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Is there anything else that causes constipation in children apart from diet?

(44 Posts)
linspins Sun 03-Nov-13 19:37:00

Please help - I'm at my wits end and very confused. My son, (aged 3 and 3 quarters,) has been soiling himself for almost a month now. He does just a tiny bit, enough to smear his pants and smell, but seems not to know he needed a poo. He's been potty trained successfully for well over a year, so i don't know why he seems not to recognise the feeling now. When I sit him on a potty or toilet he doesn't/can't go. He will soil 3 or 4 times in one day, which is hard work with cleaning him up and keeping on top of washing pile. We have been to the GP 3 times now, the first time they said 'it might be leakage round some impacted poo, have some lactulose to soften everything and it will sort itself out.' The other two times they happily admitted to having no idea! My son is still on the lactulose, and if we forget or decide to try without, his poo does seem harder than it should be. But generally taking it or not makes no difference to the soiling.
He has a good diet, with plenty of fruit and veg, and has had no changes to his diet - is there anything else that could be causing him constipation? Does too much dairy do this?
What else could be causing all the poo accidents?
Help!!

Shallishanti Sun 03-Nov-13 19:42:24

Don't really have any expertise re children and soiling, but in adults constipation is often down to dehydration- you could try getting him to drink more? Other than that, have you talked to the health visitor?

bundaberg Sun 03-Nov-13 19:43:28

too much dairy can do it, yes, if he has an intolerance to it

BoundandRebound Sun 03-Nov-13 19:48:27

Is he drinking enough? Moving around a lot?

ggirl Sun 03-Nov-13 19:50:14

food ontolerance can cause bowel problems , both diarrhoea and constipation

linspins Sun 03-Nov-13 20:01:06

He drinks a lot (much of it milk, but I have been watering this down) and he moves around a lot. Would a food intolerance start out of nowhere at almost 4 yrs old?

kd73 Sun 03-Nov-13 20:03:58

We find white bread helps cause constipation, Orange juice with breakfast normally has a positive effect

RandomMess Sun 03-Nov-13 20:05:07

intolrances and allergies can start at any age I'm afraid.

Dairy and wheat are classic for intolerances causing constipation or diarrhoea

NothingMoreScaryThanAHairy Sun 03-Nov-13 20:18:18

Ask for referral to the paediatric continence nurse.

I could have written your post word for word with dd1 (except she had been dairy intolerant as a baby and grown out of it.

I does in my (very inexpert) opinion sound like an impaction of some sort. When the bowel has been stretched (with any significant constipation it takes a long time to return to it's previous state (think months rather than weeks). DD1 now takes movicol ( much better than lactulose) she was on huge doses at the start but now has a maintenance dose of a sachet a day.

Another good resource is Eric Don't ignore it or get fobbed off anymore by Dr's with the right help it can and does improve!

SteamWisher Sun 03-Nov-13 20:20:11

Yes it could be dairy - was he an unsettled or windy baby?

If not, cut down the milk. He doesn't really need to drink that much now. Give more water and only milk at bedtime.

Consider coeliac disease too...

pudseypie Sun 03-Nov-13 20:26:28

Yes I agree you should ask to be referred to a paediatrician or be given movicol to try. Movicol softens the poo so should help get any impaction out. My ds has been constipated since birth and although they are looking for a medical reason as they suspect something is wrong with his bowels, the paediatrician did say that generally it's the most common childhood complaint they see and they usually resolve themselves or grow out of it. Lots of fluid, exercise, fruit but no bananas. I would go back to gp.

munchkinmaster Sun 03-Nov-13 20:30:53

Lots of smearing might indicate impaction. With the old hard stuff sitting in the bowel and any runny stuff seeping through. This creates a vicious cycle where it's sore to poo so the child holds in more. I'd ask for referral to paeds/continence services as you maybe need a stronger laxative (lactulose not actually a lax just a stool softener).

Also be really thoughtful about how you react to accidents. It's gross yes. But if you show your displeasure or yuck reaction it leads to more holding in. Never praise 'clean pants' or no accidents as again this encourages retention. Instead praise any poos which end up in the potty.

