Constipation in Teens & Preteens
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12-year-old daughter's chronic constipation
June 2007
Our daughter, 12, has chronic constipation; typically having a bowel movement only once in three days. She holds her bowel movements whenever she is away from home. She recently returned from a 5 day trip in severe pain, having held herself closed the whole time. Despite the discomfort, she refuses to use any toilet except that in our house. She resists talking about it, but we're worried. She is very active physically, a bit skinny, and we try to feed her fiber rich foods, although she's quite the picky eater. Any suggestions? Worried parents
Re: chronic constipation. Do not guess as to what may be the problem. Take your daughter to her pedeatrician and take it from there. They should run blood tests and so on. It could stem from emotional stress or it can be biological or in most cases a bit of both. mka
Hi Worried Parents, I understand your concern. Hope you're up for some frank advice from a nurse-mom! A BM every 3 days can be normal, but it should be soft and comfortable to pass. Since you describe her as chronically constipated, I assume hers is hard and painful to pass. For simple constipation, try these measures: 1) make sure she drinks 64 oz. a day, 2)increase the fiber in her diet gradually, and 3) give her a stool softener daily. The one I use with my own family is Colace, which only softens stool; a version called PeriColace contains a laxative also. Both are available over-the-counter in any drug store. (Check this out with your doctor first to make sure it's suitable advice for her and to find out the MD's advice on how to approach this problem.) I too am concerned that she wouldn't go for 5 days and came home in severe pain. The key to helping her is to find out why she won't have a BM away from home (embarrassment? aversion to public bathrooms? etc.) It sounds like the reason is more than just pain. I think a therapist might be helpful to explore why she is hurting herself this way and ignoring her own pain. Work with your doctor on this, and I'm confident you'll find a solution. Nancy RN
Severe constipation post-partum
March 2004
This is totally embarrassing, but I am having a horrible post- birth pooping problem. Whatever it is that makes poo cylindrical shaped isn't working! I can feel all my poo massing up right at the anus, and then it tries to come out in a huge ball. This means that I end up writhing in pain, when I finally go it rips my anus so that it's bleeding, and then I deposit such huge things in the toilet that the toilet clogs. Seriously, it's almost as bad as giving birth (my first child was delivered vaginally; this didn't happen then). It's gotten so bad that I'm afraid to go at anyone's house or in a public restroom, because it'll clog the toilet. I'm three month post partum, and had a C-section. I've been exercising and doing kegals and have regained a lot of core strength, and I've been drinking lots of water and eating fiber, and nothing's working. This isn't like constipation, because it's not like I end up with those little rabbit pellet poos. Help! Am I the only one this has ever happened to? What can I do?
anon, of course Hello: I feel for you. When my first was born, almost twenty years ago, I had the same problem. It lasted for about 6 months and then slowly got better over the next 6 months or so. It hurt badly enough that I had to strip down and do my birthing exercises in order to go to the bathroom. One of the worst parts was that as I began to dread going to the bathroom, I would put it off, which lead to more difficulty. I hope that someone writes with more information for you, but I did all things you're doing, and rode it out. Best of Luck!! Michelle
This happened to me not only during pregnancy, but also for about 2 years after, and occasionally even now, 5.5 yrs later. Several things helped me, Drinking tons of water & herbal teas, prunes daily, daily mild excercise (20-30 min. hike), and inserting a finger in my vagina while eliminating & pushing against the rectal wall to ''guide/push'' the brown baby out. (ther wall seems to have permanently stretched enough that a sort of pocket forms rectally bulging into my vagina & ''trapping'' the feces.I have occasionally had to resort to rubber gloves and fecal impaction/extraction. Enemas also, at times. It has been slowly improving. Good luck! andrea
You are not alone! I thought I was going to have to go to the ER one day when I tried to have a postpartum bowel movement. It was horrifying. I actually had to put on a latex glove and manually remove the stool little by little . . . very painful, humiliating and laborious! Another of the aspects of childbirth that no one ever talks about. I took stool softeners religiously and it went away in a few weeks. Meanwhile, I kept the latex gloves at the ready. anonymous, too
I've never heard of your particular problem, but a few ideas come to mind.... try a stool softener, which may not clear up your problem but will make it easier to poop. I used an herbal one years ago when I had ripped to my rectom after giving birth to my first son. It made a HUGE difference. The poop just kind of slipped out of me.
