Constipation in Children - an American epidemic?

Countless children in the United States are diagnosed with chronic constipation every year.  Many pediatric GI specialists will tell you that it is the most common condition that they see, accounting for nearly 25% of all visits.  There are many factors that can cause this, and most cases of constipation require a variety of treatments to resolve.  Each family must take the time to discover both the physical and environmental factors that are contributing to their child’s problem, as constipation tends to have both a physical and emotional component.

            Many of us have heard of the ‘gut brain’ but don’t really know what it refers to. This is the enteric nervous system, which can not only send and receive messages, but also respond to emotions.  Your gut, or entire digestive system, contains over 100 million neurons - this is more than are found in the spinal cord!  It is no wonder that gut health is so influenced by emotions.  For this reason, almost all children and adults who are diagnosed with digestive diseases and disorders must address both physical and emotional symptoms.

            For children who are diagnosed with chronic constipation, there is likely more than one factor involved.  If a child has even one episode of constipation that results in hard and painful stool, they may internalize a feeling of fear or expectation of pain when the need to pass the next stool arises.  Some children will instead hold the stool in, rather than face the pain of attempting to pass it.  Like the colon, the rectum can also absorb water, so stool that remains unpassed in the rectum gets harder.  This can make it even more difficult and scary for the child to pass.  It becomes a vicious cycle of withholding and subsequent painful stool!  This can cause both a rectal and bowel impaction if not addressed in a timely manner.  Sometimes small pieces will break off, so called ‘rabbit pellet’ stool that some parents observe in their toddlers and young children.  Parents might think this is just their kids ‘normal’ stool, and not know that it’s because there is a large mass stuck inside.  Withholding for long enough can cause such a large blockage that only soft or liquid stool can fit around it.  Children with this condition will pass frequent very small loose stools.  In younger (and occasionally older) children this may present as encopresis, or soiling.  This occurs when small amounts of soft or liquid stool leak from the rectum without the child’s knowledge, staining the underwear.  Many parents won’t realize that the cause of this is either chronic constipation or a rectal or bowel impaction.  Other signs of a rectal impaction include increased urination or wetting accidents.  An overly full rectum can put a large amount of pressure on a small child’s bladder, causing accidents or bedwetting.  

Diet of course plays a crucial role in helping your child get relief from constipation.  Children should be drinking plenty of water every day.  If constipation is severe, try organic no-sugar-added juices such as apple, peach, pear, plum, or prune.  (Fun fact, many ‘p’ fruits are also high in fructose and promote bowel movements!) Adding 2-4 oz of aloe juice to other juices will soothe and lubricate the intestines.  Many kids are resistant to high fiber foods, but encourage them to eat carrot sticks or celery sticks with almond butter and raisins - (bonus for more fiber!), or other crunchy raw veggies that they like.  Many kids become constipated from an excess of pasteurized dairy products.  Eliminating all dairy other than butter and yogurt might help your child.   If your kids will eat broccoli with cheese try buying a raw milk cheese from your local health food store as raw milk tends not to have the same constipating effect.  Adding organic raw coconut oil, organic ground flax seeds, or organic chia seeds can also encourage softer bowel movements.  Many kids love the texture and taste of chia pudding which can easily be made or purchased already prepared at most health food stores.  

Over the counter laxatives and enemas should be avoided until needed as an absolute last resort.  Some GI specialists will recommend a ‘clean out’ for your child to relieve the impaction.  They will likely recommend senna-based laxatives, Miralax, magnesium citrate, or a combination of all of the above.  If your doctor recommends this, ask if it can be done with magnesium citrate only.  Senna-based laxatives not only cause painful cramping, but can quickly becoming habit forming.  Miralax is also habit forming, and while less so than senna laxatives, has never been approved for use in children, despite the fact that many doctors prescribe it regularly for long term use.  There are many natural products that can be used to keep the stool soft and moving that are not habit forming.  Organic oils are very lubricating to the intestines and can be given daily - raw organic coconut oil has a laxative effect for many people.  Others to try are organic sesame oil or olive oil.  

In addition, address any emotional issues that your child might be having.  Is there a negative attitude in the home surrounding defecation?  Does your child feel the need for a certain amount of control?  Harsh punishment for encopresis or soiling will only make the problem worse. Many kids thrive on somewhat of a schedule during the day.  No need to be militant, but kids like to know what’s coming up next.  A particular effective strategy is that of ‘toilet sitting time.”  Pick one or two times during the day when you know you will be home, and have your child sit on the toilet for 10 or 15 minutes.  Give them a book to look at it if they’d like.  Have a stool for their feet to encourage a more squat-like position, and give them some time to see if their body will relax enough to have a bowel movement.  Having ‘sitting time’ at the same time every day will encourage your child’s body to move the bowels at that time.  Many adults naturally have a bowel movement in the morning.  If mornings are not rushed and there is time for your child to sit on the toilet for a while, try that.  If evening is a more calm time in your house, try sitting time after dinner.  Don’t expect immediate results.  This is a complex problem that will involve a fair amount of work on both you and your child’s part.  Seek help and support from other parents or a professional if you are getting frustrated or not seeing progress.  

            Regular chiropractic care can be a critical aspect of managing your child’s chronic constipation.  The message that a child needs to defecate is sent from the intestines and rectum to the brain.  If the spine is maladjusted in any way, a young child will not receive the message, so to speak.  If your child is not consciously realizing that they need to defecate, stool will continue to harden in their rectum.  In addition, many children will have been constipated or withholding stool for a long time before parents realize that something is actually amiss.  By this time, the child’s rectum can be stretched out, and they won’t even receive the message that their rectum is full and needs to be emptied until the stool is too large to pass comfortably.  One simple adjustment may be all your child needs to break the cycle!  Other children require more frequent and regular care to maintain a healthy frequency of bowel movements.  A case study presented here http://www.sciencedirect.com/science/article/pii/S1479235408000588  demonstrated that chiropractic care not only increased the frequency of bowel movements in constipated children, but that the stools were “described as soft without the accompanying straining, pain and rectal bleeding.”  A more in-depth study can be found here: http://drdianemeyer.com/Dr%20Meyer.pdf

Chiropractic America describes in easy-to-understand terms how chiropractic care helps relieve both the symptoms and some of the underlying causes of constipation: “Chiropractic adjustments (particularly in the lower spine) may help relieve constipation in certain individuals. Muscles in the intestine push stool to the anus, where stool leaves the body. Special nerve cells in the intestine, called ganglion cells, make the muscles push. These nerves connect directly to the celiac ganglion, which also innervates the stomach, liver, gallbladder, spleen, kidney, small intestine, and the ascending and transverse colon. The celiac ganglion, in turn connects to the spinal cord (and the brain) through nerve roots that exit the spine in the lower thoracic and upper lumbar region.  Pressure on these nerve roots caused by misalignment of the vertebrae in this area may interfere with the normal function of the bowel as well as other organs of the digestive system.”

If your child is suffering at all from constipation, even just occasionally, come see us at Pea and the Pod.  Like many health issues, constipation is easiest to relieve when addressed early.