Chronic constipation/hard BMs

[DesertBlossom]

I may delete for the sake of privacy for the child involved. Do not quote.

DS9 started having hard bowel movements when he was a preschooler that resulted in bloody stool. I suspected it was because he drank a lot of milk and was generally a picky eater, but I took him to a pediatric GI. One of my concerns was that immediately after a BM there was a dark purple.... bulge... on his anus. Not like an external hemorrhoid. But it was only there immediately after a BM.  When I brought it up to the Ped GI about the purple bulge she gave me this look.... like she didn't believe me?  I don't know. Anyway. She put him on Miralax and suggested more fiber and fruit in his diet. Well, the miralax was awful. It did soften his BMs, but if we ever forgot even one day, the day after was horrific. Screaming agony. It was awful. I took him to this Ped GI at least twice and these were her only suggestions ever. 

After reading about the dangers of long-tern miralax use in children, I took DS off it. We managed the hard BMs with daily doses of prune juice, probiotics, and digestive enzymes. He might not have gotten all 3 every day, but at least something every day. It worked and it was fine. We did this for at least 2 years. Maybe 3? I figured he needed some time to heal. Eventually, we phased out and quit giving him those things and I have assumed he was fine. I'm no longer the one wiping his bottom so I don't actually see it anyway. 

Well, it has been brought to my attention that this is happening again and has been for a while. (hard BMs and blood, apparently quite a bit of it) *Cue mommy guilt*  I am putting him back on supplements, but the question I keep asking myself is WHY?! Why is this happening? He is not a picky eater anymore. Besides tomatoes, he eats almost anything. And while we aren't health nuts, we eat a wide variety of foods and he likes his vegetables. He does not drink a lot of milk anymore or consume excessive cheese. He is otherwise incredibly healthy and as far as I can remember, he hasn't ever been on antibiotics. 

Could there be a physical reason for this?  Or is he just very prone to constipation and will need prune juice for the rest of his life?  I mentioned taking him to the doctor again and he wanted to die at the thought. He remembers the doctor closely inspecting his bottom and is so embarrassed. But I am concerned. If I do take him back to the Ped GI (maybe a different one this time?) I'd like to have a solid plan or least a whole new set of questions to be asking. 

Edited October 29, 2019 by DesertBlossom

[Susan in TX]

My 8yob has trouble with constipation and magnesium supplements helped a lot. I get NaturesPlus Animal Parade chewable ones. I give him two or three a day and that has kept him from being very constipated.

I have also wondered what causes it. I have read that some kids will have the problem because they hold it and don't go for whatever reason and then that causes the constipation.

Susan in TX

[Laura Corin]

How much water does he drink and how much exercise does he take?

[DesertBlossom]

He actually brought this up again about 6 weeks ago. I had some leftover magnesium calm from pregnancy. He hated drinking that so I ordered some magnesium supplements and started giving him some probiotics and enzymes again. Then we went on a week long vacation and it all fell off my radar until last night. 

He's definitely one of those people who can only go in their own toilet. He'll hold it on camping trips, for example. But I don't know that he's holding it in general. Unless that was a learned thing from the initial constipation and subsequent pain. He does take a really long time in the bathroom. 

[DesertBlossom]

Just now, Laura Corin said:

How much water does he drink and how much exercise does he take?

I couldn't say... I don't monitor. We have a water dispenser readily available. Water is definitely his main liquid, but I couldn't tell you how much. As for exercise, he's a typical kid. Doesn't watch a lot of TV, so he is up a moving a lot. But he is not currently in a sport. (other times of the year he does basketball and swimming)

[Pen]

1) Plenty of water, vitamin C, oral magnesium of sorts that tend to cause loose stools

2) fiber - things like pumpkin and sweet potato have fiber. It doesn’t have to be a horrible sawdust like supplement.  It could be a pumpkin curry soup or even pumpkin pie.  And plenty of food greens.

could possibly work out a daily smoothie he likes that is rich in good healthy ingredients including fiber 

3) Hot lemonade made with honey as sweetener (molasses even better if he’d drink it that way, and possibly some ginger), not a lot of honey.  Goal is fluids, natural C and electrolytes.  If he doesn’t have bed wetting trouble this can be a nightly thing.