Secondly, I wonder if something was damaged in your intestines when you had the c-section. They have to move your intestines aside, I believe. Maybe a muscle was torn, or something else was damaged. Possibly an MRI would show this(?) I don't really know, just a thought.
Also, sometimes when people have digestive problems one of the added factors could be weak abdominal muscles (I'm a massage therapist). The abs help give structural integrity to the organs. Is it too soon to start strengthening your abs? If you can, start with very gentle easy ones (ask your Dr.) Hope this is helpful. Good luck. anon
I had problems that may be similar. I suggest two things: 1) see your OB. I believe these types of problems are more common than we realize, and OB's are quite familiar with diagnosing and treating them. Mine was. 2) My midwife recommended I see Linda Avery on Telegraph in Oakland, across from Whole Foods. I believe she's a nurse practitioner(????), but her entire practice is with women with these types of problems. You could call to see if she addresses your specific problem. anon
Someone recently recommended Linda Avery to someone with post partum elimination problems and said she thought she was a nurse practitioner and that she worked solely with women with pregnancy and other issues. This is not correct. Linda Avery is a physical therapist (highly recommended) and she and the other practitioners in her practice (also highly recommended) (Ashby and Telegraph....blue building) see women and men with all kinds of issues. anon
I believe that what you are describing is severe constipation. I have had this problem all my life and when I am really constipated, it is as you describe. The ''rabbit pellet poos'' as you describe it, is only mild constipation for me.
Try Colace (or the generic equivalent which is cheaper). Get the one which does NOT have a laxative and is simply a stool softener. I would use this until any rectal fissue (the tear you describe) heals, which could take up to 1 month. After that, try Citracel. If you are taking pre-natal vitamens with Iron, switch to something with NO iron. You can also use cortizone suppositories to help heal/sooth any swelling/hemmorhoids which you may have. Continue to drink lots of water (especially if you are breastfeeding...drink a full glass before each breastfeeding session).
Also, what type of fiber are you getting...it has to be insoluble fiber (not oatmeal, celery etc which is soluble fiber). Raw carrots, grapes, blueberries, whole grain cereals like Smart Start, prunes, etc. There is a lot of misleading info out there. Given that Citracel says it is soluble fiber...I don't know why...but it does work.
One other thing...try to relax during bowel movements...don't push too hard. If it's bad, try a water enema (I believe oil enemas are supposed to help to break up hard stools). I don't know much about these...you might want to check with your doctor. But there are things which can help. Good luck and you are not alone! anon
I also had these problems, to the extent that I had to physically remove the poop one time, it just would not come out. I went to see the Dr, and he said to avoid milk products, and eat an oat bran muffin daily (making your own is best, so you can leave out the yucky stuff - feel free to email if you want the recipe). I did that, plus ate 2 or more prunes, and often would take a stool softener as well (either peri-colace or just colace). These things combined seemed to work pretty effectively, and immediately. After 8ish months, it finally started getting better (where I could stop some of the extra interventions, and now (child is 20 months) I am pretty much back to normal, other than the fact that I just found out I have a hernia. So, my advice is, try these things, and if they don't work, go see the Dr. ASAP. Good luck! Kelly
Embarrassing or not, I would call your doctor right away. They have seen/heard it all. I also had a c-section and never had problems with elimination. They might have left something in there or sewed up somewhere that is blocking your intestines, bowels, etc. Call your doctor today!!! DiAnn
Definitely go see your OB and tell him/her your problem, embarrasing as it may seem. It's a very common problem. My OB prescribed me colace and metamucil to help make things come out easier. She also had me put in suppositories she prescribed to help heal 'the area'. Both helped a lot and I was back to normal within a couple of weeks. been there!
That happened to me too... I had a vaginal birth, but I tore a lot, and had a really long recovery period. Seriously, I was having problems pooping for months afterward. My midwife recommended a laxative, which I took for months, and which helped. I think I finally stopped the laxative 4 months after giving birth, and I was mostly fine after then. anon
Make an appointment with your doctor. I know several new moms who had similar issues after C-Section. You may just have a fissure or even internal hemorroids. YOu won't know until they do a sigmoidoscopy.
