Suggest Remedies For Severe Constipation In A Child

Posted on Tue, 12 Apr 2016

Tue, 12 Apr 2016 Answered on

Wed, 8 Jun 2016 Last reviewed on

Question : Hi. My son is 4 yr old has been having constipation since past 2 yrs. As a child he used to have regular bowels every day in his diaper. Once he was off the diapers he started passing alternate days. He i still not potty trained and sits on flush yet not able to pass stool. He used to pass stool standing only and even today he does same. Last 2 months it has worsened with him passing stool on after 6 days. On 6th day there is heavy liquid discharge and on 7th day he passes a big lump and then his system clears. We had used lactulose in the past and also laxopeg for 6/months in the past when he was 3 but then decided to let it be as it is and he was passing stool every 2-3 days. Sometime in sleep also he used to pass stool
He has this habit of holding stool if hes playing or busy and hides ans pulls back the stool.This time it was bad as he had nausea and vomiting on 6th day and we gave him dulcolax suppository twice the 7th day. After that the doctor asked to get his usg abdomen done where his entire large bowel was full of gas and potty. Also his rectum was distended. Doctor gave him enema whicj was not succesful as he had closed his inside tightly. That night every 15/mins he passed stool and only next morning he passed stool which was a dry lump. I could see this big piece inside the anus as it had become wide and open. We consulted a doctor now who told us that we need to stop his milk intake as he was having 2/bowls.of milk XXXXXXX and one cup of milk a day firstly. Apart from this he used to have dal roti,khicdi,etc. he asked us to start one scoop of muout laxative every nite for 90 days. Apart from milk he has asked us to add few veggies and fruits like banana to his diet. Now it's been 3 days and again we find his tummy getting heavy which is concerning me. Doctor is asking for going for barium enema to rule out hursh sprung even though he feels that this is not the case.pls suggest us a line of treatment. He is a fussy eater and doesn't eat fruits though now we have started banana. Do u think we should continue with current approach or try for going for barium enema which mite traumatize him. We have also been asked to give glycerine suppositories but since enema was done he is not allowing anyone near his buttocks. Otherwise he is active and good in his class.Thanks

Answered by Dr. Diptanshu Das (1 hour later)

Brief Answer:
Fiber rich food is the mainstay of management.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone very carefully through your query and also the attached USG report. Incidentally, constipation in children has become a very frequently encountered problem these days. The primary reason for the same is lack of adequate play as well as the lack of adequate amounts of fiber containing foods in diet. You can feel free to investigate but consitipation does not necessarily indicate Hirschprung disease.

Going through the following link should help:
http://patient.info/health/constipation-in-children-leaflet

Enemas and glycerine suppositories can be used without any worries but the mainstay of treatment would be to increase the total dietary fiber consumption. Wheat, corn, and rice XXXXXXX are high in insoluble fiber, which helps prevent constipation. XXXXXXX can be sprinkled into his favorite foods, from hot cereal and pancakes to muffins and cookies. Many popular high-fiber cereals and bars are also packed with XXXXXXX Beans really are the magical fruit. Isabgol (psyllium husk) or senna can also be given as fiber supplements.

Make sure that he drinks plenty of water and goes to pass stool at a regular time every day (irrespective of whether he feels an urge to pass). This will demote stool holding habits and would promote regular bowel habits.

Let me know if I could help further.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Diptanshu Das (6 hours later)

Thanks doctor. Had few more questions post your reply which I will request you to clarify.
1. Is oats a good source of fibre-I have tried to give him by making it in water and putting sugar like a kheer.
2.Can he have ripe bananas as on net someone says its good some others said it causes constipation hence I am confused?
3.since he has a distended rectum/colon(as mentioned in the usg) how long does it take for it to come back to shape?
4.should we consult a clinical psychologist for this condition?
5.I have given him glycerine suppository in the morning but that didn't work. Can this be repeated?also how long should I wait to give him a suppository as its been 3 days and hes hardly tried to pass stool, is this due to the distension in his colon?
6.we are giving him wheat rotis and parathas. does wheat in this format provide good source of fibre?

Thanks once again.

Answered by Dr. Diptanshu Das (3 hours later)

Brief Answer:
Questions answered one by one.

Detailed Answer:
Thanks for writing back. Let me answer your queries one by one:
1. Oats is a good source of dietary fibres. You can prepare a porridge by boiling it with small cut vegetables. I would discourage using much sugar.
2. Ripe bananas are good source of dietary fibres and can be given. Since it is also a good source of iron (which is important but may cause constipation), the contrary belief is there. But I would promote giving bananas.
3. The distension is due to stool accumulation. It will go away once the constipation goes away. Unless a barium enema points to Hirschprung's, you need not worry about it.
4. I do not see a role of a psychologist provided you are able to take care of his stool holding habit. If not, a psychologist would be helpful.
5. Glyceine suppository can be repeated. But if one has not helped, another is unlikely to help. Concentrate on the dietary fibre intake. Give plenty of water to drink.
6. Rotis and parathas (with less oil) made from unrefined wheat flour (aata, not maida) is a good source of dietary fibres.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Diptanshu Das (29 hours later)

Thanks doctor. I have made the dietary changes as advised - giving him oats twice a day half bowl. added XXXXXXX to his rotis, giving bananas and veggies with roti and dal. milk is only now 100ml and paneer paratha. some digestive biscuits if he feels like and probiotic drink yakult. This is the diet from past 3-4 days. however he passed stool last on Thursday full day loose motion then Friday he passed hard piece and he cleared up. little bit on Saturday but after that he has not done anything. today is the 4th day ending. while I understand dietary changes do take time, is it advisable at this time to do something else as even enema doctor told me wont help since he had shut himself tight inside so water came out without any impact. as of now he is active and not feeling any urge.

Answered by Dr. Diptanshu Das (56 minutes later)

Brief Answer:
Thanks for the updates.

Detailed Answer:
Thanks for the updates. It is good to know that you have incorporated the changes. Rather than giving probiotic drinks, I would suggest giving him homemade lassi (made from curd using yeast-seed to make the curd). Other steps seem fine. You would need to be patient and wait for the effects. It may take as long as 6 weeks for the bowel habits to normalise. Till then you may give enema as per requirement.

Regards

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Above answer was peer-reviewed by : Dr. Deepak