I n p ar t n e r ship w i t h P r imar y Child r e n’s H os pi t al
Constipation and Home Bowel Program
What is constipation?
Constipation happens when:
•• Achild does not poop often enough (at least once Stomach
a day)
Small
• • Poop (stool) is hard, painful, or difficult to push out intestine
• • The body isn’t getting all the poop inside to come out Colon,
lower part
Constipation can get worse over months and years. It of bowel
Weak, stretched out
can cause stomach aches and big hard stools that clog colon that never
the toilet. Some children who have been constipated knows it is full.
for a long time begin to have accidents, soiling, and
poop stains in the underwear. These are signs of
months or years of constipation.
What causes constipation?
Most constipation in children is caused by a child
holding poop in too long, over and over, often for
months or years. Children often hold it in without
their parents knowing it. Many things can cause Strong, normal sized
a child to hold poop in. Painful experience in the colon that lets
everything out and
bathroom can create fear and make a child never want
stays empty.
to let poop out again. Stress about life changes, toilet
training, and school can also make a difference.
Other things can make constipation get even worse:
The colon moves waste or poop from the body. Each
• • Eating
too much junk food and fast food. These
time a child holds poop in too long, the colon gets foods are high in fat and sugar and low in fiber.
more and more stretched out and weak. Think of it like
a balloon that has been blown up over and over again. • • Not drinking enough water
Once the colon gets stretched out, it becomes more • • Not getting enough exercise
difficult for a child to feel a normal urge to use the
toilet. Without reminders the child can walk around How is constipation treated?
full of stool without knowing it. At this point a child 1 Bowel cleanout. Your child needs to drink a large
does not even know they are holding in their poop. amount of liquid mixed with medicine. This will
Once the colon gets stretched out, It also becomes flush all the poop out of the colon. No treatment
more difficult for the colon to push all the poop out. A plan will work until this step is done.
stretched-out colon is almost never empty. It is always 2 An ongoing daily bowel program for months or
full of poop, and the child is always uncomfortable. years. Your child needs to take medicines to keep
the poop soft. Then your child needs to sit on the
toilet at regular times each day. Doing this daily
retrains the brain to sense that it is time to poop.
1
Bowel Cleanout
Check dosing with your child’s healthcare provider
Age 2–4 years Age 5–10 years Older than 10 years
Time of day
(22 to 44 pounds) (45 to 88 pounds) (over 88 pounds)
Morning Take 1 chocolate laxative Take 1 + ½ chocolate Take 2 chocolate laxative
square laxative squares squares
Throughout the day Mix 4 capfuls of PEG3350 Mix 7 capfuls of PEG3350 Mix 14 capfuls of PEG3350
powder in 20 ounces of powder in 32 ounces of powder in 64 ounces of
fluid fluid fluid
Drink it all over 8 hours Drink it all over 8 hours Drink it all over 8 hours
Evening Take 1 more chocolate Take 1 + ½ more chocolate Take 2 more chocolate
laxative square laxative squares laxative squares
1. Bowel cleanout If you finish day 1 and the poop is not yet clear, repeat
everything again for day 2 or day 3.
The goal of bowel cleanout is to wash all the poop
out of the colon. The stool will come out brown or If your child’s poop is still not clear after day 3, call
dark, and will slowly become more see-through until your child’s healthcare provider.
it is gone. Keep going until the liquid coming out of
your child’s bottom is mostly clear, like urine (pee) 2. Daily bowel program
or tea. This may take multiple days. Every day for at least 6 months your child needs to:
To do a bowel cleanout at home you will need: • • Take medicines to keep the poop soft
•• A stool-softener medicine called PEG 3350 • • Sit on the toilet at regular times each day
(Polyethylene glycol 3350). It is sold as Miralax®, This process retrains the child’s brain to sense that it is
ClearLAX®, and several similar names. time to poop. It reminds children when the colon is
• • Chocolate laxative squares, called sennosides. This is full so they can let poop out. This will prevent a child
sold as Ex-Lax® Chocolate Stimulant Laxative. from getting a stretched out colon again.
• • Plentyof fluids. Sports drinks work best. Examples Medicines to keep poop soft
include Gatorade® and Powerade®. Your child should take between ½ capful and 2
• • Atleast 3 days to spend with your child at home capfuls of PEG3350 powder per day. This should
near a bathroom. Your child will not be able to cause 1 or 2 soft poops a day.
attend school. • • Startwith 1 capful of PEG3350 powder mixed in
Food allowed while on bowel cleanout 4 to 8 ounces of liquid one time a day.
Only clear foods that you can see through. Examples • • If
your child is pooping more than 3 times per day,
include gelatin snacks (JELL-O® or similar), cut down to 1/2 a capful per day.
Popsicles®, sports drinks, and plain broth (vegetable, • • Ifyour child is still not pooping daily, or the poop
beef, or chicken). Solid foods like pizza or sandwiches is not soft, go up to 2 capfuls.
only create more poop and make this take longer.
• • Talk to your child’s doctor if you feel you need to
• • How long do we need to do the bowel cleanout? give more than 2 capfuls of PEG 3350 each day.
• • It
is common to need to do the bowel cleanout for a It likely means the bowels aren’t clean. Another
few days in a row. Every child is different. cleanout may need to be done. The last cleanout
may not have been done long enough.
2
Regular toilet time Toilet positioning
Have your child sit on the toilet for 2 to 3 minutes after Place a stool or solid box at the base of the toilet so
each meal. Our bodies naturally try to move contents that your child’s feet don’t dangle or hang off the
out to make room for what we just ate. Sitting on the toilet. With the feet resting on the stool, the knees
toilet at this time will make use of that opportunity. should be above the hips. This puts the body in the
best position to let everything out.
Do not pressure your child to push during this time
— just have them sit. This is especially important Tips:
for children who are afraid of the toilet. Getting • • Put a chart on the wall next to the toilet. Let your
in the habit of sitting with no pressure to make child put a sticker on the chart as a reward each
anything happen will help them feel like the toilet time they sit. Do something special with your child
is a safe place. when the chart is filled each week.
Over a couple of weeks a child will grow more
comfortable with sitting regularly. The key is to keep How long do we need to do the daily
doing it and build it into a habit. bowel program?
The keys to success with a bowel program are to do it
every day for many months. It probably took months
or years for the problem to get this bad, and it will
take months or years for it to get better. There is no
quick fix.
Elbows on knees
When should I call my doctor or
Knees higher
healthcare provoider?
than hips
Call if your child:
•• Is vomiting over and over
•• Has a swollen, bloated belly that is painful
Feet to touch
supported •• Can no longer poop and is no longer passing
gas (farting), despite taking the poop-
softener medicines
•• After 3 days of cleanout medicines, your child’s
poop is not clear (changed from brown to
mostly see through, like urine or tea)
•• Dizziness, or fainting
•• Has a fever over 100.4°F (38.0°C)
3
Cycle of Constipation When this cycle happens over and over, the colon
becomes stretched and weak. Children need a long-
term treatment plan to break this cycle and repair
the colon. This takes months or years.
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A stretched-out colon
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Video
Our video Constipation in
Children, a Very Common Problem rd e r S t o o l
will demonstrate why constipation
happens to children and what you
can do to fix it.
To watch the video, do the following: Scan the code to watch Clickto watch the video
and learn more. and learn more.
Godirectly to YouTube and search Primary Children’s
Hospital Constipation.
Or download a free Quick Response (QR) code reader
from iTunes or Google Play to your mobile device.
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LTA159 - 06/20 (Last reviewed - 06/20) Also available in Spanish. 4
