Dr. Hive: 8yo constipated /--looking for natural solutions NEW update in #35

[38carrots]

DD8 used to be *very* regular. She'd eat, and she'd go within 30 minutes. 6 months ago we were camping, and I think the washroom being far + lots of convenience foods led to some constipation. It took us some time to clue in, as she didn't complain of pain or anything much, other than "it is not coming out as well as usual." At that time we got her to eat lots of prune popcicles and a laxative jello DH got at the pharmacy. Things were fine for a while, until a couple of weeks ago.

 

She started complaining about it not coming out easily. We started her on prune popcicles, metamusil, extra liquids. Some of that very same jello. No substantial improvements. Things come out, but I think they are moving around a blockage, as she'd dirty her panties or softer consistency comes out, but not much.

 

The day before yesterday it seemd there was improvement, but yesterday she said she didn't have to go. And today she felt she had to go, but very little (softer stool) came out.

 

She is on prunes, extra water, metamusil, coconut oil... I even got her some coffee with milk and sugar.

 

I'm really reluctant to put her on laxatives. I'm willing to try more things at home. What else can I give her at home? Or is it too late and we need to see a doctor? She is not upset or in pain, but the issues are there. Thanks.

 

Edited February 14, 2016 by 38carrots

[StephanieZ]

Try glycerine suppositories?? They work quite nicely sometimes, but I've never dealt with a severely constipated child. Or a simple OTC enema if the suppositories don't work? The glycerine suppositories are very gentle and safe. 

 

If they don't work, I'd take her into the pediatrician no later than Monday morning, as the longer you wait, the worse things will be, and you could end up with a lot longer course of treatment and/or longer term problems. If your pediatrician has office hours on the weekend, I'd get her in tomorrow. 

[IfIOnly]

Have you tried magnesium? Natural Calm is a good brand that works great here.

[38carrots]

I'm going to get the suppositories now. Thanks. I forgot about them.

 

[38carrots]

Have you tried magnesium? Natural Calm is a good brand that works great here.

 

oh, I even have it! Will try now. Thanks! We use it for relaxation, but I do remember reading that side effects can be diarrhea.

[ktgrok]

miralax is very safe, it just draws moisture into he bowels, it doesn't cause cramps or anything. Just softens the hard poop. You can't overdose on it or anything. And it is tasteless, you just mix it in juice or whatever. 

[Ali in OR]

We use Miralax on a daily basis with our wheelchair kid (constipation is common for kids who don't move around). Just a teaspoon a day in a glass of water is enough to keep her regular. When we had problems in the past we used an OTC enema and that always worked within about 20 minutes.

[DesertBlossom]

Probiotics, digestive enzymes, prune juice and magnesium.

[J-rap]

Glycerine suppositories worked for my kids.  Also, a handful of almonds often helps once things are more regular.

[Amy in NH]

Pineapple juice

[melmichigan]

If you search the Children's Hospital has a recipe for the Miralax clean out based on age and weight.  That is what our peds prescribes, then a small dose daily if needed to maintain.  I have DD with CP, the standard we use is 2 capfuls to 32oz of Powerade in one hour, followed by Dulcolax.  There are other schedules out there that can be given over a few days.  This is similar to a bowel prep and will be your best solution if you are concerned about a possible obstruction.  If one of the recipes doesn't work then I would contact your peds for X-rays.

Edited February 6, 2016 by melmichigan

[38carrots]

Thank you all. I got suppositories and bribed her. But then noticed it said ages 2-5...I hope it works. Because we have an ice storm, and I'm not walking to the drug store again, it was a nightmare. Got her Magnesium Calm as well. Fingers crossed. She's my little trooper.

 

I remember reading that Miralax was hard to wean off, hence my reluctance. But we might need to resort to it. The storm is really bad now, I'm glad I made it home when I did.

[Ottakee]

Research encopresis. We did a clean out and then years of miralax to get over that hump here. It generally isn't a one time thing but rather keeping the stool soft and moving and retraining the bowels.

