Simple Guidelines for Countering Constipation

I have a hunch that many of you aren’t comfortable talking about human waste. To be honest, it’s not my favorite topic either. But we need to address it because digestive irregularities can lead to too many serious problems if not properly addressed, especially in kids. Since I have your attention, let’s tackle this topic together.

Many kids suffer from producing stools irregularly or stools that are harder than usual. This condition is called constipation and sometimes leads to pain and anal fissures (blood on the surface of the stools). Because of this, many kids fear going to the toilet, which further reinforces constipation.
Children have varying levels of sensitivity to constipation, but these general guidelines can help decrease the likelihood and severity of constipation.

WASTE MANAGEMENT

The general principle is this: part of everything we eat will be absorbed by our bodies for metabolic purposes; what’s left in the digestive tract is waste. As waste products are moved out of the body, they are progressively dehydrated. Larger amounts of waste will be excreted more quickly to make room for incoming food. When waste moves faster through the digestive tract, the waste will also be wetter as it has less time to be dehydrated. Smaller amounts of waste will slow the excreting process, thereby making the stools dryer, denser, and harder.

From this general principle, we can infer certain things about the quality of stools:

• Foods rich in potential waste products (i.e., indigestible parts) will make bulkier stools.
• Bulkier stool content will move faster towards the end of the digestive tract to be excreted.
• Bulkier stools will also be wetter, less dense, and softer, thus becoming easier to expel.

EATING PLANTS = EATING FIBER

We often hear about the virtue of fiber. The problem is that there isn’t actually a food called “fiber.” Many foods are advertised as containing fiber, but in reality, eating fruits and vegetables will do the job. So, forget about foods that claim to “contain fiber” and eat vegetables and fruits – which actually do contain fiber and don’t come in potentially misleading packaging. It is worth mentioning that not all vegetables have the same fiber properties. Roots do not have the high fiber content that leafy vegetables do because they often act as a reserve system for plants. For example, carrot puree seems to promote constipation, at least in the way it is prepared for infants, often in isolation from other food.

EAT LESS OF “WASTE-LESS” FOOD

Foods that can be completely digested leave less waste behind. These foods often contain proteins, starches, simple sugars, and fat. Therefore, they slow down the emptying of the digestive system and tend to result in waste that has low water content. This kind of waste produces hard stools. Milk, biscuits, sweetened / soft drinks and commercial juices (especially apple juice!), industrial breads, and white rice will tend to make stools dryer and less frequent.

Processed foods – often packaged and containing ingredients that you cannot see and that have weird names, fat, and simple sugars –tend to produce the same result: constipation. I’m not saying that starches, fat, and sugar are inherently bad. Remember that these starches, fats and proteins are also necessary for our health. The problem is that we eat too much of them and often in processed forms outside of the home.

FINDING THE BALANCE

Another factor to recognize is that each child will have a different level of susceptibility to constipation. The balance of the kinds of foods each child should eat will have to be discovered through trial and error. Therefore, aim for at least one soft stool per day. (Exclusively breastfed children have their own regimen. They are not addressed in this article.)

To discover this balance for your child, the following usually works:

• Offer proportionally bigger portions of food of vegetable origin. If possible, vary the type of vegetable twice a day during the main meals. This will automatically decrease the amount of other foods your child will eat.
• Offer a variety of fruits as snacks and avoid biscuits.
• Have your child drink water instead of juice, and definitely avoid commercial juices and soft drinks.
• Have your child drink a moderate quantity of milk. Milk is food too, so it will decrease your child’s appetite for other foods. Opt for fermented, semi-solid dairy products. (Obviously, this will not apply to infants on a milk-only diet).
• Get rid of those foods that do not contribute to your health. Some foods not only have no nutritional value, they may detract from your health by decreasing your appetite for healthy foods. Additionally, these foods (i.e. processed foods) give you harder stools. It’s much better to let yourself indulge in a weekend treat that you take the time to make at home.

Diversity in a diet is also important for your child’s bowel movements. Infants often start with only one type of solid food, which makes their diets poorly balanced in terms of residue accumulation. This often leads to constipation. In some countries, carrots are a very popular food for starting infants on solid food. However, pediatricians also often find carrots in the stools of constipated kids. Carrots are ok, but not as the only vegetable!

The regularity of the stool is also essential to avoiding constipation: the longer waste stays in the digestive tract, the dryer and harder it will be, making it more difficult to expel. Make sure your kids are eating regularly and are having regular bowel movements as well.

TREATMENT FOR CONSTIPATION

If constipation becomes a problem, there are solutions, but it is important to recognize the goal. In my opinion, autonomy should be the target: I always encourage my patients to avoid further issues with constipation without relying on drugs or medical intervention.
The mainstays of medical intervention for constipation are the following:

• An enema is administered through the anus to soften the rectal portion of the stool (glycerin is an example).
• Medications taken orally will soften the stool by attracting water to the digestive tract content and hasten its expulsion (lactulose is an example).

The idea of taking medication is to first reestablish a regular soft and painless stooling pattern with your child that will:

• decrease the fear of expelling waste
• empty the sometimes massive quantity of stool matter accumulated in the digestive tract

The treatment process:

• Treatment starts with several glycerin enemas and lactulose medication, progressively softening the newly formed stools.
• Helping the child adapt to a healthier diet should be pursued steadily.
• Parents should pay attention to daily bowel movements to make sure children are passing soft stools.
• As stools become softer, medication is progressively decreased.

Treatment is rarely this straightforward, especially because children don’t always like to eat what is best for their stooling routine. However, the principles remain the same.

It is interesting to observe that the advice regarding dietary habits for countering constipation would apply to excessive weight gain, a growing need for children, who often become overweight. This is because our digestive tract is designed to eat food that contains fewer calories per volume (these are foods are less “energy dense,” e.g., plants) and that helps to add more bulk to stool than most foods available today.