Constipation

You are coming to this clinic because you may be constipated and are having problems going to the toilet. When you and your parents talk to the doctor or nurse you may hear words like bowel movements, motions or stools. All of these words mean the same as poo. You may have a different word for it in your family please tell us what it is.

Constipation means that you are not passing your poo properly and it can mean that doing a poo is very difficult or that you have trouble knowing when you need to go to the toilet. We see lots of children with this problem.

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 goodness is taken out of the food to give us energy. After that the bits of food that are left over come down the bowel and become poo. At first this poo is very watery but as the poo reaches the bottom end of the bowel it becomes firmer. The poo comes through to the bottom of the tube and into our rectum or back passage. This is the bit of bowel just inside our bottom.

What is normal poo?

When the poo comes into the back passage, it stretches the bowel and a message is sent to the brain to tell us that we need to do a poo.

Normally if we are not near a toilet we can tighten the muscles in our back passage for a short time which will stop the poo from coming. When we get to a toilet we can relax those muscles and with a small push the poo will come out.

What is happening to me?

As you have not been able to poo properly, the poo has started collecting in your back passage which has become full.

This stretches the bowel and at first it feels like you need to pass a poo all the time. After a while the bowel becomes so used to being stretched that your back passage does not feel the need to poo. The longer the poo stays in your bowel, the harder it becomes and it can become difficult and painful to pass this poo. It is very hard to relax to let the poo come out when you think it will hurt.

Why might I have accidents?

The bowel is squeezing to try to pass this poo but instead the softer poo comes down the tube and squeezes between the hard lumps. This loose poo may leak into your pants without you being able to stop it, sometimes without you realising it, so it is not your fault. This is what we call overflow soiling. It may be helpful to work out what to do with any pants that have ‘sneaky poo’ in them.

It is important to remember that if you have been having accidents then you may have been constipated for many months without anyone knowing.

Am I the only person who has this?

It probably sometimes feels like it. Most children with a poo problem think they are the only one. However, we see lots of children just like you. You may be embarrassed to talk to other people about your problem but we hope you will be able to talk to us and your parents.

What can I do to help?

Your back passage has been so full of poo for a long time that is has become stretched. It is important to retrain your bowel and to do this you need to give it lots of chances to empty out. By doing regular poos your bowel can start to work again. We do this using medicines and by asking you to do some things to help.

This means sitting on the toilet three times a day, usually after meals. You need to sit on the toilet for at least 5 minutes each time. Take a book or comic with you and warn your family that the toilet is busy for a while! Don’t forget to help with a gentle push. It is worth staying on the toilet after doing a little bit as often more poo comes along a little later.

• Try not to hold the poo in! Even when you are busy it is important to make the time to poo.
• It is very important to drink plenty of fluids as this will help to keep your poo soft. Try to have 6-8 water-based drinks every day.
• Certain foods contain fibre which helps the water to stay in your poo and this stops your poo from becoming too hard. These are foods such as fruit, vegetables, baked potato skin, brown bread and porridge.

What medicines will I have to take?

We will give you medicines to help the poo stay soft and help it to come out more easily. These medicines are called laxatives.

It is very important that you keep taking these medicines regularly while your bowel is retraining.

When you first start taking the medicine, soiling may get worse. This is just whilst the bowel is clearing out and should settle.

You will probably need to take them for quite a long time until your bowel is working normally again. It is not a good idea to suddenly stop these medicines. If you have trouble taking them please tell us and we will try to find a medicine that is better.

What if I do not like doing poos at school?

Lots of children tell us that they don’t like going to the toilets at school. However it is not a good idea to hold on. Sometimes it is helpful for a teacher to know so that they can allow you to go. We can speak to your teacher and explain the problem but only if you have asked us to. Also your school nurse may be able to help.

You may need a toilet pass to allow you to go during lessons. Some schools have a more private toilet that you could be allowed to use.

Important things to remember

• This is a very common problem, you are not alone.
• Team work is needed. We are here to help you but it is also up to you!
• You need to sit on the toilet after breakfast, lunch and tea. Try to remember to go as Mums and Dads get fed up with nagging.
• Remember to take your laxative medicines
• Please bring your charts or diary to clinic. It is one way we know that you want to get better and it gives us a good idea of how you are doing.
• Remember it takes time to get it right. Be patient and stick to the plan.

Important things for parents and carers to remember

• Your child’s problem 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 their pants have very little control over this. Try not to get angry or upset. Praise their efforts.
• Do not suddenly stop the medication even if your child seems much better.
• Do give all the medicines prescribed, as they act in different ways.