4) child size suppositories to help hard poops get out with less pain 

****Btw, is blood red blood looking? Or black? ****

ted means blood coming from toward end of tract and should fix up as he stops having hard stools     Black would mean higher up and would be reason for further medical workup

5) work on regular time spent in bathroom getting fully pooped out (holding it in can itself cause hard stools). Possibly on a regular schedule that seems to fit him and perhaps after exercise  and or a certain number of hours after eating      

[Pen]

You also might be able to squeeze a little extra fiber like slippery elm bark powder into something like pumpkin soup or pumpkin pie

ted above was supposed to be “red “”color means blood is from toward end of gi tract

[Pawz4me]

1 hour ago, DesertBlossom said:

Or is he just very prone to constipation and will need prune juice for the rest of his life?

The short answer here is -- yes. That very well may be his situation. Chronic constipation is very, very common. Millions of people deal with it. It's WHY you go to the store and see shelves of Miralax, Metamucil, Benefiber and other stool softeners and laxatives.

First thing you need to be aware of is that the advice to add more fiber may be spectacularly wrong for him. For some people adding fiber just makes things worse. Perhaps much, much worse. It's very much a trial-and-error process to figure out whether that's true for any given individual.

These are the things that work or have worked for me. Some have been helpful long term, some for only a few days/weeks. Again, it's trial and error, and sometimes when you think you've got a routine figured out your body will rebel and you'll have to start figuring something else out:

Miralax. For me it truly is a miracle. I've been taking it daily for years and doubt I'll ever stop.

Magnesium, taken with the evening meal or at bed time. I take inexpensive magnesium oxide. It's the most irritating to the stomach/intestines, and for constipation that irritation is exactly what you want. Too much can cause diarrhea/loose stools, so it's best to start at a lower dosage and increase as needed.

Benefiber. I only take it when traveling and eating normally is difficult, but for others it's helpful to take it regularly. Be careful, though, as it can cause gas and/or cramping to begin with. Start with a tiny amount and work up.

I eat a very high fiber diet (both types of fiber), because those are the types of foods I love--lots of whole grains, beans, veggies, etc. Sometimes I have to intentionally dial it back (because -- see my second paragraph in this post). And I shall repeat -- too much fiber is absolutely disastrous for some people.

Recently I'm playing around with a little extra fat in my diet, particularly at dinner. Fat can be very beneficial in helping with constipation (or at least the reverse is true--too little fat can contribute to constipation).

A warm drink in the morning. I do coffee, but I'm guessing anything warm would serve the purpose.

And as others have said, exercise and adequate fluid intake.

This recipe is often recommended on the cancer board I'm on. I've never tried it so can't make a personal recommendation.

Quote

Fruit paste

Take one or two tablespoons a day, or as needed. Can be eaten plain; as jam on toast, bread, or crackers; or mixed into juice, applesauce, or yogurt. (This recipe can be quadrupled using 14-18 ounces of each fruit, but that makes a lot of fruit paste!)

One ounce senna tea or senna leaves
One cup water
Bring water to a boil. Add tea, remove from heat, and allow to steep for at least five minutes to make very strong, black tea. Remove leaves or tea bags.
4 ounces dried prunes
4 ounces figs
4 ounces raisins
Remove any stems or pits. Add the fruit to the tea. Bring to a boil; then simmer several minutes until fruits are soft.
Mix in:
1/4 cup brown sugar
1/4 cup lemon juice
Let it cool. Make into a smooth paste using blender or food processor. This keeps well in small containers in fridge or freezer. (Fruit paste will not freeze solid.)

Edited October 29, 2019 by Pawz4me

[Pen]

Also look at diets used to help firm stools and make sure he’s not heavily eating firming foods like applesauce, white rice ... 

[klmama]

A friend's ds needed to eat a full-size carrot daily, on top of Miralax and lots of fluids, to be regular.  Totally anecdotal, but it's an idea....