In my experience this can all start from nothing or a tummy upset and then gets into a vicious cycle.

munchkinmaster Sun 03-Nov-13 20:34:23

Swap some milk for water. Even if no dairy problems/intolerance lots of milk doesn't help in the same way water does

linspins Sun 03-Nov-13 20:47:54

Thanks all, very good advice! He does eat a lot of dairy, and bananas too!! I will switch us to orange juice and water. We do eat wholemeal bread though.
The leakage isn't particularly runny, (usually sticky or soft) so I wonder about impaction, but it could be that he is holding it in.
He was a windy baby, with silent reflux and we gave him meds for that for some months (and let him sleep on his front). But he has always been a regular, normal and frequent poo-er. It just changed overnight, with suddenly 12 poo accidents in 3 days and then continued..and nothing else has changed in his life. Most confusing. I reward him with a sweetie and lots of praise if he poos in his potty/toilet, and although I don't show disgust when he soils, I do admit I show some frustration. Will try harder to keep calm and breezy.
I will press for a referral i think.

linspins Sun 03-Nov-13 20:59:44

Just been reading the ERIC site, thanks, that's a useful resource.

deepfriedsage Sun 03-Nov-13 21:02:32

Are you or Dad bendy? If your dc is too then I may be able to help with the riddle.

linspins Sun 03-Nov-13 21:04:12

Bendy? As in flexible? I'm most def not, sadly, and I wouldn't say that DH is either. Intrigued though!

deepfriedsage Sun 03-Nov-13 21:14:33

There are links between autonomic, GI system disorders and hypermobility.

LoveSewingBee Sun 03-Nov-13 21:16:16

Does he drink enough? Could he drink maybe a little less milk and more water? Some foods can cause constipation, most notably bananas, rice, carrots. Foods which can help relieve constipation are prunes and especially drinking a lot of water.

There was a BBC program recently called 'Trust me I am a doctor' in which they reported that having every day oat porridge for breakfast shows after a six week period a significant increase of good bacteria in the gut, even more successfully then can be achieved with probiotic powders etc. So maybe worth considering if he likes oat porridge.

linspins Sun 03-Nov-13 21:17:24

Don't think that is the case here, but useful info to know, as I have a good friend whose Dd is hypermobile.

linspins Sun 03-Nov-13 21:20:16

Lovesewingbee - carrots? really? goodness me I wouldn't have guessed that one! Right, so cut down on milk, bananas AND carrots. Porridge for brekkie..if he'll eat it - what he likes to eat changes from day to day.

LoveSewingBee Sun 03-Nov-13 21:22:32

Yes, carrots, that is why you have to be careful when you give carrot puree when you are weaning. You also have to be careful with mushrooms as they can cause blockages in small children.

LoveSewingBee Sun 03-Nov-13 21:24:41

I also would be cautious with the orange juice. It is brilliant as a laxative but oh so bad for the teeth (natural sugars plus acid). Ideally after the orange juice he should drink some water or rinse his mouth with water. Under no circumstance brush teeth within 15 minutes of having eaten or drunk as you brush softened enamel away.

linspins Sun 03-Nov-13 21:25:50

Thanks Lovesewingbee, I learn something new everyday. I will phone the Gp's tomorrow and ask for us to see a specialist or a paediatrician.
According to the ERIC site, if soiling and constipation problems are caught early enough then they can be helped much quicker. Fingers crossed.

mmmmmchocolate Sun 03-Nov-13 21:46:29

I've been going through this with DD (3) the lactulose does seem to have mostly sorted out the soiling but I think the main issue is that when constipated pooing had probably hurt her and she was too scared to do a poo incase it hurts. She had a slightly red bum so the doctor prescribed a cream that has a numbing effect and we are getting there slowly. She agrees that it doesn't hurt anymore so hopefully she is on the mend. I agree it is very frustrating, I hope you get it sorted quickly.

linspins Sun 03-Nov-13 21:50:21

Mmmchoc, Hope your little one gets back on track soon too. My washing machine and dryer are loving this. sad

BigBad1SaidNo Tue 05-Nov-13 08:58:02

Don't want to be the bearer of bad news for your washer and dryer but ds2's paediatrician told us the "mistake" most parents make is to assume things are sorted and reduce treatment too quickly. We were also told movicol is more effective. Ds2 was on movicol for about 20 months. IF (we don't know this from the Internet) your child's rectum has stretched to accommodate a large amount of impacted poo it will take a while to get back to normal.

Definitely worth seeing a paediatrician though - they can take a decent history and exclude the incredibly rare other causes. Be prepared to be asked in detail about size/shape/appearance of every poo your child ever did and exactly how long after birth the early poos happened. It's like nappy brain of Britain!

