Bowel management parent information

Many children with special health care needs develop belly aches and abdominal problems because they have trouble moving food and waste (poop or stool) through their systems. Other factors include: high or low muscle tone, diets without enough fiber or liquid, and, for some children, immobility. Sometimes this constipation is obvious – when your child has painful, difficult-to-pass, hard, incomplete, or infrequent poops. Sometimes constipation is not obvious but you may notice your child is having discomfort, decreased appetite, or a distended abdomen.

If the stools are thick, like clay, or hard, large, or like pebbles then stool may get backed up. Not having regular meals or drinking too little can contribute to developing constipation. When this happens, the large intestine gets stretched and that causes crampy, sharp, or achy pain around the belly button or the sides of the belly. Usually this pain occurs during the day while your child is awake and is worse after eating or with exercise. Although the cramps or aches may keep your child from falling asleep, the pain does not usually wake them from sleep. You may see blood streaks on the side of the stool, but not mixed in or coloring the whole stool. When some kids get constipated, they feel sick to their stomach, fill up fast when eating, have problems with reflux, or may begin to wretch or vomit. Some kids hold enough poop in their rectum to keep the anus open, resulting in leaking. This leaking can be bad enough to fool you into thinking it is diarrhea or that your child had let the stool out intentionally.

If your child is severely constipated, and having the problems described above, trying to have bowel movements on a regular schedule, using extra fiber, drinking plenty of fluids, and using laxatives may not work. When the constipation is causing belly aches, feeling sick, or having hard stool, we usually have to completely clean out the large intestine before we can change pooping habits. At that point, increasing fiber and fluids, and taking laxatives works much better.

The prescribed bowel program will first clean out the large intestine and then continue to keep the stool mushy and easy to push out. It is important for the treatment to continue for 6 months, if not longer. Miralax/Glycolax is a key part of your child’s treatment program. It is not a drug and using it will not cause your child to become dependent on laxatives. The Miralax stays in your child’s poop, holding onto water to make the stools softer and easier to pass. You can adjust the dose yourself to meet the goal of 2 mushy, easy-to-pass, painless poops every day. It is helpful if your child goes to the toilet and tries to poop after meals. This is particularly important after breakfast on school days, when he or she may not have another opportunity to poop till evening. Regular meals and lots of fluids are important, but develop a schedule instead of allowing your child to nibble on snacks or sip fluids all day long.

Some problems your child may have that warrant asking your physician about include:

• If your child has motor problems that make it hard for them to sit comfortably to poop – there are potty chairs for children with special needs that can solve this problem.
• Some children have difficulties coordinating the muscles around their rectum to poop, making it difficult to pass even soft poop.
• Some children have fears of the toilet or bathroom.
• If your child has any problems with the prescribed bowel program, or is not getting better after following the program, you should contact your doctor or nurse immediately.