 

[Pawz4me]

3 minutes ago, Seasider too said:

 

You are so right that this is an individual thing! Different bodies have different quirks. 

This fruit paste recipe fascinated me. What, specifically, is it targeting? It looks like a good potassium/iron supplement and stool softener. 

Constipation. It's from a cancer board, and many of the medications those people are on can cause either diarrhea or constipation, or alternating bouts of each.

[DesertBlossom]

All of your replies have been really helpful. Thank you.

I asked him some more questions today and relieved to hear that this problem has only recently resurfaced. I was worried it had been going on the last couple years and he wasn't telling me. He says that he started to drink more milk and that's why-- it's probably not that simple though. But apparently it's just been the last 6 weeks to 2 months. (still too long, obviously) I suspect if he got backed up that maybe he started holding it, causing more issues. I'm not inspecting the toilet or his bottom, so this is all coming from him. But he says he is passing very large, round balls and there is bright red blood.

I really like the water bottle and I will do that. 

As far as going to the bathroom right after eating... we always do "dinner chores" right after dinnder, and a lot of the time he runs to the bathroom to spend 20 minutes there. We kinda joke he's just trying to get out of chores, but I think eating dinner triggers his BMs. And he takes for.ever. So he's not rushing the process at all, for sure. 

I like the idea of the fruit paste. He's not a picky eater by anyone else's standards, but I doubt I could get him to eat that though. We were having decent luck with just 6-8 oz of prune juice every day. He hated it, but he would tolerate it. And I suppose the alternative was worse than the juice. I think we may go back to that because it's easy and fairly painless.

I probably do need to evaluate his diet better. We eat a wide variety of things, but I can't say I carefully monitor anyone's diet besides the nursling. That's hard to do. 

[jen3kids]

My kids hated prune juice, but loved actual prunes.  Whenever they had trouble pooping (but none of them had serious issues), I would always give them a couple 'poop treats' and a big glass of water or two.  

[Farrar]

I know you're concerned about the long term use of Miralax, but I'd consider breaking it out for trips, especially ones longer than a couple of days. Using it for a few days a couple of times a year is really different from everyday for years. One of my boys has struggled with some constipation (though not on this level) and Miralax is almost never used at home (not for years) but was a key thing for him to have at sleepaway camp.

[Tanaqui]

I bet he really is holding it in, and may not even realize he's doing it. Definitely make sure to get more exercise in, throughout the day - even if you have to do it formally, as in a "We're all gonna go for our morning walk right now!" and "Now it's time for our daily 15 minute aerobics video!" and so on. Definitely increase the water intake, and make sure he's getting plenty of fruits and vegetables and whole grains. And, yes, invest in a squatty potty.

[Katy]

A serving of applesauce at every meal is enough for many kids.

[DesertBlossom]

1 hour ago, Farrar said:

I know you're concerned about the long term use of Miralax, but I'd consider breaking it out for trips, especially ones longer than a couple of days. Using it for a few days a couple of times a year is really different from everyday for years. One of my boys has struggled with some constipation (though not on this level) and Miralax is almost never used at home (not for years) but was a key thing for him to have at sleepaway camp.

I am sure that is a more appropriate use of it. But we were instructed to take it daily. But it wasn't solving the overall problem and he ended up taking it for months with no end in sight.  I was frustrated with the dr's lack of help. It was "take Miramax and eat more fruit."  Thanks, but not all that helpful. Especially when accidentally skipping a day made things so much worse. All other supplements and remedies he ended up taking were things I looked up and sought out on my own. 

[Laura Corin]

I agree with others that tracking and probably increasing water is a good place to start. If there's too little liquid, the body seems automatically to reduce it in the digestive system. His pee should be very light coloured, almost colourless.

[gardenmom5]

magnesium. water - lots of water.  coconut water is better, as then you know it's getting absorbed into the body, and not just straight to the kidneys and out.

more fiber. FRESH fruit,/veggies. (they have probiotics that will help)  fewer carbs.

[mlktwins]

Water and prunes.  Both my boys will eat prunes and they really do work, but water is a must!  Especially if upping the fiber.  Without water, it ends up like toothpaste in the bowel!