[Okra]

When you have soft stool coming around constipation or stains on the underwear this is a sign of encropresis.  Basically, it's more than constipation.  The kid is constipated and the colon has gotten "stretched out" because of all the stuff that is in there and not coming out.  We battled this for years.

 

First, you must get her un-constipated.  There are numerous ways to do that, you/and your doctor can decide what is best.

 

THEN, you must make certain the colon goes back to the normal shape and she does not become constipated again. (This is the part that we battled.)  

 

Ultimately, per doctors instructions, we used Miralax every single day.  I resisted this too much thinking that it could not be good for my child.  Then, he would get seriously constipated, and we would start the whole cycle again.  Ultimately, my child was on Miralax for 8 months straight.  And, when he went off, finally, everything was good.

 

We battled this for way too long.  This can cycle for years.  If the colon gets stretched out because of all the poop in there, she will be that much more prone to constipation issues until the colon goes back to normal size.  But, once we finally got it taken care of, our child was absolutely fine and has been for many many years.

 

 

I would take her into the doctor and see what doctor says.

 

ETA - We had ZERO trouble going off Miralax once everything was fixed up.  

Edited February 6, 2016 by Okra

[zoobie]

One of my best friends went through encoparesis with one of her DC very recently. The ped GI said he's moving away from Miralax based on current research (I know NYTimes has done an article if you want to read). He recommended daily enema suppositories of some type for a month then every other day for a month. Her son had a severe case, so that not be right for your DD. You don't want to ignore encoparesis.

Edited February 6, 2016 by zoobie

[melmichigan]

One of my best friends went through encoparesis with one of her DC very recently. The ped GI said he's moving away from Miralax based on current research (I know NYTimes has done an article if you want to read). He recommended daily Fleet enemas for a month then every other day for a month. Her son had a severe case, so that not be right for your DD. You don't want to ignore encoparesis.

This greatly surprises me.  It's not something I would consider for my dc, and certainly not something anyone should attempt without a physician's careful oversight.  Fleets enema (sodium phosphate) has a black box warning for a reason.  Maybe this was a different type of enema? That said, I do agree with the importance of treating encoparesis.

[zoobie]

This greatly surprises me. It's not something I would consider for my dc, and certainly not something anyone should attempt without a physician's careful oversight. Fleets enema (sodium phosphate) has a black box warning for a reason. Maybe this was a different type of enema? That said, I do agree with the importance of treating encoparesis.

It might have been a different brand. I certainly wasn't assisting! As I said, ped GI is the way to go. It's not something I'd ignore.

[T'smom]

We dealt with encropresis with a 7 year old after a long camping trip! It only took a couple of months of miralax for us. No problems since.

[JFSinIL]

I read that if a person is severely constipated, adding fiber may only make it worse (adding to the blocked up stuff already in the colon

) you do need Miralax and enema/suppositories to get what is in there softened and out. Then can work on adding natural fiber and lots of liquid to the diet...along with continued Miralax for a while to keep things moving. Am going through this with my 24-year-old son with autism, and myself (after car crash and losing part of my colon). Feel like I am the Poop Expert now ;-)

 

Was at my gastro. doc the other day and he confirmed safe to use daily Miralax.

Edited February 6, 2016 by JFSinIL

[AK_Mom4]

Not every kid will respond to miralax. It did nothing for DD14 during her struggles with constipation that was a side effect of a drug she needed. Fortunately, there are some good prescription alternatives that are very safe, such as Lactulose. Not as convenient as OTC, but very effective.

 

For DD, there were food allergies at play and avoiding those did wonders for helping avoid getting constipation in the first place. Also avoiding dairy during a flare up was a must for her.

[catz]

Once you clear this crisis, you may want to think about daily probiotics and a morning dose of a gentle fiber (I like 1-2 tbsp ground flax).  I especially need to be diligent on vacations.

 

I have IBS and miralax does nothing for me at all and actually makes me feel worse.

