Constipation in toddlers

[RachMG]

My 21 month old daughter has real problems going to the toilet and has done for the past year. I have made numerous trips to the drs. She has been taking latolose twice a day but the problem still persists. Even with the Latolose she strains really hard and is often in extreme pain. This can happen several times before she can finally go, and even then its only a tiny amount. Her poo is soft (due to the lactolose) and she does go every day. The doctors have also diagnosed anal fissures, which may presumably be the cause of the pain, however these seem to have healed (although its difficult to tell when they are inside). I have also tried glycerin suppositories but these didn't help. The Drs also precribed senocot, however this seemed to make her in more pain. The drs have suggested that she is now just scared of going for a poo and is holding on, rather than being in real pain. However the pain looks pretty real to me and is very upsetting. She eats healthy home cooked food, however she does not drink much or eat any fruit and despite trying lots of different fruits/drinks in lots of different forms its impossible to force her. I have been thinking about trying a gluten free diet. However as shes quite a fussy eater I'm worried about how hard it will be and whether its actaully worth embarking on a gluten free diet and whether it would help. I'd be interested whether anyone else has experienced similar symtoms and has any advice.

My friend's dd had the same problem and it wasn't gluten but dairy free she was advised to try. Would this work for you?

It sounds to me like she does need to drink more, especially if she's getting lots of bulky fibre. My DD always drinks more if she has a sports bottle with water or something of novelty value. I think it's the novelty. Have you tried giving her drinks in different containers, dolly cups, tea cups that kind of thing. Make a game of 'making a cup of tea' in her tea set and you both drinking the water. Would a picnic idea work with fruit and dried fruit too? Apricots perhaps? or perhaps those fruit bar type things like zingers or what ever they're called.

This sounds very similar to my DS. Lactulose worked to soften the poo and make him go every day but he still was very uncomfortable and distressed when pooing. But with him it was psychological. The 6 weeks or so of being constipated/retaining poo/fissures had made him terrified of pooing and I think as soon as he felt the urge to go he started to panic.
I don't think a change of diet will help if the poo is already soft. And I have taken Senacot and it can make you feel very crampy when you are about to go (sorry if tmi) so this could be what is happening when your DD has taken it.
Sorry this prob isn't much help but I really sympathise as it was one of the horriblest things my DS has gone through!

Having had an anal fissure myself I can tell you it is the most freaking painful thing in the world so I agree it is probably more psychological but you need to make sure it doesn't keep opening up which it will if you don't change the diet. Can't imagine it's good to have a child on lactulose indefinately.

Poor thing.Not drinking much is going to make poo harder.
What goes in must come out. Would you say she wees enough? Is it dark?

I leave drinks lying around for ds who HATES water apparently. Cold herbal tea in his special cup and water that I usually end up drinking. He has large quantities of milk too.

Maybe I should have said 'what doesn't go in, is not going to come out '

Thanks for all the messages. Have tried to get her to drink more, but its impossible, she will only drink water or milk and not very good at different containers although I will try the tea party idea. Fruit is really difficutl although i've now reverted to the puree verions like she had when she was little. I think maybe it is pychological (thats what the drs think). Jammietart - sounds lke you have had very similar experience - how long did it take till your DS got back to normal - is he still on lactolose? Did you just see your dr or get reffered to anyone else?

My niece had this problem badly when she was a baby and still has problems - shes nearly3.

All is know is my sister did try the lactulose and it didn't really help that much.

She used to give her childrens enemas because her stomach would go hard from all the poo (not ideal but when they are really really hurting). She used to give her diluted prune juice (I think helped slightly). Massaging the stomach. Erm also, she's just found that for her daughter eating peanut butter makes her go! Wierd I know, but may be worth trying - if your DD hasn't got an allergy to nuts, that is. She also seems to like drinking those Tropicana juice for kids, they are in sports type cap bottles and are only juice and water - no additives or sweetners.

When she was really bad they used to put her in the bath and sometimes the water would help soften things up (although there would inevitably be a poo in the bath!)

I think it can be physcological (spelling!) too, my niece hates doing poos now and will not potty train!!

Have you thought of taking her to a nutritionalist or someone who can allergy check her?

It's not nice, I know, I've seen my niece in pain and its awful.

Rach, DS's problem started when we were potty training. he was bad for a few weeks, then saw the GP who prescribed lactulose, then 10 days for the lactulose to work (gradually increased the dose) THEN once the poo was soft again it was a case of getting him to go again regularly ie not try and retain when he felt the urge to go. So (and this is going to sound very gross) I just tried to remove all stress from the experience. Rather than trying to get him to poo in a potty or on the loo or put a nappy on him when i saw him needing to go I just let him poo anywhere. In his pants, on the floor, in the bath and made absolutely no comment until he had finished then I praised him lots and cleaned up the mess! After ten days of this and once he was happily pooing his pants without any upset I got tough with him and made him sit on the loo. He has been fine pretty much ever since. I stopped the lactulose very soon after. DS eats lots of fruit and drinks lots of water so it wasn't a problem with his diet (although I have a theory about bananas!) so I would just keep your DD on the lactulose if it is working to soften the poo.

