Digest This – Treating Troubles with Pooping
Last month, we discussed constipation and soiling. Part two of this article is an overview of how we treat troubles with stooling, aka pooping. See your doctor for specific advice for your child. In general, stooling therapy has two phases when both constipation and soiling are present. Phase one involves clearing the large, hard stools from the large intestine, the colon. Phase two is maintenance to prevent buildup of stools and to allow the colon to return to normal size.
The first step of clean out therapy involves oral medication. Your doctor may, depending on your child’s needs, suggest agents such as polyethylene glycol (PEG 3350, also known as Lax-a-Day or Restorlax), mineral oil or lactulose. These medications work by pulling water into the stool to make it softer to pass. They are gentle and well tolerated. Your child will not develop dependence. Sometimes, enemas or suppositories are used in the initial phase to clear out stools in the lower part of the colon. During clean-out, your child is expected to pass a lot of stool for one to two days. Schedule clean out when your child is not in school and a toilet is readily accessible. Discuss the best clean-out plan with your doctor.
Once the colon is cleared of stool, the maintenance phase begins. Your child will usually continue taking a stool softener (like PEG 3350), but at a lower dosage than used for clean-out. The goal is to keep your child stooling regularly with one to two soft stools per day on a daily basis. Scheduled toilet sitting is vital. The best time to stool is at least twice daily, about 15 to 30 minutes after a meal. Make sure your child is seated comfortably on the toilet seat. Putting a stool under the feet for smaller children to raise their knees higher than hips can help them bear down. Other lifestyle measures that will help regular stooling include getting enough fiber, fluids and physical activity.
This process may sound easy but challenges can occur. Be patient. It may take months to years for the bowel function to normalize. Relapse is also common, especially if stool softeners are stopped too early. Avoiding anger or punishments is important for your child’s well-being. Often, soiling accidents are not intentional, your child may simply not be aware of stool leaking out. Get help from your doctor to troubleshoot problems that may come up.