Dr. Bob: My 7-year-old son has been having problems with a lot of stomach aches recently. His bowel movements are quite large and infrequent. Sometimes he will have problems controlling himself and have accidents. He is quite upset with this. We don’t know what to do and fear that the problem will only get worse. What should we do?
Answer: You are describing significant constipation which can present in many ways. It can present as solely abdominal pain, painful defecation or fecal soiling. He can be withholding stools because of discomfort with a bowel movement and he wants to avoid the discomfort. He might have lost some of the usual signals that tell him to go to the bathroom. Withholding of bowel movements can develop into a serious problem and will need long-term care. When this occurs, further evaluation is necessary. Please seek help with your pediatrician. A regimen of stool softeners and other measures are probably in order. I would avoid using laxatives without the advice of your doctor.
I must note that this is exceedingly common, and everyone should be calm and reassuring as the problem is addressed. I have seen hundreds of children with this problem during my career. One of the telltale signs for me was the ability to actually feel some firmness in the left lower abdomen during examination. That is why I always examined the abdomen of all children that I saw even if they came in for an earache. I wanted to detect possible constipation before it was a big problem.
The problem can present as pure constipation or can even present as diarrhea (soiling). This latter presentation baffles most parents. They are convinced that there is no way a child can be constipated and still have loose stools that, at times, are not well-controlled. The underlying problem is that affected children have so much stool that they cannot comfortably have a bowel movement and they are effectively backed up. When this happens, oftentimes loose stool will go around the hard stool and lead to involuntary soiling. A vicious cycle of more retention can ensue.
A couple of things might help in the short-term – 1) Make sure that your child is drinking plenty of water; 2) Fruits, vegetables and fiber-containing cereals can be of benefit. These foods are good for our overall health also; 3) Remember that all of us tend to have a bowel movement after we eat (called the gastro-colic reflex – you put food in the stomach and the colon wants to empty). Make sure that you set aside time in the AM after breakfast for your child to sit quietly and try to have a bowel movement. The hustle-and-bustle of everyday life makes this difficult, but it is very important to do this.
This problem requires a long-term solution (many, many months) that is best managed in coordination with your pediatrician. A YouTube video call The Poo in You is quite instructive (https://www.youtube.com/watch?v=SgBj7Mc_4sc), and I have recommended it countless times. Watching it can help you and your child understand what is happening with the food that is eaten and processed for nutrition and eventual excretion. The good news is that the problem is treatable with the proper intervention. But do not delay. Seek help now.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.