MummyPigsFatTummy Tue 05-Nov-13 09:17:24

We had a similar problem with DD, linspins but it was much longer standing. DD had a tendency to constipation right from birth but was on movicol for over a year when she was a toddler. Movicol is way better than lactulose btw. DD would cry with pain sometimes - it was awful. We were back and forth to doctors and in the end she had a biopsy to exclude any serious problem (mainly because of her lack of poo as a newborn so as BigBad says expect to be grilled on poo history ). They found a cut inside as a result of all the hard poos and there was obviously a vicious cycle of pain/poo retention/pain going on. We upped the movicol, totally relaxed on where and how she pooed (often a bath or swimming pool relaxed her - I got very good at swift exits from pools). It all resolved itself amazingly quickly and she was fine a few months later so do get referred if you can to a specialist and try movicol in the meantime.

lifeisgoodwithsleep Tue 05-Nov-13 09:20:18

I agree that movicol is great . My dd 2 had this problem all through her toddler years . For us what worked was regularly giving the movicol and getting the stools passing normally for a long time and she slowly started to stop withholding process as she was scared it would hurt and started to recognise when she needed to go.

There is a good book on this subject by Anthony Cohn called "Constipation, Withholding and Your Child: A Family Guide to Soiling and Wetting" reading that and the movicol certainly helped us although I think he is not a fan of stool softeners!

MummyPigsFatTummy Tue 05-Nov-13 09:48:40

Oh and the consultant told us to reduce her milk intake as much as possible. We still gave her some but only in cereal really. She drank apple juice, water and other things the rest of the time. I do think it helped and although she is back drinking milk now I would cut it back if we started seeing constipation again. The biggest problem is definitely dehydration though. I am not very good at staying hydrated myself and we have to really push DD to get her drinking enough fluids, probably because i have not been a good example.

Definitely look at those things if they could be contributing to the problem

pudseypie Tue 05-Nov-13 09:49:58

Mummypig was your dd tested for hirschsprungs disease? Just interested as my ds had this biopsy 4 weeks ago and still nervously waiting results!

MummyPigsFatTummy Tue 05-Nov-13 14:33:11

Sorry for the delay in replying Pudsypie. Yes she was tested for HD - she was nearly 3 when tested though, so quite old really in the scheme of things. How old is your DS?.

Four weeks seems a long time to have to wait for results - have you tried calling the hospital? Nobody contacted us for ages either so I ended up ringing the consultant's secretary who was extremely helpful and definitely got us the news earlier than we would have done otherwise.

That said, I would like to think (and got the impression) you would hear much sooner if the results were not good - no news being good news and all that. You can't fully relax though until you do hear, can you?

Keeping my fingers crossed for good news for you.

pudseypie Tue 05-Nov-13 17:27:05

Thanks Mummypig. Ds is nearly 2 but had problems since birth and was in scbu because of it and been admitted to hospital a few times since because his constipation is so severe. Bit confusing but we have 2 hospitals that deal with ds and the local one have been chasing the surgeons secretary at the other hospital since fri but cant even get them to return a phone call. The waiting is a killer. I keep thinking must be bad news as they said they'd phone or write if results were negative and if not they would send us an outpatients appt. I'm thinking the delay is down to appts being generated. I will try phoning myself tomorrow. I can't stand the waiting!

linspins Tue 05-Nov-13 18:04:54

Wow, I had no idea that things could take that long to sort themselves out.
I'm carrying on with the lactulose until we can get some Movicol, cutting out as much milk as possible (and watering it down) having porridge for breakfast and sitting him on his potty 20 mins after meals. So far, 2 good poo's in potty over two days (both first thing in the morning) and I am using the bristol chart to look at them! (Who ever thought I would be analysing poos!!)
The thing I find most odd is the swiftness it all begun out of the blue, but maybe a specialist will answer this for us. My DS never says it hurts or is reluctant to do one...who knows!

MERLYPUSS Wed 06-Nov-13 08:54:59

When DT2 had problems we switched his breakfast to weetabix with warm milk (yuk), porridge or ready brek. He has a glass of fresh juice with the bits in and before he became adicted to fruit, I found pears were good as the skin has loads of roughage. We dont have egg more than once a week (unless cooked into batter mix and the like) and I keep tabs on his cheese intake. He is now nealry 6 and would happily eat a whole fruit bowl a day to the cost of eating anything else, so I dont know if this has been the cure or just his bowel growing larger?

MummyPigsFatTummy Wed 06-Nov-13 09:46:16

Wow Merlypuss, I wish DD was so keen on fruit!