[Pen]

Look up individual foods also because some things don’t work the way one would think (or at least not for everyone). For example, applesauce and bananas both seem mushy and likely to help toward softer stools— but may have opposite effect:

“You might think that eating applesauce would help constipation, but that's not the case. Applesaucecontains a higher level of pectin than apple juice. Pectin is a substance that will add bulk to your stool. It becomes firmer and more difficult to pass, making it a better choice after episodes of diarrhea.Dec 11, 2018”

 

 

[Katy]

39 minutes ago, Pen said:

Look up individual foods also because some things don’t work the way one would think (or at least not for everyone). For example, applesauce and bananas both seem mushy and likely to help toward softer stools— but may have opposite effect:

“You might think that eating applesauce would help constipation, but that's not the case. Applesaucecontains a higher level of pectin than apple juice. Pectin is a substance that will add bulk to your stool. It becomes firmer and more difficult to pass, making it a better choice after episodes of diarrhea.Dec 11, 2018”

 

 

 

Wow, not in my family.  Maybe we all have fructose malabsorption, even the adopted, but it makes all our kids have extremely soft stools or diarrhea.  I have to be careful to limit it in one kid, because he'll sneak more and then we'll think he's getting sick the next day.  Bananas definitely have that effect though.

[Tanaqui]

Pectin is a soluble fiber. Soluble fiber certainly does add bulk to your stool, that's why bulking laxatives are mostly just psyllium husk, and why pectin is sometimes added to psyllium husk to make it more fiber-y. In general, adding bulk helps the stool pass more easily - it's the difference between squeezing a brand new tube of toothpaste and squeezing one that's almost all out. It's just easier!

Bananas and applesauce are typically considered good examples of foods that help make you more regular. That is, they help if you have constipation, they help if you have diarrhea. Now, the human body can be weird and very individual, so if you as an individual find that applesauce or bananas do not help things get moving, you should keep that in mind. But in general, those foods are just fine for constipation.

[Farrar]

5 hours ago, Tanaqui said:

I bet he really is holding it in, and may not even realize he's doing it. 

That would be my assumption. Or, at least, that's certainly my experience with my kids. And the fact that it's worse on the road is telling. I would guess that there's a new stress in the house - possibly just a growing up related stress - kids are like that and it doesn't have to be a "big" deal to cause enough low level anxiety to lead to bathroom issues for kids prone to it. DesertBlossom asked about an overall physical reason this is happening -- basically, my guess is that it's a psychological cause. Of course, that's just a guess. There could be an underlying physical reason. And all the things people are suggesting should help.

I'll add one more tip... my kids won't eat prunes but dried apricots seem to help and are more appealing.

Edited October 30, 2019 by Farrar

[TrixieB]

9 hours ago, DesertBlossom said:

We were having decent luck with just 6-8 oz of prune juice every day. He hated it, but he would tolerate it. And I suppose the alternative was worse than the juice. I think we may go back to that because it's easy and fairly painless.

I was recently informed by a work mate that adding a small amount of apricot nectar to the prune juice improves the taste significantly.

Oh, the things we talk about at work!

[ktgrok]

10 hours ago, DesertBlossom said:

We were having decent luck with just 6-8 oz of prune juice every day. He hated it, but he would tolerate it. And I suppose the alternative was worse than the juice. I think we may go back to that because it's easy and fairly painless.

I probably do need to evaluate his diet better. We eat a wide variety of things, but I can't say I carefully monitor anyone's diet besides the nursling. That's hard to do. 

 

9 hours ago, jen3kids said:

My kids hated prune juice, but loved actual prunes.  Whenever they had trouble pooping (but none of them had serious issues), I would always give them a couple 'poop treats' and a big glass of water or two.  

This! I will NOT drink prune juice, but I LOVE prunes. And the orange essence ones are so good - like candy! Get a few types for him to try - the individually wrapped ones are squishier and juicier, there are flavored ones etc. 