As embarrassing as it is, you need to contact your primary care physician and discuss with him/her. familiar with it.
First I want to thank you for posting your question. I felt so alone, terrified and miserable when I developed similar problems after the birth of my second child last summer. At my post-partum check-up I described my symptoms and my OB said it sounded like I had a rectocele. She gave me a brochure about that and the other more popular ''pelvic support problems'' which I don't have but at least had heard of before: stress incontinence and prolapsed uterus. She also said to check back in six months if it hadn't gotten better, which it has, but it may just be that I'm learning to live with it because I don't want to have a surgical repair. Anyway, try googling rectocele and see if that sounds like what you have. I also second the other posters' advice about calling your doctor and starting to take Metamucil and stool softeners right away. Lots of water and a high-fiber diet are just not enough when things get this bad. Last, please give me a call so we can share what we learn about this condition (which can be a life-long affliction), emotional support and grown-up poop jokes. I couldn't find anything on the Web except for medical sites, when what I really wanted to find was personal experiences and a community of other women who know what it's like. Maybe we can start our own online confidential pelvic- support-problem support group! Jen
You are definitely not the only one with this problem. It will probably resolve itself in the next month or so. My midwife told me that the problem is a result of not enough water being retained in the colon due to nursing. She suggested dried fruit. Prunes were too potent for me but apples worked well. I also carried little tushies wipes wherever I went for a while. Sorry you are suffering with this. It will get better! Anon too
You are describing exactly what I experienced for about 1+ year after having a baby! I felt so guilty because I thought it was because I wasn't excercising as much as before I had our baby (even though I was still relatively active), and just felt I wasn't trying hard enough. I ''ate an apple every day'', drank water all day long, still to no avail. I had blood work done and discovered I have hypothyroidism. Constipation is one of the symptoms. I simply had no idea I had this condition. The bm problem cleared up as soon as I started taking the thyroid replacement medication and after 2 years it's never happened again!
Okay - If any of you readers don't want to hear about solutions to big poops, just don't read this entry. I've got this problem at times, too and have clogged my share of toilets, even before I had my children. In the interest of keeping you from becoming housebound, here is the scoop on big poop from my perspective. Keep up the water and fruit and veggies and don't overdo it on the serious fiber or meat feasts. And (my secret weapon) keep a few of those disposable medical gloves in your purse and when you know the poop that you just put in the toilet ain't gonna make it through that 100 yr old plumbing, put on the glove and carefully break up the poop with your discretely and sanitarily gloved hand. When done, use the clean hand to put a piece of tissue in the gloved hand. Invert the glove and hide it in the trash can (don't put it in the toilet). Wash your hands really well and use that sanitizer stuff if available. And you may also want to see a doctor who specializes in this stuff. Perhpas your muscles need a bit more help in healing there. My friend says Toto brand toilets are really great for folks like us. (I don't talk about it either)
have you tried a stool softener? It sounds like you are doing all the ''right'' things to help yourself recover from the c- section. Maybe it takes awhile for everything to get back into place. hope you feel better
I am so sympathetic to your plight - had something similar but from giving birth vaginally - it was a large anal fissure that took almost a year to recover from. I would writhe in pain every bowl movement, there would be blood in the stool, paper,etc. Then for hours after it would burn. It was horrible and painful. GO TO a colon rectal specialist because they are the only ones that know what's going on and how to treat. My OB and primary doc kept saying it was hemmoroids so it got worse and took so much longer to heal. There are medicines that can help - Don't be embarassed! it happens to alot of people but no one shares this side of birth. SEE A DR! Feel free to email if you need more info meri
I had a similar situation with my child. We were referred to UCSF Urology where we worked with a Nurse Practitioner on the issue. He was put on a nightly enema regimen for an extended period of time. The enema frequency was gradually decreased until he was able to move his bowels without them. It worked really well.
