Constipation – emergency department advice

This resource is for children with constipation who are attending the Emergency Department.

Our general advice on constipation.

Constipation

Constipation is very common. If your child is constipated, they may find it very difficult to do a poo or have trouble knowing when they need to go to the toilet.

Where does poo come from?

The food we eat goes into our stomach and then into a very long tube, called the bowel.

At the top of the bowel the nutrients and other things our body needs is taken out of the food, to give us energy. The leftover bits of food travel down the bowel and become poo.

At first this poo is very watery but as it reaches the bottom end of the bowel it becomes firmer and passes into the rectum or back passage. When the poo reaches the rectum (the last part of the bowels), the rectum stretches and that sends a message to the brain saying we need a poo.

What happens to poo in constipation?

In constipation, poo starts collecting in the back passage which then becomes full.

This stretches the bowel and your child might feel like they need to do a poo all the time. After a while the bowel becomes so used to being stretched that the back passage no longer feels the need to poo.

The longer poo stays in the bowel, the harder it becomes and it gets more difficult and painful to pass this poo. Children often find it hard to relax to let their poo come out when they think it might hurt.

How can you tell if your child is constipated?

Signs that your child is constipated include:

• small hard lumps like rabbit droppings
• overflow soiling – runny poo which leaks out past the hard, constipated poo. Your child will not have any control over this
• large poos, which are hard or difficult to push out
• finding it painful to poo, which might lead to your child avoiding going to the toilet

What can be done to help?

Your child’s bowel will need to be retrained as it has been so full of poo for a long time and has become stretched. To do this, it will need lots of chances to empty out. This means getting into a routine of sitting on the toilet regularly, usually after meals, for at least 5 minutes each time.

By doing regular poos their bowel can start to work normally again. Here are some things that might help:

• Make sure your child drinks plenty of fluids as this will help to keep their poo soft. We advise 6 to 8 water-based drinks every day.
• Encourage them to eat a variety of food, including a high-fibre diet. Fibre helps water to stay in the bowel, stopping the poo from becoming too hard. These are foods such as fruit, vegetables, baked potato with the skin, wholemeal bread, porridge, beans and lentils.
• If your child is toilet or potty-trained, make sure their feet are flat on the floor or on a step when they are pooing so that their knees are higher than their hips. They can also try and lean forwards a bit. This will help them to be in a good position for pooing.
• Encourage your child to be physically active as this helps to keep bowels healthy.

What medicines might be needed?

We sometimes give medicines to help the poo stay soft so it can come out more easily. These medicines are called laxatives and include Movicol, Laxido, Lactulose, Senna, Bisacodyl and Sodium picosulphate. More information about taking macrogol.

If we do prescribe medicines, it is very important that your child takes them regularly while their bowel is retraining.

When they first start taking laxatives, soiling may get worse. This is just while the bowel is clearing out and should settle.

Your child might need to take laxatives for a long time, and it is not a good idea for them to suddenly stop taking them.

If you are worried about the medicines or you think they are not working please talk to a healthcare professional.

Disimpaction regime and what to expect

With severe constipation, your child may be prescribed a disimpaction regime for at home.

This means giving macrogol laxatives such as Movicol, CosmoCol or Laxido in sufficiently large quantities to ‘clear out’ all the accumulated poo.

Once your child has had an improvement, usually seen as regular, soft poo then the number of sachets can be reduced to a maintenance dose. This maintenance dose is usually 1 sachet a day, or half the number of sachets when a good result was achieved during the disimpaction regime.

It is important to follow-up with your GP before the end or just after the disimpaction regime.

What dose does my child need?

For children under 1 years

Give half a sachet to 1 sachet for 7 days.

For children aged 1 to 5 years old

On day 1, give 2 sachets.

On days 2 and 3, give 4 sachets.

On days 4 and 5, give 6 sachets.

On days 6 and 7, give 8 sachets.

For children aged 5 to 12 years old

On day 1, give 4 sachets.

On day 2, give 6 sachets.

On day 3, give 8 sachets.

On day 4, give 10 sachets.

On days 5 to 7, give 12 sachets.

For children aged 12 and over

Children over the age of 12 should be treated with adult preparation. The macrogol is exactly the same but there is 2 times as much in the sachet.

On day 1, give 4 sachets.

On day 2, give 6 sachets.

On days 3 to 7, give 8 sachets.

Important things to remember

Your child’s constipation has built up over a long time and it will take some time to recover completely.

Try to stay positive. Slow progress can be very disheartening, but your child will be helped if you can remain positive.

Children who soil themselves have very little control over this. Try not to get angry or upset. Praise their efforts.

Do not suddenly stop their medication even if your child seems better.