Severe Constipation Issue

Emerald27

Hi, mamas! I usually just post over on October 2014, but decided to hop over here for some advice about toddler constipation. So hello!

Backstory: My DS (2.5yo) struggles with chronic constipation. It's most likely from a combination of diet (kid loves bananas, yogurt, and cheese and refuses to eat fruits, veggies, smoothies, etc...but we really do try, and offer healthy options all. the. time.) and ignoring the urge to go/trying not to poop for fear that it will hurt. "I don't want to poop right now." is a common sentence we hear in our house.

Pedi has prescribed 1tbsp Miralax daily, and we also give him activia yogurt and try try try to get him to eat high-fiber foods. We also constantly offer water.

Last weekend we went out of town to visit relatives and forgot then Miralax. He went a few days without a BM, and then he only produced a very small, hard, and dry poop. Back home, we started up the Miralax again...only, no poop! He has been grouchy and complains that his tummy hurts off and on, so since the Miralax seems to not be working, we gave him a liquid glycerin suppository yesterday. Within an hour, that produced one very small poop...like way too small to have actually cleared any blockage. Today we gave him a regular child's glycerin suppository, but no poop! Not even a smear! He was able within the hour to push the suppository back out but hasn't pooped at all all day.

I'm going to call the doctor in the morning because Miralax not working and 2 failed suppositories has me so worried...what else is there to do? He has had a warm bath today, he gets lots of exercise, running and playing outside, has had about 6oz of prune juice and lots and lots of water. Says his tummy hurts. Says "I don't want to poop right now," and wants to be held nonstop. Poor kid.

Does anyone have any other ideas I can try? Tricks to help your toddler poop? Does anyone know what the next step is, that is, what they will do at the doctor for him? Thank you!!

TL;DR My toddler is chronically constipated and I've tried everything I can think of to help him (bath, juice/water, exercise, Miralax, suppositories...and NO poop). I need some more ideas! TIA!

TiffanyBerry

I think you're right that the next thing to do is the doctor.  Enema, maybe?  I'd certainly wait for a doctor to try that.

I know you've worked on it left and right, but I don't know if you've tried eliminating dairy.  (I know, I know... HOW?!)  But sometimes dairy can be very constipating, even in small quantities.

Good luck with the dr. tomorrow.  I have my fingers crossed for you!

Emerald27

@TiffanyBerry‌ Ugh. Eliminating dairy! Kid lives for WCM (we already limit that to just a couple oz per day when we can), begs for yogurt for breakfast and cheese sticks and everything dairy. My house would be a nightmare if all the dairy disappeared. Maybe it's worth a try, though?

TiffanyBerry

It sucks.  I'm gluten/dairy free and find dairy to be more annoying to avoid that gluten, and I've been doing both for years and years, as an adult!

There are other ways to get yogurt (soy, coconut, almond), though they are more expensive.  And other milk subs (much the same, though the magnesium in the coconut variations might help with the bowel movements).  Cheese is tough.

Some people are intolerant of casein and it can cause constipation, but *sometimes* the intolerance is to a particular subtype of casein that is significantly more prevalent in one type of milk than another.  So *some* people who don't do well with cow-based dairy can tolerate other kinds, especially goat.  And you can get goat milk yogurt (Trader Joe's) and cheese (either the standard chevre available in most every store, or Trader Joe's and places like Whole Foods often have cheddars or goudas made from goat milk.  

I'm sorry you have to contemplate this one!

ELF4321

I would start with eliminating bananas before going dairy free. Bananas are the one and only thing that ever binds DD up, without fail, every time she eats one (or even half of one). If that doesn't ease up the problem, then I would consider cheese next (one of my doctor friends jokingly refers to cheese as a "butt plug")

Chuck1906

You probably should go to a GI doctor and then they can prescribe Lactolose. My son had the same issue prior to him being placed on Lactolose. He is doing much better now. They had him on Miralax at first but that was giving him cramps and he was pooping like 5-6 times or more a day so we took him off that and they put him on Lactolose and that seems to be working just fine.

LSU628

DD was constipated to the point of impaction. They had as do a Miralax cleanse. I had to give her  I want to say a cap a day? for 3-4 days. It was seriously gross and the poor kid couldn't control her bowel movements, but it got the job done. We also had to do the suppository and DD hated it and still talks about how much it hurts. We basically had to tell her look, you have to poop every day or we are going to have to do the penguin. We told DD that her poop was soft now and didn't hurt so she was more agreeable to going. We still have to do low doses of Miralax if we notice she isn't going every day or the consistency is getting more hard, but we are MILES from where we used to be when she was holding poop and doing everything possible in her power not to poop.