[zoobie]

I read that if a person is severely constipated, adding fiber may only make it worse (adding to the blocked up stuff already in the colon

) you do need Miralax and enema/suppositories to get what is in there softened and out. Then can work on adding natural fiber and lots of liquid to the diet...along with continued Miralax for a while to keep things moving. Am going through this with my 24-year-old son with autism, and myself (after car crash and losing part of my colon). Feel like I am the Poop Expert now ;-)

 

Was at my gastro. doc the other day and he confirmed safe to use daily Miralax.

As I understand it, the Miralax concerns are specific to children. http://mobile.nytimes.com/2015/01/06/science/scrutiny-for-a-childhood-remedy.html?referer=

[DesertBlossom]

To elaborate on my previous post.... My 5 year old was on Miralax for a long time. Probably almost a year. I was frustrated with it because I felt like if we missed a day, it was disastrous. I ended up taking him off miralax cold turkey (don't judge) and we went to a cup of prune juice daily, digestive enzymes before each meal, probiotics and an occasional magnesium supplement. The result was soft, pudding like poop, just like the miralax.  This was about 6 months ago and we were very diligent about those things every day at first. The last couple months we've gotten lax about it and he's been fine. He still gets prune juice most days and the other supplements when I remember. 

[TammyS]

A couple of more things to try to clear her out:

 

1. Exercise!  Doesn't matter what, but get her moving.  At the least, take nice long walk, a run is better, if you can.  This works better than you would imagine.  Read up on "runner's trots".

 

2. Warm bath!  A nice, cozy bath, so that her stomach is submerged.  And just let her hang out for a while, maybe read to her.  This also works well.

[38carrots]

So a mini update: A lot of soft stool came out after a suppository yesterday and today. In between she went once, and what came out was very compacted and she felt like she needed to go more, but nothing came out. Interestingly she is not upset or in pain (which is good). She's on board with suppositories, which is great.

 

I started making her kefir + prune juice + blueberries smoothies, and she likes them. She likes prune juice popsicles. I'll see if I can convince her to drink the juice straight.

 

If it is not better in 3-4 days, we'll go to a doctor. But I really really don't like and don't trust the only doctor we have available.

[Okra]

That sounds good…..however you work it, try to make absolutely certain that she doesn't get constipated in the next few months.  If she does have encropsis, she will be prone to constipation for the next few months.   

[ktgrok]

That sounds good…..however you work it, try to make absolutely certain that she doesn't get constipated in the next few months.  If she does have encropsis, she will be prone to constipation for the next few months.   

 

Exactly. It's not that it is hard to get off of Miralax because of the miralax it is that it is easy to get constipated again because the colon is stretched out and that interferes with the nerves that tell you to go. So you have to work very hard for several months to keep her regular while the colon shrinks back and the nerves start working again. 

[applethyme]

Sugar free gummie bears can also cause diarrhea.  When dd is constipated and I can't get her to take anything, I will giver her a handful or two, works wonders.

[38carrots]

That sounds good…..however you work it, try to make absolutely certain that she doesn't get constipated in the next few months.  If she does have encropsis, she will be prone to constipation for the next few months.   

 

Thanks.

 

She had prune juice and kefir / prune smoothy before breakfast today, and did have a bm within an hour. I could still see that t was comprssed, but it was encouraging that she went pretty much right away, and it was a bigger amount as well.

 

We are continuing with frequent drinks of prune juice throughout the day--half a cup every couple of hours, fillowed with a cup of water.

[38carrots]

Exactly. It's not that it is hard to get off of Miralax because of the miralax it is that it is easy to get constipated again because the colon is stretched out and that interferes with the nerves that tell you to go. So you have to work very hard for several months to keep her regular while the colon shrinks back and the nerves start working again. 

 

Thanks.

[AK_Mom4]

Dd14s ped GI had us help her build some new habits that helped. 4 times up and down the stairs after breakfast to "get things moving". Full water bottle at hand all day long to encourage hydration but also because constipation can contribute to UTI and peeing more often really helps with both. Making time in the schedule every day to "go", which meant I had to structure our day to encourage that. Foot stool in the bathroom for her to put her feet on when she went.

