Q&A: My 5-year-old has many bowel issues, such as constipation. How can I help?

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.