Emerald27

Took DS to the doctor. She prescribed 20ml of magnesium citrate every 12 hours for one day (unless he poops after the 1st dose in which case we skip the second dose), followed by 1tsp of Miralax daily for a week. After that, we're supposed to go to 1tsp Miralax every other day for a week, then every third day, etc., unless his poop becomes hard/dry or infrequent and painful again.

We are also supposed to limit dairy products and other binding foods, and increase fruit and veggie intake. lol - this is the hard part. My first plan is to make smoothies to replace yogurt, and to hide the bananas in the pantry. :P The real fight will be over WCM, but a small glass each day shouldn't hurt if I'm limiting other dairy intake, and hopefully will be enough to satisfy him.

Gave him the MC this afternoon and still no poop, so we'll see! I really don't want to have to give him another dose. Thanks for the advice and support, ladies!

TiffanyBerry

It's worth noting that IF it is a casein intolerance issue, just limiting dairy (as opposed to fully eliminating it) may not make a difference.  If it's a calcium intake excess, then it would definitely help to limit. (Yes, this stuff is ridiculously complicated to sort out!)

Emerald27

TiffanyBerry said:

It's worth noting that IF it is a casein intolerance issue, just limiting dairy (as opposed to fully eliminating it) may not make a difference.  If it's a calcium intake excess, then it would definitely help to limit. (Yes, this stuff is ridiculously complicated to sort out!)

Thanks! We're supposed to limit dairy not based on the idea that he has a sensitivity to it, but just because those foods are binding...basically, we are supposed to feed him for output for a while.

The magnesium citrate did NOT work! So when he wakes up from his nap, doc wants me to give him another glycerin suppository. Poor kid. I hate doing this to him, but he needs to "go"!

ETA: His doctor thought that a dairy sensitivity might produce gas and diarrhea more so than constipation. Thoughts?

TiffanyBerry

Lactose (milk sugar) intolerance produces gas/diarrhea. Casein (milk protein) intolerance produces a wide variety of other symptoms. But it falls into the category of food sensitivities that are not true IgE mediated allergies, so many main-stream docs dismiss the possibility of them.

Emerald27

@TiffanyBerry‌ I'll do some research on casein allergies and see what I can find. Thank you!

The glycerin suppository didn't work this time either. I'm at a total loss. I suppose we'll call the doctor AGAIN in the morning, but I don't know what they'll do next. Poor baby. (

acbfreire

It sounds like you tried a lot of stuff, but maybe massage your DS on the tummy clockwise and move his legs in and out (a massage therapist showed me that and it is supposed to help the digestive tract to flow). It may help the other stuff to work. GL!

Emerald27

acbfreire said:

It sounds like you tried a lot of stuff, but maybe massage your DS on the tummy clockwise and move his legs in and out (a massage therapist showed me that and it is supposed to help the digestive tract to flow). It may help the other stuff to work. GL!

Thanks for the suggestion! Just put him to bed and did a clockwise tummy rub before he fell asleep. Also bicycled the legs. We've done lots of that, prune juice, lots of water, exercise, warm baths, and Miralax. I'm at a loss because I don't know what else there is besides the suppositories (and the magnesium citrate he's already had 2 doses of)!

I'm also afraid of what will happen once he does expel the blockage...he is full of mc, Miralax, and prune juice...I'm afraid it won't be pretty.

TiffanyBerry

Any chance he are something he shouldn't have that's causing a blockage? How long has it been since a bowel movement? I'm worried about an ER trip in your future.

Fingers crossed for huge messy poops tonight. Rather than none, anyway.

Emerald27

TiffanyBerry said:

Any chance he are something he shouldn't have that's causing a blockage? How long has it been since a bowel movement? I'm worried about an ER trip in your future.

Fingers crossed for huge messy poops tonight. Rather than none, anyway.

I really don't think he could have eaten something that would cause a blockage. He doesn't generally put anything in his mouth except food. Also, the blockage is definitely way down in his colon (you can feel it if you press gently on his tummy). Wouldn't some "object" get stuck in his small intestine rather than down in his colon? I'm really clueless about all this stuff.

I really hope he doesn't have to go to the ER. How traumatic that would be...and I don't know what they would do there? Ugh. ...poop, boy! Poop!

