Constipation issues?

Q: My five year old daughter has constant issues with constipation.  What foods are best to avoid?  What foods are the highest in fibre?

A: Constipation is the passing of dry, hard stool.  Constipation is painful and can be frightening for children which can make bathroom routines challenging.  Infrequent passing of stool does not equal constipation, providing the stool is soft.

Top things to try:
Food: Choose foods high in fibre and water content. There are two types of fibre: soluble and insoluble. Soluble fibre absorbs water as it travels through the digestive tract and provides bulk to the stool. Insoluble fibre does not increase bulk but do increase the speed at which the food waste travels through the large intestine (a good thing when it comes to constipation).  Our bodies need both. Pressure against the wall of the bowel stimulates the muscles surrounding our food tube to move.  Sources of fibre include:

•    All vegetables and fruit
•    Whole grain breads, cereal and pasta, brown rice, bean flours
•    Beans, lentils and peas

Sugar alcohols: Cherries, prunes, blueberries and other berries contain sorbitol, a sugar alcohol that causes transfer of fluid into the gut. This is what causes softening of the stool (not the fibre!). When we eat too many cherries or prunes at once diarrhea can result.

Here are the links to the BC Health Files on Fibre and Constipation in Children: be sure to scroll down and click to advance through the pages (lots of info on food choices there) 

Allergies: Determine if food allergies are a root cause of constipation. Working with a Registered Dietitian or Naturopath can help you to figure this piece out.  Having a family history of allergies (to food or environmental allergies) increases the risk of allergies. 

Fluid: Enough hydration is essential. The longer waste stays in the large intestine, the more fluid is pulled from it and absorbed.  Encourage frequent drinking of water throughout the day. From a nutrition and oral health perspective, avoid too much juice (1/2 cup is a serving) and if serving juice, have it with a meal or snack.  It is better for your daughter to have the whole fruit and water to benefit from the fibre.

Active Play and Massage: Running, jumping and climbing stimulates muscle and stimulates the muscles surrounding the large bowel (the squeezing of the large bowel is what moves the food/waste along). Massage in a circular,  counter clockwise upside down “U” motion from the right hip to the left hip can help move food waste up the ascending bowel, across the transverse bowel (above the belly button) and down the descending bowel. There is an “s” shaped curve at the end of the descending bowel – this is where the “next” bowel movement comes from.  Paying special attention to that part can be helpful (counter clockwise circles).

Bathroom Routine: Our bodies strongest urge to defecate (have a bowel movement) comes in the morning after we eat and after meals.  This is because messages sent from the stomach to brain tell the bowels to empty, in other words it sends the message, “more food is coming down the food tube – make room.” 

Leave enough time in the morning to encourage and allow your child to use the washroom. Having her place her feet on a stool while she is “on the pot” can relax the perineum making it easier for her to have a bowel movement.

Responding to the urge to defecate is key. When we ignore our bodies' signals, our bodies stop sending them but the more we listen and respond, the stronger the messages can become. Sometimes it isn't convenient to stop and have a bowel movement, but it is so important to do so, especially as you are trying to retrain the bowel.

Other - Warm baths and sitting on your haunches: This works really well actually.  It is about relaxing the muscles around the perineum.  When your daughter is playing, have her sit on her haunches (her bum on her ankles). Warm baths are soothing and she can pop out when she thinks she might be ready to have a bowel movement – just keep a warm towel nearby so she doesn’t get cold.

Most importantly!  Connect with your child’s doctor or pediatrician – ask for a referral to a pediatrician if your child doesn't already have one. Pediatric services are covered by the Province. A doctor or pediatrician will be able to determine if there is anything else on going on for the child. A rectal exam and other investigations may be performed. In some cases, the lumen of the bowel (the tube) is too large so even if there is bulk to the stool it doesn't cause the pressure required to send the messages. Other anatomical abnormalities can also exist (see the Health File information in the first link I provided). Find a pediatrician that you connect with and if you don’t, keep looking. Having a positive working relationship with your health provider is so important.

HealthLink BC – Toll Free Number: 811.  Registered Dietitians, Nurses and Pharmacists are available to take your calls and answer questions.  Nurses and Pharmacists are available 24/7; Registered Dietitians are available Monday to Friday 9-5.

I hope that you find some of the tips helpful :)  

Yours in health,
Areli Hermanson, RD
Dietitian consultant to Pomme Natural Market

Health science changes quickly.  The information contained in this material should not be misconstrued as medical advice.  Always consult with your doctor or trusted health provider to determine what is best for you.