This sounds terrible for both of you! Have you tried blood tests for food intolerances? Not the standard food allergy tests (IgE), but the ones that measure for food sensitivies (IgG and IgA)? We went through an awful ordeal with our daughter when she was 2 and having major skin flare ups all over her body and horrible constipation. All kinds of topical medications and even antibiotics for months did nothing to help. Miralax was not helpful and we didn't feel comfortable having her on it indefinitely. We tried Chinese herbs, increased fiber, we tried ALL the things... Doctors and dermatologists and specialists kept saying it wasn't food related since her allergy tests were negative. Then we finally found a doctor who ran a different set of labs that specifically checked for food sensitivities and we discovered she was intolerant of wheat, dairy, egg and pea, among a few others. We eliminated those from her diet and her issues were mostly resolved in a few months. It took a while to completely stabilize, but now 2 years later, we've been able to re-introduce all of those foods and she tolerates them fine in small doses. Might be a long shot, but perhaps worth checking out. I'm so sorry - I hope your little guy feels better soon!
Have you checked whether he has any nutrient deficiencies? Being deficient in B12 or D can cause constipation. I was malnourished before I found out I have celiac disease, and boy, let me tell you that those nutritional deficiencies can really cause a lot more problems than people would expect.
Also, have they checked for small-intestinal bacterial overgrowth (SIBO)? Hypothyroidism? Constipation is a common sign of hypothyroidism.
I wish you the best of luck!
Generations of my family have struggled with constipation. It can be so painful and stigmatizing. After all the OTC stuff, we finally went back to basics which really helped. Eating brown rice, corn, popcorn, peanuts, peanut butter every day. Do not eat any carbs made with white flour or any processed alternative flour, whole wheat only. Gluten free doesn't help and may hinder. Massage and relaxation exercise. Since it has been a long time, and your child's bowl movement may be impacted, you may need to use a rubber glove and help it out but that can be painful. It is all trial and error until you find what works. Good Luck!
So sorry you and kiddo are going through this!
My 8yr old just would NOT be poop trained. This went on for years. Tried EVERYTHING and nothing worked. We finally did the fleet pediatric glycerin suppository DAILY for a month. That got him used to the idea of pooping daily in the potty. Then we reduced that to every other day, then once every few days, now rarely, in the meantime we sit on potty daily after dinner, so now he generally does a poop every day. If not, we ask him if he wants to use the suppository or if he wants to try again tomorrow. No doctor liked the idea of daily enema, but you know what, it’s fine and he saw the benefit so he was on board. The baby version called liquid glycerin suppository is better because it is glycerin based, unlike the bigger bottle which was more problematic for longer term use, and the baby version works for him so it’s fine. So now he is more or less there. Best of luck!
Prune juice...?maybe give it try. also prunes and apricots (fresh and dried)
It could be a food sensitivity (to dairy, gluten, etc.). When you say he barely eats anymore, what DOES he eat? My child was dealing with encopresis ~7-8, and we ended needing to do child-size enemas each night to get things moving and get him going regularly. But exercise, both soluble and insoluble fiber in the diet, and water intake are all really important. If he's on crutches, do some floor exercises with him. Movement helps. Sometimes there is not an overnight miracle, but a consistent effort to build flora in the gut to help with motility. Look into "Heather's Tummy Fiber," prokinetics such as Iberogast, and feed him "jam" made of blended stewed prunes and peaches on oatmeal. Good luck.
I just posted a similar question. I don’t have any answers but just wanted to say that I’m in the midst of it too and it’s awful. Therapy might be a good option (for him).
There is an Ayurvedic remedy called Triphala. It is a poly medicine consisting of 3 different herbs. It is gentle. One herb fights inflammation, one lubricates, one softens waste. I am an adult, but it can't hurt to ask a knowledgeable health store individual if it is safe for younger folks. I swear by it, and also had a friend who had lung cancer, was on oxy, and was also miserable. She had tried multiple remedies. Her partner was an acupuncturist and nothing helped. She tried Triphala and viola! Success.
Important to note that it is not a spasmodic and could take up to 3 days to work. Of course, water is extremely helpful.
"Triphala is a powerful herbal remedy that consists of Haritaki, Bibhitaki and amla. It is used in traditional Ayurvedic medicine to prevent disease and treat a number of symptoms, including constipation and inflammation."
