Constipation is one of the most common intestinal problems in children.  It is a symptom that signals something is wrong. It is not a disease.  Most constipation is not caused by a serious medical disease.

The cause of most constipation has no sign of injury, infection or blood abnormality to explain the very real symptoms. Children need help from their parents and sometimes from a health care professional, to prevent or manage constipation.

Constipation can be defined as the passage of painful stools or a reduction in the frequency of stools.  An important feature in this definition is the perception of pain or difficulty in passing stool, regardless of frequency. The experience of pain when going to the bathroom can lead to avoidance of having a bowel movement.

It is not correct to assume that a bowel movement every day is normal. There really is no right number of bowel movements. In general, 2 or less normal bowel movements a week may be a sign of constipation.

Constipation is generally caused by a change in diet and fluid intake, or by avoidance of bowel movements because of pain such as anal irritation or small tears in the skin or rashes. Other factors such as change in daily routine, stressful events or postponing using the toilet when the urge to have a bowel movement can play a role in a painful bowel movement.

There are a number of ways to help avoid constipation- such as paying attention to what you eat and drink and getting exercise.

Certain foods can contribute to constipation and should be avoided such as: High fat foods, high sugar foods, processed foods such as instant mashed potatoes, macaroni and cheese.  Food that have little or no fiber such as ice cream, milk, dairy, cheese and snacks like chips and pizza can be a contributing factor in constipation.

Eat more fiber.  Add fiber to the diet. Fiber helps form soft, bulky stool.  It is found in many fruits, whole grains, and vegetables. Be sure to add fiber a little at a time, so the body can get used to it.

Drink more liquids- water is best, sugar drinks are the worst.  Drinking sugar drinks, without fiber, fills your body with calories without fiber.

Exercising helps the digestive system to stay active and healthy. A walk for 20 minutes a day can help or you can break it up into two ten minute sessions.

It is important  to allow enough time to have a bowel movement and not to ignore the urge to have a bowel movement. Waiting only makes constipation worse.


Withholding of stool

Yesterday I saw a 4 year old boy who is not potty trained. Mom is having problems because he holds his stool and refuses to let go. After taking a detailed history and a physical exam it was determined he had a hard collection of stool in his rectal area that he would not be able to pass on his own. His problem was a physical one and can become an emotional one if not treated. Mom was given advise and will be coming back in 2-3 days to monitor his progress. Dietary advice was given as well. Many people are not aware of the constipating effects of milk and cheese. These products are CASEIN predominant. Casein as you will remember from Little miss muffet sat on her tuffet eating her CURDs and whey. Casein curdles in the stomach to form balls of protein which slow down digestion. There also is no fiber in casein to help with a soft formed stool.
Casein also gets converted into alpha caseomorphine- which is similar to morphine the narcotic and slows down the entire intestinal tract, also contributing to constipation.
One of the first things I tell parents of children with constipation, is to limit the intake of milk and dairy products. We don’t see adult cows drinking milk, do we?
So, children and adults really don’t need milk. They can get their calcium and vitamin D from other sources. Milk in moderation if not allergic or sensitive to the cow protein is fine, but if youre constipated, one should rethink how much milk and cheese is in your diet and perhaps cut back.
For more nutritional information on constipation