Q&A: My 5-year-old has many bowel issues, such as constipation. How can I help?
My daughter will be five in January. She will only have a bowel movement when she is sleeping. I can get her up and put her on the toilet and have her go then, but she'll go while she's asleep and I can't wake her up. The few times that I did wake her up, she then said she couldn't go.
I put her on the toilet every night at 11:30 pm. She has very hard stools. She is on Lactulose Syrup and that has helped some, but it seems to not be helping as much anymore. She was put on the syrup for rectal prolapse. It has helped but lately, her stool seems very hard again and I'm afraid of another prolapse, in which case the doctor said that they'd have to do a biopsy.
It is so traumatizing for her to have me give her a suppository, let alone a rectal. I can't even imagine a biopsy. I've been sitting her on the toilet every night for at least ten minutes after dinner, but nothing yet. If asked, she says it's too hard and hurts. I don't know what to do. I'm afraid that with her stool so hard, she'll never learn to go on the toilet because it hurts. Could I try Miralax? My friend swears by it, but her son has a whole different issue than my daughter. We try to do a high fiber diet, but she has started protesting this type of food lately.
There are two separate issues your questions bring up. The first pertains to successful toilet training, the second to the managemant of the constipated child.
You need to focus on the constipation first. A constipated child, just as you mention, begins to fear the toileting process if she has come to expect pain, will ‘hold it in’ rather than being in pain, and create more constipation and a bigger problem the next time.
Training can only be successful when a child is both physically and mentally ready.
The constipation sounds significant and long-standing. Rectal prolapse isn’t common in childhood. I don’t know all that you’ve tried, you mention Lactulose, suppositories and diet, but there are many medicines that are used. There are stool softeners, bulking agents (like fiber) and drugs that stimulate the gut to contract. Success often requires more than one type of medicine at the same time. Equally important is the right behavioral approach: regular toilet sitting (that you mention), rewards, lots of time and patience.
This problem is much more common than most families think, and can get so complex that special clinics in big children’s hospitals are devoted just to constipation and its effects. It sounds like it’s time to take a step back and review with your pediatrician all that you’ve tried and why, or, request to see a pediatric gastroenterologist who is the expert in this area. He/she can explain the details to you, go over why a biopsy is or isn’t needed, help you find the right medications and support you through this process.