What is Constipation?
Constipation means the bowel actions are hard, dry and small. There are many causes. In babies there may be too little carbohydrate and fat in the formula, inadequate fluid intake, or too little bulk from fruits and vegetables.
Usually the baby will have one soft bowel action a day. But this can vary without serious disorders being present. Breastfed babies are not so likely to have constipation worries as bottle-fed infants, whose stools tend to be hard and dry.
Many cases of constipation are temporary, and require little treatment. However, as the causes vary, so does treatment.
Often inadequate fluids will produce constipation. If baby has an infection, such as a respiratory tract or other bacterial or viral infection, there is generally a lot of fluid lost from perspiration. So there is less in the bowel, and the actions become firm.
It is common for hard, firm stools to over distend the anal opening. This can produce a tiny tear or “fissure,” which can make subsequent bowel actions very painful. In fact, it will aggravate the condition, for baby will tend to hold back to avoid further discomfort. The fissure can often be seen. Applying a local anesthetic cream or ointment just before the bowel action will often give relief. Giving a mild laxative until the tear is healed is a good idea too.
Some parents are so enthusiastic about toilet training that they can induce constipation without realizing it. Overuse of cathartics can also be a cause. Growing children, enjoying their playtime, may regularly fail to heed the normal desire to attend the toilet and gradually become constipated.
Some other illnesses are responsible, especially any causing fluid loss. A dilated large bowel (a congenital defect called Hirschprung’s disease) means material simply collects in the lower bowel without normal actions. It is uncommon. Some drugs reduce bowel frequency, such as aluminum or calcium (sometimes used for stomach upsets).
If the condition is acute and causing distress, simple measures are often effective. Liquid paraffin in a pleasant form is non-harmful and often effective (such as Parachoc). The old-fashioned idea of inserting a glycerin suppository still works well. Various commercial brands are effective. After about half an hour, a good bowel action often results. Sometimes a soap-and-water enema may be needed, but this is unusual. A nursing sister may do this for you.
This can often be corrected by attention to the child’s diet. Babies should have an increased intake of fluid between meals – maybe the sugar content of feeds could be increased. Prune juice or pureed prunes is often effective.
In older infants, increase the daily intake of fluid, fruits and vegetables. Older children also benefit by an increase in the bulk-containing foods. Prunes, plums, apricots, figs, all help. Also, most fruits and bulk-type vegetables assist. High residue vegetables, leafy greens and salad vegetables are recommended as well.
Whole-wheat products and unprocessed bran are excellent. In fact, getting the child on to the daily intake of bran is a good ongoing event that may help ensure good health throughout life. Bran absorbs water and increases bowel bulk, which encourages regularity. It is also beneficial in helping to remove waste products from the system. Long-term, it is claimed to reduce a person’s tendency to bowel cancer, appendicitis, gallstones, hiatus hernia and many other bowel related problems of later life.
The idea that prunes (and prune juice) are the “ideal laxative” has been around for many decades. Indeed, prunes do have a beneficial effect on the bowel of the baby and infant.
Prunes have the advantage of being mild, natural food, readily available, easily prepared, and usually effective. Plums, which are in the same family, are sometimes used with equally beneficial effect.
When baby’s bowel actions are hard and dry (irrespective of how frequent they are), there could be benefit from the use of prunes.
A common “dose” of prune juice is 15ml (one half ounce) a day. This will frequently be quite sufficient to produce an easy, soft bowel action each day. For older infants, pureed (sieved) stewed prunes can be used instead of, or in conjunction with juice. The amount needed will vary from infant to infant, and the mother will soon discover from simple experimentation the amount producing the ideal results.
If attention is given to increasing simultaneously baby’s daily fluid intake, an even better result will often occur. Adequate water is essential for normal “regularity” – a fact overlooked by many mothers. This is especially true in hot weather.
Drugs should be used as little as possible. Natural means are generally successful. If they do not help, see the doctor, who may prescribe medication for temporary use. But do not get your child hooked onto an ongoing medication routine
This also may be checked by the doctor. Anal fissures (causing pain with bowel action) are readily diagnosed and are treatable. Congenital narrowing of the bowel or a dilated rectum may also be discovered with the appropriate investigation. The doctor will usually suggest these means.
Constipation is a major problem besetting the Western world, where people live by the clock rather than by nature. Faulty childhood habits are a common cause. Switching from active to sedentary jobs with little if any exercise opportunity; not heeding the natural call to stool (often after food) due to social pressures or lack of convenience, and/or low roughage diets, all play a part. Functional reasons are the most likely cause. The regular use of laxatives and their sudden unavailability can produce similar results.
Occasionally pathological disorders of the bowel may be responsible, but these form a minority, and if present will usually be associated with other symptoms suggesting some other disorder.
A check with the doctor before initiating treatment may be advisable to exclude the possibility of any disease process, or local cause (such as a fissure in the anus that makes defecation painful). If there is any pathology, this must be corrected first.
Then, altering the diet is essential. Follow the unprocessed bran, high-fiber routine. This invariably gives excellent results.
Reducing the intake of refined sugar and flour, eating more roughage in the form of whole meal bread, fruit and vegetables (preferably raw), drinking plenty of fluid and taking more exercise whenever possible will all produce a most satisfactory result. But this may take a few weeks to establish.
Often with the initial use of bran, some flatulence and abdominal discomfort may be experienced. But this is temporary.