

• Medical Problems – There are many medical conditions that could be causing your child’s chronic constipation. It could be anything from an anatomic malformation, to a motility problem or some other medical disorder.

What is Motility and How Does it Cause Constipation?

For many children with special needs and for those with chronic constipation, motility plays a HUGE part! Motility is the contraction of muscles and nerves that help push food through your body starting from when you swallow all the way through the stomach and intestines until it’s finally pushed out in the form of poop.

If these contractions are too slow then your body will get backed up leading to constipation. While everyone has a different speed of motility (some people may have bowel movements multiple times per day and others may have much fewer bowel movements), you will notice if your body’s motility is way too fast (chronic diarrhea) or too slow (chronic constipation).

If your child has a motility disorder (diagnosed by a Gastroenterologist or Motility Specialist), then the methods of treating chronic constipation will be a bit different than other causes of constipation. More on this below!

Constipation: What to Try First

• More fluids/water
• Juice – (prune, apple, pear)
• High-Fiber foods (Dried fruits, Vegetables, beans, and whole-grains)
• Magnesium Supplements
• Probiotics
• Milk of Magnesia
• Miralax

Chronic Constipation: What May Work Next

What parents have a hard time understanding is that chronic constipation can happen over long periods of time. Your child may be pooping, but may still have some pretty significant constipation. My daughter’s doctors were shocked at how much stool she had on her x-ray even after everything we were doing to prevent and stop constipation.

Chronic constipation can cause BIG problems. That’s why it’s important to talk to your child’s doctor about what can be done. Below are some things you can ask about.

1. Ask About a Bowel Regimen.
A bowel regimen is a treatment plan and program to help get rid of and prevent constipation. Remember: do not start a bowel regimen without first talking with a doctor.

Before starting a bowel regimen the doctor will want to make sure your child is completely cleaned out. This will be the hardest part for both you and your child. Depending on the doctor and severity of the constipation, a clean out may be done at home or with the intervention of a hospital.

A clean out is usually done with enemas and/or suppositories to help remove everything from the colon. Keep in mind that it may take time for the colon to go back to its normal shape after being stretched out for so long due to constipation.

Here are just a few of the brands we have used to help both my kids get cleaned out. These may be used along with a Miralax cleanse (ordered by the doctor).

• Pedia-Lax Glycerin Suppositories
• Pedia-Lax Enema
• Fleet Enema

Once your child has been cleaned out fully, the doctor should have a regimen in place which usually is just a way of keeping the colon from backing up again.

Usually, this means you will have a routine for giving your child Miralax or another medicine at certain scheduled times along with a daily enema or suppository if needed. Every child is different so it’s important for your child’s doctor to create this schedule specifically for your child’s needs.

2. Ask About Senna.
When dealing with chronic constipation that does not respond as well to typical laxatives and medications, Senna can be a great option.

Senna is in a class of medications called stimulant laxatives. It works by increasing activity of the intestines to cause a bowel movement.” – Medline Plus

This just means that Senna stimulates those muscles and nerves in the intestines to actually push out the poop in the colon. For kids that have slow motility, this is a great option because it literally makes the muscles and nerves contract to clean out the colon – something that kids with slow motility need help with.

The difference between Miralax and Senna is that Miralax brings water into the bowels to help soften the poop and make it easier to come out. However, for some kids Miralax won’t work well enough and they may need more help. Senna can help those kids by literally pushing all the poop out.

Once Senna medicine has been ordered by the doctor or picked up over the counter, your child may need a bulking agent to help with watery stool. It can take some time to find the right dose for all of these so working with the doctor is important. The bulking agent my daughter uses that helps a lot is Benefiber.

3. Ask About Abdominal X-Rays.
Throughout the process above, x-rays can be very helpful in telling your child’s doctor what is going on, what medicines are needed and how backed up or cleaned out the colon is.

For my daughter, we started off with one x-ray. This told the doctor what he needed to know to get her on a bowel regimen, but so that she wasn’t getting over-medicated, we came back once a week for an x-ray before going up on the Senna again.

It took a lot of x-rays to figure out the perfect amount of medication and enemas for her, but now that we have found it, she is like a different child! If all the above still isn’t working, ask for a Small Bowel Follow-Through. This can tell the doctor if there is an anatomical problem with the structure of the intestines.

Chronic Constipation: When to Call a Doctor

• If your child has white, gray, or light tan stool.
• If your child has black stool.
• If your child is constipated but is staining their underwear and having accidents (diarrhea, bed wetting, etc).
• If your child has severe abdominal pain.
• If you think your child could have a bowel obstruction or blockage

What about YOU? Does your child have chronic constipation? What has worked for your family to help control it?

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