Also, constipation can be a sign of IBS or even celiac disease. Everyone thinks it has to be diarrhea, but in some people it causes constipation. So if this continues some lab work is indicated. 

[ktgrok]

Oh - and although it doesn't work quite as fast as prune juice, apply juice is also a laxative. I would drink it while pregnant and it always fixed me up. (ok - so I'd drink a bottle of sparkling apple cider, lol)

[PeterPan]

He can learn to massage his abdomen and open his ileocecal valve. Just google it. Not hard to do once you find the spot. He can do it at night after his bath, when he's very relaxed.

Also, he really should be having bowel movements 3-4 times a day, not one. So as far as your goal and where this should be going, that's something to keep in mind.

Does he have sensory issues? He might want to learn about interoception and do some self-awareness work. https://www.kelly-mahler.com/what-is-interoception/  There are OTs doing work on using interoception and interoceptive awareness to improve toileting issues.

If there's any possibility he had trauma exposure, that can tighten things up.

https://www.amazon.com/gp/product/B00BKNLHAS/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1 I particularly like these very soft Fiber Choice gummies. They are inulin (the fiber in asparagus, oatmeal, etc.), tasty, easy to chew. What he might do is try 1-2, taking them once or twice during the day, again trying to work toward multiple bowel movements rather than just one.

Cheese and white flour can be pretty death on the bowels.

He sounds possibly dehydrated. 

I think that whole sensory gig is what I'd be going back to, like why he's holding it, why he's so picky about the location, what body signals he's ignoring. If he's ignoring one, maybe he's ignoring thirst, etc. too. So interoception work might turn out to be a helpful part of his turn around. What he might do in the meantime is use paper or an app and keep track of how many glasses of water, how many pieces of fruit, etc. to see if he can get those numbers up.

Fwiw, when I was having trouble, eating scads of fruit and veges didn't actually do it for me. Fiber supplements did. For me, on top of everything else (thyroid, blah blah), for me it was the trauma experiences. When we got those dealt with, my bowels improved over night. The nutritionist had blamed me for years, saying I clearly wasn't eating her plans just right, wasn't walking enough, blah blah, and we did that work (releasing stored trauma in the PSOAS), and boom my bowels started working. So I wouldn't let somebody imply food will certainly solve it, as sometimes there is more going on.

Has his thyroid been tested? 

Edited October 30, 2019 by PeterPan

[Farrar]

2 hours ago, PeterPan said:

Also, he really should be having bowel movements 3-4 times a day, not one. So as far as your goal and where this should be going, that's something to keep in mind.

 

Where are you getting that number? It’s pretty widely accepted that while more can also be normal, that once a day is fine. More than 50% of people have one bowel movement a day. 

[Pawz4me]

4 hours ago, PeterPan said:

 

Also, he really should be having bowel movements 3-4 times a day, not one. So as far as your goal and where this should be going, that's something to keep in mind.Has his thyroid been tested? 

 

1 hour ago, Farrar said:

Where are you getting that number? It’s pretty widely accepted that while more can also be normal, that once a day is fine. More than 50% of people have one bowel movement a day. 

Every credible source I've ever read (research based on my own IBS-C and DH's cancer medicine induced diarrhea issues) says that anywhere from three times a day to three times a week is considered normal. Obviously, quite a broad range.

[Pen]

3 minutes ago, Plum said:

 

Some food are good for diarrhea and do constipation. Apples are one of those. Whole apples are good for constipation while applesauce is good for diarrhea. The A in the BRAT diet is for applesauce.
When I researched foods to give my dog with digestive problems, pumpkin was one of those that works for both. It digests slowly so it’s easy on the stomach, it has high fiber and water content which helps to regulate stools.  

 

We also find pumpkin wonderful that way.  

[Katy]

2 hours ago, Plum said:

 

Some food are good for diarrhea and do constipation. Apples are one of those. Whole apples are good for constipation while applesauce is good for diarrhea. The A in the BRAT diet is for applesauce.
When I researched foods to give my dog with digestive problems, pumpkin was one of those that works for both. It digests slowly so it’s easy on the stomach, it has high fiber and water content which helps to regulate stools.  