It sounds like you are pretty upset about the whole thing (I know I was) but try not to let her see that - -its easy to feed their anxieties in this way. Is there someway of distracting her when she needs to go. Reading a few books, watching TV, leaving her alone or putting her in her cot so she can concentrate? Cuddling or going for a walk in the buggy? A bath like amireallythatsad suggests?

Please don't try a gluten free diet without medical advice and support from a dietitian. Many foods containing gluten are also fibrous foods and could make her constipation worse.

I would imagine the main reason for her constipation is her lack of fluids - this would be the main area to work on. Increase fluids by any means possible ie juice, squash, milkshakes, ice pops, soup, jellies, whatever she will take in really. Don't worry about 'healthy' fluids for the minute, you can work on that once she's drinking more.

I wouldn't give a young child Senokot (it can have a very dramatic effect and cause awful tummy pains and bowel cramps.) I would ask for Paediatric Movicol, or just work on more fluids and continue with the lactulose (it's not a medicine, it's a food substance so is quite safe).

Try sitting her on the loo/potty about 20-30 minutes after breakfast or dinner - we have a gut reflex that can be 'trained' so that we poo after eating. Most of us have lost the reflex as we ignore it over the years but children can respond very well to a toiletting routine and can 'regain' the reflex.

Also this is a really good website

Rach - Lactulose is crap for children with severe constipation probs because it basically does very little. As sidge says you would be better off getting paediatric Movicol into her and also getting her to sit on the loo about 20 mins after meals.

Sidge has put it better than me.

The little one I mind suffers terribly, I now give him chopped dried prunes and apricots for morning snack, sometime it works by the afternoon!

They keep him a lot more regular and softer to pass.

Hi I just wanted to add to this post my experience because when I was searching for an answer this is the first post that I came across so maybe able to help others. My son is 2 and seems to have always suffered with constipation. He manages to stop himself from going and with hold the stool for days!hes been on lactolose for a while and tried every route with gp/ health visitor. He has a healthy diet lots a fruit and veg, water, fluids. We really felt like we'd tried every. Then we tried reflexology!!! It has massively helped our son, it's something still we need to keep on top off with diet and reward chart etc but he has improved so much, she also done some crainial on him too. I only had 2 sessions with her. Just thought I'd post this in case any one else was having the same trouble and had tried every route. Even if it's something you don't maybe think works it's worth giving it a go and your little one is suffering.

Hi

I feel for you - my DD is now 12 years old and has suffered from constipation since she was a baby. She has been under various NHS hospital consultants for most of her life and she's suffered from daily faecal soiling and megarectum (stretched bowel) as a result. We tried absolutely everything they suggested....high fibre diets, prune juice, pears, increased fluid intake, loo breaks 20 mins after eating, bowel transit time tests, lactulose, senokot and Movicol. For the last 4 -5 years she's been taking 4 Movicol sachets and 25 ml of senokot daily just to keep things moving.

Anyway, I would suggest that you do as a previous poster suggested and go see a nutritionist or naturopath as soon as possible and get your daughter tested for food intolerances.

I'd always been a bit suspicious / cynical about these intolerance blood tests, but after years of absolutely no change under conventional medicine (and a DD about to enter her teens where the potential social consequences of faecal soiling are just devastating), I decided we had to try another approach and took her to see a naturopath this spring.

We discovered she is intolerant to cow's milk and wheat. We cut those out of her diet (pretty easy now with so many great products on the market) and she started taking various probiotics and digestive enzymes. Eight months later, she is virtually off Movicol (just half a sachet a day), totally off the senokot, ultrasounds show her bowel has returned to normal size and she has stopped soiling totally.

It has been such a long and difficult road, but I cannot describe the difference it has made to her life.

Your DD may be in a totally different (& less extreme) situation, but I wish to God I'd thought about checking this out sooner and feel so cross with myself for blindly trusting conventional medicine for so many years even though I could see her condition was not improving. I think the NHS is amazing, but sadly, I think the doctors just aim to treat the constipation, rather than looking for the underlying reason behind it.

In any event, it might be worth a punt. Severe constipation in children seems to be incredibly prevalent in the UK but notoriously difficult to 'treat', but in eight short months, my DD's life has totally changed. If sharing this can help anyone else avoid the years of anguish we've been through, then hurrah for that!

Thank you so much I will defiantly look into this woof67 pleased you have found a solution.

One thing I should add is that from my years of looking for information about constipation, is that dairy seems to be the most usual culprit, rather than wheat and gluten. Specifically the protein in cow milk (CMPA) rather than the lactose sugar. So those lactose free milk and cheeses didn't help us. Many of the nut milks are delicious and fortified with calcium and vits, but as another poster said, best to go talk to a nutritionist or experienced naturopath before making big dietary changes in young children.