 

These didn't really help during the crisis times, but for keeping everything moving going forward, these really made a difference.

Edited February 7, 2016 by AK_Mom4

[38carrots]

Dd14s ped GI had us help her build some new habits that helped. 4 times up and down the stairs after breakfast to "get things moving". Full water bottle at hand all day long to encourage hydration but also because constipation can contribute to UTI and peeing more often really helps with both. Making time in the schedule every day to "go", which meant I had to structure our day to encourage that. Foot stool in the bathroom for her to put her feet on when she went.

 

These didn't really help during the crisis times, but for keeping everything moving going forward, these really made a difference.

 

Thank you for the tips.

[38carrots]

So she went 3 times since breakfast already. The second time it was hard, clay like stool. The last time it was a lot of stool, of softer consistency. But she still feels like "I felt more had to come out, but didn't." She drinks half a cup every couple of hours. The older kids scared her a bit about "going to the doctor" (ugh, but we'll deal with this) so she is very eager to get better with our own measures

 

Are we on the right track? Should we continue with prune juice? Can I give her too much of it? I plan to give her another suppository tonight.

 

 

[ktgrok]

prune juice can cause some cramps, is the only issue I know of. And gas. 

[38carrots]

UPDATE: Since she's my little maximalist, she's been drinking 4-5 cups of prune juice daily. And yes, diarrhea. She doesn't seem to have typical signs of encopressis--she does have urges, she goes, and then either nothing comes out, or it is diarrhea, and when diarrhea is done, she still feels that something still has to come out (irritation?) It seems that some clay like bm comes out before the diarrhea, but hard to tell.

 

When she said she felt like she had to go but it wasn't coming, I gave her suppositories, and bm did come out (did this on two separate days.)

 

Yesterday she said it felt like she needed to go but couldn't,  I gave her an enema--stuff did come out.

 

So even with the diarrhea I'm not sure if the clay like stuff has cleared out. She didn't have "smears" in several days, though.

 

The plan is to reduce the juice slowly to 1-2 cups a day, for maintenance.

 

We also fed her corn tonight. If I don't see it in the bm within 24 h, I'll freak out and take her to the doctor. If I do see it, then we are going to work on reducing the juice, keeping up with fruits and veggies and almond flour muffins and will start her on probiotics.

 

She's a very easy going kid, so she seems not to mind, and is not upset, which has been a blessing. I think if it happened to either of my oldest, we'd all be in the crazy house by now.

 

Could it be that her urge to go is irritation and there's actually nothing to come out? Anything alarming that I'm missing? Any other tips and btdt? Thanks.

[melmichigan]

In all honesty it doesn't sound like she is clear.  If you don't trust what your doctor would prescribe, would you trust his exam, or an x-ray to determine if she is clear?  If you are concerned about Miralax there are other bowel prep products available, such as Magnesium Citrate, that will do that same thing so that you are sure she is clear, then you can work to maintain it in a natural way.  The advantage of these products is that you will know she's clear when she is passing clear water, not diarrhea.

Edited February 14, 2016 by melmichigan

[Okra]

I'd take her to a Dr. if it was me.

[Ottakee]

Even your update sounds like encopresis and blockage....the loose stool getting around the blockage. I really think an x Ray is in order. For us the doctor couldn't feel anything but ordered the x Ray. My daughter was blocked all the way up.

[ktgrok]

Also, the feeling like there is something there could be gas....prune juice makes me gassy and can cause cramping that makes you feel like you have to go. Although the fact that you do get stool after an enema is concerning. 

[MamaBearTeacher]

I wonder if so much prune juice could cause diarrhea? Is she used to drinking that much juice? Could you switch to magnesium citrate mixed in water and see if that worked?

