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Tuesday, May 21, 2013
Holding back bowel movements
my 2year old daughter was constipated and got an anul fissure. now she is holding in her poo for up to 4days then she will go, but shes in so much pain and keeps saying sore tummy! shes on lactalose and we have some anaesthetic cream to help and it doesnt seem to be helping and also is only allowed to be used for no more than 3days. she lets little bits out every now and again and its affecting her sleep because her tumy is bloated and painfull.
This is certainly a distressing problem for both parents and children! Your daughter has a condition called encopresis. As you have noted it all started with a painful experience in having a bowel movement because of the anal fissure. Dry, hard, large stools will continue to be painful to pass reinforcing your child's notion that stooling is always painful and something to avoid.
The cycle needs to be broken with a good cleaning out of the existing dry, hard stool followed by consistent treatment with bulk laxatives and stool softeners to keep everything moving regularly. This allows the bowel smooth muscles that have become overstretched and unable to contract to regain their normal contractile ability to move stool along in a timely manner preventing constipation from re-occurring.
If lactulose is not working, you need to return to the doctor for a new plan of care. Sometimes it takes more than just one medication to get things ready to heal. For example, she may need to have a larger dose of a bulk laxative, more fluid intake to keep the stool soft, a stool softener, and an enema for the initial clean out. None of this easy on parent or child but it is the only way to get a handle on the problem and begin the healing of her intestinal muscles. If your daughter's doctor is unable to help, ask for a referral to a pediatric gastroenterologist.
Other things you can do to help are to have your daughter sit on the toilet after every meal when the gastrocolic reflex is activated. As she eats, her intestines propel digested food along her track. Eventually she needs to have a bowel movement. Sitting on the toilet will make it impossible for her to cross her legs and prevent the stool from passing.
Make sure her diet is rich in whole grain products such as whole wheat bread and whole wheat crackers, fresh fruits and vegetables. Restrict her milk intake to no more than 16 ounces of skim milk. Too much milk can be constipating. Make sure she drinks only 100% fruit juice, no more than 6 ounces per day and as much water as she wants. Fruit juices that promote stooling include apple, prune and white grape juices as well as pear nectar. Also make sure she is physically active for numerous small bouts of time throughout the day. The action of large muscles for running and climbing actually help stimulate action of the intestinal smooth muscles to promote regular stooling.
I hope this proves helpful information for you and your daughter.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University