Emerald27

So no ER trip for us (yet!!! Fingers crossed). Doc prescribed MORE Miralax, specifically a Miralax cleanse done by taking 1tbsp at a time 3x per day, accompanied by 64oz of fluid intake per day, for two days. The Miralax is easy to get him to take...but getting him to drink that much will be quite the challenge. She said juice or lemonade was a fine option, so we've started with diluted juice.

She also referred us to a pediatric GI specialist, so we will go to the specialist to try to determine what the underlying cause of his constipation might be. I'm so ready for this to be over.

Thanks for the support and suggestions!

blushingbride_08

Chia seeds. They are high in fiber. If he likes yogurt and banana mix it in there to make a parfait.

LSU628

We ended up at the GI after DD was impacted. I hate to say it, but he really wasn't a whole lot of help. He prescribed a Miralax cleanse to get the impaction cleared (gross!!!), had me keep a poop journal for about 2 weeks (also gross!) and gave me sheets on high fiber foods to help DD go. Her problem was more fear of pooping based not that she couldn't go. Once we got her poop soft and it no longer hurt she is much more agreeable to going. Occasioanlly when we are on vacation and she isn't eating the best diet her poop will get hard and painful again but once we get home and get the Activia or Miralax going we are back to normal. Hoping your LO has the same results!

LSU628

Another suggestion the allergist had us do was a tsp of flaxseed oil in DD's milk. She wasn't a fan and I had to give it to her in a sippy cup with a straw to help her get the oil down but it was a great help and gave my skinny minnie some extra fat and calories.

Emerald27

@LSU628 Thanks! GI said it doesn't seem like an allergy or sensitivity, but based on when it started he thinks it's functional constipation. He says that as DS gained awareness of and some control over his bowel movements, he sensed the pressure you feel when you need to poop and tried some different ways if relieving it. He tried wrong and withheld the poop rather than just pooping, so it became hard and uncomfortable, making actually popping painful and difficult.

So DS apparently taught himself that the more comfortable way of relieving the need-to-poop sensation is withholding the poop, inadvertently making pooping worse and causing himself to become more and more constipated.

Basically, the GI prescribed Miralax until DS is potty trained. We are supposed to interrupt him when he shows signs of trying to avoid pooping, and either ask if he wants to sit on the potty or just have him sit in our lap. We can also try teaching him to tense and relax, tense and relax, by making tight fists and holding his breath, then blowing out and opening his hands, etc.

Justabean3

@Emerald27‌ just FYI too, watch out for teeth issues. Extended use with a toddler can cause teeth decay. My nephew takes it daily and they were warned about this. He didn't start really having teeth problems until about 4... Just something to watch for if it continues you have to do this .

Emerald27

Justabean3 said:

@Emerald27‌ just FYI too, watch out for teeth issues. Extended use with a toddler can cause teeth decay. My nephew takes it daily and they were warned about this. He didn't start really having teeth problems until about 4... Just something to watch for if it continues you have to do this .

Thank you! DS now has some cavities we need to have filled. I wonder if it's from the Miralax? I brush his teeth thoroughly twice a day but he still has cavities!

Justabean3

My nephews GI told my sister specifically that daily use of Miralax while a necessity causes tooth decay and cavities especially in small children.

I would keep a close eye on it. Jack has had to have some pretty extensive work done the last 2 years HOWEVER. I don't think my sister is as proactive about keeping them cleanly all the time.

Ya Never Know

Emerald27 said:

@LSU628 Thanks! GI said it doesn't seem like an allergy or sensitivity, but based on when it started he thinks it's functional constipation. He says that as DS gained awareness of and some control over his bowel movements, he sensed the pressure you feel when you need to poop and tried some different ways if relieving it. He tried wrong and withheld the poop rather than just pooping, so it became hard and uncomfortable, making actually popping painful and difficult.

So DS apparently taught himself that the more comfortable way of relieving the need-to-poop sensation is withholding the poop, inadvertently making pooping worse and causing himself to become more and more constipated.

Basically, the GI prescribed Miralax until DS is potty trained. We are supposed to interrupt him when he shows signs of trying to avoid pooping, and either ask if he wants to sit on the potty or just have him sit in our lap. We can also try teaching him to tense and relax, tense and relax, by making tight fists and holding his breath, then blowing out and opening his hands, etc.

