Constipation

Dear Lisa,

My four year old son has a problem going to the bathroom. Usually his bowel movements are very hard and he spends a lot of time in the bathroom trying to get them out. This causes him a lot of pain and I wish there was something that I can do for him. What can I do to make his stool softer and help them come out easier?

“Problems pooping in N.Y.”

Dear “Problems pooping”,

A child with hard stools and straining is constipated. Many times constipation in children is due to their dietary intake. I find, many children become constipated because they don’t drink enough liquid. This occurs a lot in the warmer weather when children spend a lot of time outside in the heat and seem less interested in drinking. Stool is mainly made of water, therefore when a child doesn’t drink enough, the body compensates by holding in the stool. The longer a person’s stool stays in the body, the more fluid is absorbed into the body, leaving a hard dry stool. The first thing that you can do to help your son is to increase his fluid intake.

Secondly, some children may be eating food which tends to be binding. These foods include soy, rice and bananas. If he eats a lot of these foods, try to reduce the amount that he takes or possibly eliminate them all together. Some children do not have enough fiber in their diet which is found in grains, fruits and vegetables. By increasing fiber in your child's diet, it increases the bulk of the stool, promotes stooling and returns the stool to a normal size. (1) I suggest trying Frosted Mini Wheat cereal; most children love the taste and the fiber adds bulk to the stool. Grapes, raisins, prunes, apple juice, peach nectar and oatmeal also may help loosen your son's stool.

If your child is having pain while he is trying to stool, you can put him in the bathtub filled with warm water up to a level covering his belly (always supervised of course). You should let him play in the bath tub for 30 minutes. The warm water will relieve discomfort and increase peristalsis (the movement of the large intestines). The warm water also acts as a natural enema. When he plays in the tub, water will go up into his rectum and add water to the stool which will help it come out easier. When your son gets out of the tub, gently put Vaseline in the crack of his but and tell him that it’s special medicine that will help him go to the bathroom. The Vaseline helps the stool slip out easier and prevents the child from pushing it back in. I find this trick works almost every time, because the child thinks the “medicine” will help him go.

If your child continues to have hard stools and straining despite dietary alterations, I would recommend an evaluation by your healthcare practitioner in order to rule out disease states that may be contributing to the problem.

(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA: Saunders Company. 1994: 1490-1491.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Healthy Kids