[NoPlaceLikeHome]

Honestly I would take her to a doctor soon. Clay colored stools are concerning if you are referring to almost white or pale stools. It also seems like she is still blocked up since one can have diarrhea around a blockage. Honestly, I would not hesitate to use Miralax at all. The gastroenterogist at a renowned Children's Hospital recommended it and still recommended it after some articles about it a year or so ago. Our pediatrician gives it to their child as well. She actually might need a clean out with Miralax over several days as ordered by doctor and possibly several suppositorys or enemas as well. Then she might need Miralax daily for about a year till her bowel returns to normal. I would definitely see a doctor. :grouphug:  

[Laurie4b]

I wonder if so much prune juice could cause diarrhea? Is she used to drinking that much juice? Could you switch to magnesium citrate mixed in water and see if that worked?

 

 

Prunes and prune juice can cause both diarrhea and gas. 

 

I would be worried about that amount of prune juice being consumed. 

 

 

 

Edited February 14, 2016 by Laurie4b

[38carrots]

Honestly I would take her to a doctor soon. Clay colored stools are concerning if you are referring to almost white or pale stools. It also seems like she is still blocked up since one can have diarrhea around a blockage. Honestly, I would not hesitate to use Miralax at all. The gastroenterogist at a renowned Children's Hospital recommended it and still recommended it after some articles about it a year or so ago. Our pediatrician gives it to their child as well. She actually might need a clean out with Miralax over several days as ordered by doctor and possibly several suppositorys or enemas as well. Then she might need Miralax daily for about a year till her bowel returns to normal. I would definitely see a doctor. :grouphug:  

 

Her stools are not pale, I was referring more to the consistency. Though I have very little exprience with actual clay.

 

So what about the articles that say that Miralax was never tested nor intended to be used for more than a week? Here everyone is using it for months / years and this is a big concern to me.

 

Regardless, we'll see a doctor tomorrow or Tuesday. I'm not at ease with what's going on.

[ktgrok]

Her stools are not pale, I was referring more to the consistency. Though I have very little exprience with actual clay.

 

So what about the articles that say that Miralax was never tested nor intended to be used for more than a week? Here everyone is using it for months / years and this is a big concern to me.

 

Regardless, we'll see a doctor tomorrow or Tuesday. I'm not at ease with what's going on.

 

All it does is draw water into the stool to make it softer. That's it. Various other things that do the same, like lactulose, have been used for a long time. It really is very safe, and helps to prevent the hard stool from backing up without causing changes int he peristalsis of the bowel. 

[Tanaqui]

38carrots, while I concur with everybody about going to the doctor, I want to ask this as well: When she poops, does she have her feet on the floor or on a footstool? The latter helps get more poop out.

[Amy in NH]

38carrots, while I concur with everybody about going to the doctor, I want to ask this as well: When she poops, does she have her feet on the floor or on a footstool? The latter helps get more poop out.

 

Have you seen the ad for the squatty potty?

[Tanaqui]

Who hasn't? I'll never look at soft serve the same way again!

[melmichigan]

All it does is draw water into the stool to make it softer. That's it. Various other things that do the same, like lactulose, have been used for a long time. It really is very safe, and helps to prevent the hard stool from backing up without causing changes int he peristalsis of the bowel. 

This is the tricky part of treating encopresis, and why Miralax is used so much, it doesn't cause changes to the peristalsis.  Both of my children eventually got off Miralax, but it is still our go to solution if they experience problems.  

Edited February 14, 2016 by melmichigan

[JFSinIL]

gross, but I find this helpful:

http://www.webmd.com/digestive-disorders/poop-chart-bristol-stool-scale

[38carrots]

38carrots, while I concur with everybody about going to the doctor, I want to ask this as well: When she poops, does she have her feet on the floor or on a footstool? The latter helps get more poop out.

 

I encourage her to have her feet up. She doesn't always like it.

 

Well, she did have a firmer bm, after we reduced the prune juice. It seemed on the harder side, but not clay-ish in consistency. And the corn that she had yesterday came out as well.