DD has been withholding poop for a while. It got so bad she was getting anal fissures from having baseball sized poops because she would hold it so much she stretched her insides so the poop didn't have the right form. Trying to get DD to understand why or how to poop has been impossible, she is only starring to understand I think, but now you ask her what she's doing when she's hunched in a corner, and she says "holding it". We've been trying to teach her to push, but as long as there's hard poop, it just cycles over and over. We had her on restolax at one point, and it did wonders, she was a different kid when she stopped holding, but we had to take her off the stuff when she broke out in hives. She was doing so good for a while after she was off of it, so we didn't put her back on. It's been about 6 months since she was on it, and now she's starting to have hard poops again, and she's started holding again, so she's back on restolax for the next 3 months. A low dose that she takes every day works for her in a way that it softens things up, but not to the point where she can't hold it at all, just enough so that it doesn't hurt her.

I'm not sure any of this helps you, but just wanted to say I've been there, and it's a challenge. I really hope this time we'll nip it for good, it's so hard to watch them go through it.

LSU628

Unfortunately, my daughter was a little bit older (around late 3, early 4) when this was going on, so I was able to reason with her a little more. She HATED the pediasure suppositories. They have a penguin on the box so she would beg us not to do the penguin again. Through much coaxing, pleading, begging, and finally just relaxing and letting her read or reading to her on the potty she finally relaxed enough to go. Poor baby had to go through all sorts of testing, bloodwork, etc at the Children's Hospital to make sure there was no physical reason why she wasn't pooping. I think the whole experience helped her realize that holding her poop wasn't really an option anymore. I will say and give you all a head up that once we cleared up the impaction she had a really really hard time controlling her pee. The pedi explained that the poop had been pushing on her bladder for so long that once it was cleared the bladder was soft and floppy so we basically had to re-PT DD. We've also discovered that with DD the holding thing is psychological. Now she's not holding poop, but she's trying to hold pee. Unfortunately it's not as easy to hold pee. :-(

StellaMakes3 said:

LSU628 said:

DD was constipated to the point of impaction. They had as do a Miralax cleanse. I had to give her  I want to say a cap a day? for 3-4 days. It was seriously gross and the poor kid couldn't control her bowel movements, but it got the job done. We also had to do the suppository and DD hated it and still talks about how much it hurts. We basically had to tell her look, you have to poop every day or we are going to have to do the penguin. We told DD that her poop was soft now and didn't hurt so she was more agreeable to going. We still have to do low doses of Miralax if we notice she isn't going every day or the consistency is getting more hard, but we are MILES from where we used to be when she was holding poop and doing everything possible in her power not to poop.

@LSU628 we went through something very similar a few months back with impaction and the miralax cleanse, and it's really set potty training off for us. She's still fine to pee in the potty but absolutely HORRIFIED at the thought of pooping in the potty- screaming, crying, begging not to- I don't try and make her any more because it was so upsetting for her. Now she's down to 2 pull ups a day- nap and bedtime- and usually poops at naptime. Is your LO pooping in the potty now? Any tips to help her move past this?

Hennessy

I know this post is a little old and that it seems that you've had quite a few conversations with doctors since your post but I want to 2nd someone's suggestion of Lactulose.

When DS was only 2 weeks old we had him at the hospital for a distended abdomen.  After countless tests and even a barium upper GI, he was diagnosed with severe reflux and MFPI.  The details of this diagnosis aren't necessarily relevant.. However, I bring it up because he was put on a specialized amino acid formula which caused horrible constipation.  I also mention it because we started seeing a Pediatric GI when he was only 2 weeks old and continued to see her regularly until he was almost about 16 months.  For almost as long as he was on this special formula (approx 10 months) he was also prescribed lactulose to help with the constipation.

The Dr prescribed this specifically because she said it was safe for prolonged use.  And, I can tell you it was necessary for all of us to survive the constipation challenges.  As he got older we tried everything else.. prune juice, pear juice, bicycling his legs, rubbing his belly, his back.  Nothing had the results that the Lactulose did.  

It might be worth researching and asking your Dr about it as an option.  I'm surprised it hasn't been suggested as an alternative to the Miralax.

Good luck to you (and your LO!)

Emerald27

Thank you so much, @Hennessy‌! DS has been on 1tsp of Miralax daily since we did the cleanse, and he has 1 normal bowel movement each day. Actually, the last two days he's pooped on the potty!

I like that he's doing so well, but I AM concerned about his teeth. I'll look into Lactulose, and if it doesn't pose the same risk as. Miralax for dental health, I'll give our GI a call to ask about that as an alternative.