Again, I am not a practitioner, just a person who's been there.
hi--my daughter and i both struggle with constipation. I had no idea my daughter was backed up until her pediatrician saw her tummy and recommended we try psyllium husk once a day. As soon as we did things began to clear out for her. We stir a tablespoon of organic psyllium husk into our morning oatmeal or porridge. That stuff moves things along really well. It doesn't taste super good but we add maple syrup to the oatmeal and it helps. Also make sure he drinks lots of water. And this probiotic also helps me--it came recommended from a friend who is a nutritionist--she says most probiotics don't survive our digestive tract. but when i take this regularly it really helps keep things normal. it's called SporeBiotic--start with a half capsule a day and after a week work your way up to one capsule. (you should also try eliminating dairy and gluten--both really stop people up--even if he doesn't have celiac he could be gluten sensitive). Also, I remember post c-sections that prune juice worked really well for me too. You might want to avoid bananas as they can slow things down. I would talk to a nutritionist--they can give you a lot of food recs like these that should help.
Here's a suggestion:
While I am an adult, I have had constipation issues since childhood.
After trying lots of types of remedies, the thing that really works is a two-step process:
First, go on a hike (one mile or more, hill work is even better than on a flat trail).
Second, eat a LARGE bowl of hot soup, broth-based rather than cream. As my gastroenterologist says, exercise signals your guts to do stuff.
Hope this is helpful.
I’m sorry you and your son are going through this. What is his diet like for breakfast, lunch and dinner? (When he eats)
Another thing you can try is Natural Calm for kids. It's magnesium supplement you can buy at pharmaca. That particular form of magnesium helps move things along as well.
Try a gluten free diet. Your child could have a gluten intolerance but not celiac and that won't show up in blood tests. My child was very similar and none of the Western docs we ever saw had anything helpful to say -- Gi specialists, testing, etc never helped. Miralax didn't help. But a gluten free diet solved everything! Your child may also have other food intolerances - dairy, corn and soy are other common ones. But start with cutting out gluten. Best of luck!
Smooth Move tea has been the only solution for me. I buy it in bulk on Amazon. I experimented with different frequencies and # of teabags to find what works for me (presently 2 bags every 2 days). Definitely recommend experimenting starting on a Friday afternoon, so you have the weekend to be close to home. Also, FWIW, after plane trips is a notorious "stopped up" time for me, so I drink tea before and during a plane ride, and that first evening. I use as little liquid as I can stand (a measured cup or so), since I don't really like the taste. Best of luck.
Hi there, I am so sorry your son is going through this! What you are describing is very similar to what I experienced when I was a teenager. I was constantly constipated and bloated which made me feel miserable. And just as you mention in your post laxatives didn't help. I even ended up in the hospital once because I didn't have a bowel movement for more than two weeks and was in a lot of pain. I had ultrasounds and a colonoscopy done when I was 20 but the only diagnosis I ever got was: there is a lot of stool and gas! After years of suffering I decided to try an elimination diet and it turned out I had "just" lactose intolerant for all those years! I eliminated dairy from my diet and I never had any issues again (plus lactase pills also help). This was 15 years ago when food intolerances weren't really a thing but I am surprised your doctor hasn't tested your son for it (or maybe they did?). Good luck and I am sure you will figure it out!
It sounds like OT/PT might be good. There is a pediatric pelvic floor PT in Walnut Creek. A daily combo of mag citrate gummies (new chapter), exlax, and probiotic help our kiddo. Exlax dose may need to be higher in your child's case. We also play close attention to hydration, fiber intake (both soluble and insoluble), the med routine, timed sits (really important, about 10 mins, about 20 mins after each meal), and exercise. OT may help with the inability to go if there are interoception issues (feeling too much or feeling too little of the sensations around pooping). You might also consider therapy. And Chadd/Attitude has an article about ADHD and constipation-- they often go together, so if there are other signs of ADHD it might be worth pursuing the dx.
Try Welch's 100% Juice White Grape Peach. It works unbelievably well for my child. Also Siggi's nonfat drinkable vanilla yogurt.