 

Again, maybe this depends on the family.  Applesauce causes diarrhea in mine if they have more than 1 serving a day.  I've changed 8 poopy diapers and 3 rolls of toilet paper since 5am because DH got generous with the applesauce for dessert after dinner last night. Processed, skinless applesauce.

I know we're not the only family because I've had the conversation that applesauce causes loose stools more than once with mom friends.

[BeachGal]

It’s not unusual for kids with encopresis to clench their sphincter until the feeling to go goes away. They do this in response to prior painful BMs. The signals to their brain get a bit mixed up as a result.

Some ideas to deal with it:

These kids also tend to get wrapped up in what they’re doing and ignore cues to go so conditioning can help. Routine practice sits at home and away especially after breakfast and other meals. No need to produce, just make time to respond to cues to go to the bathroom. A little stool for his feet while he sits on the toilet can help to align himself better so that it’s easier and less painful to pass hard BMs.

Put out a pitcher of water for him to drink throughout the day.

Figure out which foods help to make his stool soft. Raspberries, lettuce, greens, whatever works.

Inulin and psyllium can help but start with small amounts, especially the inulin, because too much initially could be painful. More foods high in magnesium and some magnesium citrate might be worth a try.

It sounds like he has a hemorrhoid that’s causing the bleeding. Lots of movement can help. Also if that area is painful, itchy or uncomfortable, he should clean it well and then apply some hemorrhoid cream or ointment. If he can feel a bump down there and it goes away, that is likely a hemorrhoid. If it does not go away, that might be a hematoma. He needs to have some smooth and easy BMs for awhile before those heal up.

The blue bulge you saw was possibly a hemorrhoid. Fissures can occur, too.

 

[Pen]

27 minutes ago, Katy said:

 

Again, maybe this depends on the family.  Applesauce causes diarrhea in mine if they have more than 1 serving a day.  I've changed 8 poopy diapers and 3 rolls of toilet paper since 5am because DH got generous with the applesauce for dessert after dinner last night. Processed, skinless applesauce.

I know we're not the only family because I've had the conversation that applesauce causes loose stools more than once with mom friends.

 

Could well depend on the family!

 Could also well be a fructose/ sorbitol / etc gut issue.  I think around 75% of population supposedly has fructose effects with diarrhea commonly resulting - especially in kids.

 If it’s processed, it could have other things affecting them also.  

(ETA: could also depend on the applesauce if some people you know are using ones with added high fructose corn syrup etc.   It probably wouldn’t take a lot to go over the fructose tolerance level of someone young enough to wear diapers.  Apparently even Mott’s which used to be 100% apples - naturally high in fructose - has added hfc to its “original” applesauce. Says Google.

We have some old apple trees and even with 100% apple there’s a lot of difference amongst the apples.

Peeled also means you are probably avoiding a good bit of the pectin . )

 

 

Edited October 30, 2019 by Pen

[Katy]

4 hours ago, Pen said:

 

Could well depend on the family!

 Could also well be a fructose/ sorbitol / etc gut issue.  I think around 75% of population supposedly has fructose effects with diarrhea commonly resulting - especially in kids.

 If it’s processed, it could have other things affecting them also.  

(ETA: could also depend on the applesauce if some people you know are using ones with added high fructose corn syrup etc.   It probably wouldn’t take a lot to go over the fructose tolerance level of someone young enough to wear diapers.  Apparently even Mott’s which used to be 100% apples - naturally high in fructose - has added hfc to its “original” applesauce. Says Google.

We have some old apple trees and even with 100% apple there’s a lot of difference amongst the apples.

Peeled also means you are probably avoiding a good bit of the pectin . )

 

 

 

I always buy unsweetened, but you never know.  About a month ago I bought a case of cucumber scented Target baby wipes, which I normally love, and the smell was so strong and off putting I took a pregnancy test just to make sure that wasn't the reason they made me gag.  I finally decided it must be a mixture of some floral fresh scent from the end of a production run and the beginning of the cucumber scent.  I don't see why applesauce wouldn't be the same thing, contamination from shared equipment.