Linspins, I don't suppose you have a younger baby do you? I only ask because a friend's child reverted to having accidents just after a second baby arrived. It was very frustrating for my friend but started (and seems to have ended, fingers crossed) fairly suddenly. Otherwise, I hope you will solve it with diet. if he doesn't appear to be in discomfort, impacted poo seems a bit unlikely.

pudseypie, how mean to keep you waiting so long over something you are bound to be concerned about. I would definitely call today and, again, I hope it is good news.

soupmaker Mon 11-Nov-13 16:30:12

Definitely get a copy of Anthony Cohn's book. It could have been written about our DD1 who is nearly 6 and has had poo issues for 3 years. The issue was the withholding. The solution for us has been a mixture of getting the right medicine levels and using the strategies in Anthony Cohn's book. Poo holding in is mostly a head issue in our experience. We spent so long treating the physical symptoms as that is what HCPs tend to major on instead of the psychological side of things. Switching tack has seen massive improvements.

linspins Mon 18-Nov-13 22:12:12

Thanks Soupmaker. Been away from the thread for a while but very depressed about lack of any progress on the pooing front. I had no idea at all about the length of time these things can go on for. I've been reading other threads and it seems to be months at best, but often years. I feel very much in the dark about why my DS begun to have problems out of the blue, and how diet and lactulose hasn't made much difference. The lactulose ran out last week and we saw the practice nurse. She gave us movicol but little advice. I am amazed that a problem which is seemingly so common can be glossed over so easily but the health professionals we've see so far. They give no advice about when to take it, what to mix it with, how to know when to up or lower the dose, any foods to give or avoid etc.
My son is passing both firmish poo's, in his potty, and softer poos, both in potty and pants, and one runnyish poo in potty. He complained yesterday of "my waist hurts" and let me put him to bed at lunchtime (unheard of occurrence) and slept for 2 hours. Is this side effects? He begun Movicol last thursday.
I've got him on 2 sachets: one morning and one evening. He had two soiling incidents today at childminder.

Pudseypie, hope you got the results you needed.

Mummypigsfattummy, no new baby on the scene here! The only new thing is Kindergarten, but he enjoys this and is familiar with the place and the staff because he's been to Nursery there for a year.

I'm stressing about what to feed and not feed him dietwise, and worrying generally because I feel so out of my depth information-wise. Is it impaction? With-holding? Something else? Arghhhhhhhhhh! I'm being very gentle and "oh never mind honey" with him, but my heart sinks when I smell the smell.
Off to wash pooey pants and go to bed.

pudseypie Tue 19-Nov-13 15:15:32

Sorry to hear the problems are still going on. Have you seen the gp again or just the nurse? I mix the movicol into milk as it disguises the taste and my ds still has 2 bottles a day anyway so I put it into that. 2sachets a day is what my ds has and it's a reasonable amount and should get things moving. If your ds is pooing sounds like it's coming out at least and just soiling is the issue? I don't remember any side effects but my ds was only 7 months when he started on it.

I think diet wise you just need to avoid bananas and limit rice as it can be quite binding. Plenty of fruit and veg and roughage and lots of fluids.

My ds got diagnosed with hirschsprungs disease in the end, am just battling with the hospital to try and find out what surgery and when.

linspins Tue 19-Nov-13 22:15:17

Ahhh, pudsypie, sorry you got that news and I do hope you get better support from now on and a date for surgery.

I am freaking out here: Ds now has WORMS!!!!!!! I discovered them in his poo today. He does it in a potty which is more comfy and cosy for him and easy for me to check consistency too, which is when I spotted the blighters. Pretty sure they weren't there yesterday, but not totally sure.
I am wondering - could this have anything to do with his poo soiling problem? Could worms in his intestine cause him problems that would involve small soiling issues?
And is it ok to give him movicol tomorrow after having a worm tablet tonight?
(AND, despite teaching for 15 years, how come no parent has ever told me their kid has worms? I will be telling Ds's Kindergarten tomorrow.)

Our house is like poo's 'r' us, and my washing machine is on overdrive. DH will be staying up to put next load in tumbler. Small whimper.

BackforGood Tue 19-Nov-13 22:46:40

Can I agree with others it's worth pushing for a specialist referral ASAP. I used to take ds to the Dr regularly, who tired things like movicol but it made little difference long term, and by the time we eventually got to the specialist, in effect, he told us that the years of compacting had in fact stretched the bowel and that made it more of a problem than it would have been had they seen him at 3 sad

Do keep looking at ERIC site though - loads of support there.

cantsleep Tue 19-Nov-13 22:50:41

My dcs have ehlers danlos syndrome and dd2 in particular has horrendous bowel problems pain and constipation due to this.

She was initially on lactulose but couldn't continue when she became diabetic so changed to moviolas and has 2 sachets every night but still gets constipated. She will be having a test for coelias soon as her consultant is concerned about her stomach pains.

Movicol is def worth a try,

pudseypie Wed 20-Nov-13 08:15:38

Don't know about the worms but I can say that I've always been told to continue the movicol even when ds has been on antibiotics so am sure it will be fine but maybe check with pharmacist?

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