About 30% of children are constipated, and 95% of children and adults in the US don’t meet their daily fiber needs. Children’s growing bodies have easily affected bowels due to lifestyle factors. Severe constipation can cause urinary issues like frequency, urgency, poor emptying, and urine retention, as well as pelvis, penis, scrotum, and testicle pain.

So, how do I know if my child is constipated and needs a little extra help to regulate their bowels?

Signs and Symptoms of Constipation

• Not pooping every day.
• Soiling of underwear(streaking, skidmarks, leakage, formed stool)
• Bowel movements that HURT and are PAINFUL and/or BLOODY (child cries and refuses to use the toilet to poop!)
• Bowel movements are LARGE for a child’s size (THIS IS NOT OK/NORMAL!)
• Bloating, gas, decreased appetite, and irritable behavior.

NOTE: Many children have daily bowel movements and are still constipated! As a parent, it is essential to consider more than just the frequency of bowel movements.

As a parent, what am I looking for in my child’s bowel movements?

• Soft, well-formed, smooth stools. Ideally, Bristol Stool Chart 3-4:

• Comfortable bowel movements.
• One or more bowel movements daily (ideally after meals).

Constipation Cornerstones

1. Balanced meals
2. Proper Water/Fluid Intake
3. Exercise and Movement
4. Learn poop “signals”
5. Poop posture
6. Synbiotics, as needed
7. Laxatives, as needed

Eat better + Poop better + Move better = Feel better!

Meals

Have your child eat three regular, balanced meals that include fiber every day.
Fiber recommendations: Child’s age in years +5 = Fiber amount per day.
Example: A 5-year-old child would require 10 grams of fiber per day.

Water/Fluid Intake

Water helps to hydrate the bowels and soften the stool. Recommended water intake by age:
1-3 years old: 4 cups (32 ounces)
4-8 years old: 5 cups (40 ounces)
9-13 years old: 7-8 cups (56-64 ounces)
14-18 years old: 8-11 cups (64-88 ounces)
Prune juice (mixed with grape juice) or apple juice can also help soften stools.

Exercise and Movement!

Physical movement and staying active are essential for promoting proper bowel function. Limit TV and tablet/computer time to 2 hours a day! Get outside and take walks, especially after meals, to help digestion and bowel function.

Learn poop “signals”

• Ignoring these leads to constipation. The most natural time to poop is after a meal. Sit on the toilet 5-30 minutes after each meal for 3-5 minutes to establish regularity! You must TRAIN your bowels to be regular.
• Limit grazing and constant snacking – this disrupts the “poop” signal.
• Learn to anticipate the signal- many kids learn to ignore this signal, especially at school, for many reasons, such as anxiety, dirty bathrooms, embarrassment, etc.

Posture

• Place feet flat on the ground or a footstool.
• Lean forward on the toilet with elbows on knees.
• Relax and take the time to empty completely.

SEED Synbiotics( pro+prebiotics)

PDS-08 is a 2-in-1 powdered synbiotic that is clinically validated to benefit digestive health, including intermittent constipation. Clinical trials observed no side effects or gastrointestinal distress, and children taking PDS-08 experienced an increase of 1-3 bowel movements per week compared to the placebo.
Given DAILY, it is a powder mixed into the child’s food or beverage. Safe for ages 3-17.
Parents may notice a temporary adjustment when their child starts; this is normal. Can begin with ½ dose and then increase after 3-5 days to full dose.

Enemas/Dulcolax/Miralax (Laxatives)

If your child is extremely constipated and “backed up,” this may require laxatives. These work by softening stools, increasing bowel movements, or stimulating the intestines to push out stool

Enemas

Significant constipation may require an enema for 2-3 consecutive days. This is given so there can be a “clean out.” Children sometimes have large amounts of stool in the rectum, known as impaction, that may be difficult to pass. Enemas help release this. Children will have a bowel movement quickly after receiving an enema.

Dulcolax(Bisacodyl) suppository

Some parents prefer to give their child ½ DULCOLAX suppository for 3 days in a row, instead of an enema. If there is no bowel movement after 2 hours of administering a suppository, then administer the other half each day for 3 days.

MIRALAX: Safe for LONG-TERM use!

Osmotic electrolyte solution that pulls water into the colon to soften the consistency of stool. Helps establish regularity. No secret dose, start with ¼ – ½ cap daily for small children. Full cap for older/larger children. It takes 2-4 days to receive a response.

Parents, PLEASE NOTE: These medications may cause side effects, including nausea, vomiting, abdominal cramping, and diarrhea. Initially, your child may have dark, semi-liquid to liquid stools. This is not considered diarrhea, but it can be due to a hard impaction of stool, where only watery stools are passing. If this occurs, DO NOT STOP THE MEDICINE. If this continues for 2-3 more days, then call the office for further instructions!

In conclusion, while we wish there were… there is no magic “pill” or “fix” for constipation. A variety of factors influence your child’s bowel movements, and these factors will change as your child grows and their diet and lifestyle evolve. At OKC Kids Urology, we believe that education surrounding healthy bowel movements sets everyone up for success, not only now, but for years to come.