3 year old bowl movement help

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Author Message   Heather Citizen Username: Heater33 Post Number: 16 Registered: 8-2005 Posted on Wednesday, February 15, 2006 - 10:46 pm:        I have a three year old neice who crys and hides whenever it is time for her to poop - mostly because she is always constipated and it's hard for her. She crosses her legs and holds it in. I just learned she held in it for an entire week. What I am looking for is medical help - what can happen to her if her parents allow this to continue? It's been anon-going problem, but it's just getting worse. I'm afriad for her health at this point and her parents don't really seem to think it's an issue and she'll grow out of it - but the question to me is when? And what can happen until then? Any info would help greatly!   Mr. Big Poppa Citizen Username: Big_poppa Post Number: 495 Registered: 7-2004 Posted on Wednesday, February 15, 2006 - 10:53 pm:        Mineral oil will help soften the poop. Worked with our 2 yr old. She used to have tears running down her face with the effort. With the mineral oil, she is much more relaxed. We only use it in the cases she is constipated.   finnegan Supporter Username: Finnegan Post Number: 288 Registered: 6-2001 Posted on Wednesday, February 15, 2006 - 10:56 pm:        She is constipated because she is holding it in, and holding it in just makes the stool harder and more difficult to pass - it's a vicious cycle often requiring a doctor's help to overcome. Do a google search on "toilet training impaction" and read the literature - perhaps you'll find something to share with the parents that will help them out.   SoOrLady Citizen Username: Soorlady Post Number: 2994 Registered: 9-2003 Posted on Wednesday, February 15, 2006 - 11:17 pm:        Could also be a diet issue. What does she eat? If they're not buying organic milk, suggest that they do so.   Meandtheboys Citizen Username: Meandtheboys Post Number: 3037 Registered: 12-2004 Posted on Thursday, February 16, 2006 - 6:25 am:        It's called encopresis and more than likely she will not outgrow it. Particularly if it's true what you say about her holding it in for A WEEK! My oldest had it and it caused all kinds of horrors for us when it came time to potty train. As a result he wasn't potty trained until after his 5th birthday. Now my youngest is showing signs as well, so we are dealing with it ASAP. My middle child has no problem. If the child drinks a lot of milk, that needs to stop. The protien in the milk takes the place of fiber in the diet. More fiber is needed. As a supplement, there's a juice that we order that's called Fruit and Fiber juice. It comes in juice boxes and you can order by the case at this number 800-431-1119. I bought some recently for my little one and it worked like magic, but he's not as bad off as it sounds like your niece is. My oldest saw a pediatric gastroentrologist who prescribed a safe, effective laxative called Miralax, which he was on for an extended period of time, and which really helped loosen things up. What happens is the child withholds the BM, and the walls of the rectum get stretched and lose tone and no longer function as they should, which means eventually the child will not get the natural "urge," which in turn causes the BM to become bigger and bigger and more and more difficult to pass. My oldest also had to endure adult size enemas in the early stages of treatment. The only reason I actually found out what it was called was because I saw something about it my "Parents" magazine. I initially dealt with it as a behavior issue and sought help from a psychologist. The psychologist "prescribed" extensive "behavior modification" exercises that were pure hell for our entire family. It wasn't until later that it occured to me to ask if it could be something physical. The gastroenterologist helped us almost immediately. I'll never stop feeling guilty for "traumatizing" my child over this. But I didn't know. Now you do. Thanks for looking out for her. P/L me and I'll be happy to give you my number if you'd like me to talk to the parents.   Csi_lady Citizen Username: Csi_lady Post Number: 5 Registered: 1-2006 Posted on Thursday, February 16, 2006 - 7:50 am:        Heather, try giving her some Prune juice to drink.   Meandtheboys Citizen Username: Meandtheboys Post Number: 3039 Registered: 12-2004 Posted on Thursday, February 16, 2006 - 8:27 am:        If the child has withheld for A WEEK, and this has been an on-going problem, I'm pretty certain the situation has gone far beyond prune juice. A visit to a pediatric gastroenterologist certianly can't hurt, and could very well help quite a bit.   Jennifer Pickett Citizen Username: Jpickett Post Number: 166 Registered: 4-2005 Posted on Thursday, February 16, 2006 - 9:27 am:        I agree she should go to a doctor. Impaction is very serious, and can happen quickly. Fiber and other dietary things can't help much once she is already stopped up (but will help prevent recurrence), you have to help rehydrate and loosen the stool with lots of fluids and a glycerin suppository or an enema.   Purplebug Citizen Username: Purplebug Post Number: 42 Registered: 10-2005 Posted on Thursday, February 16, 2006 - 10:06 am:        Try to give her some Castor Oil.   CLK Supporter Username: Clkelley Post Number: 1926 Registered: 6-2002 Posted on Thursday, February 16, 2006 - 10:59 am:        I agree, get the kid to a doctor. My niece in Ireland has had this problem on-going all her life, and has already had several surgeries. I don't think they tend to treat with surgery so much here in the U.S., but it is a serious problem. If the family lives around here, Dr. Tyshkov (pediatric gastroenterologist) is fabulous - we used him for a different problem my daughter was having. I've seen others here recommend him as well.   Pdg Citizen Username: Pdg Post Number: 473 Registered: 5-2004 Posted on Thursday, February 16, 2006 - 12:15 pm:        FYI, Fiber in the diet will help prevent future constipation. I highly recommend the gummy bear type fiber supplements that Whole Foods sells (the vitimins are great too!) My kids never get to eat real gummy bears, so they LOVE this brand of treat - although they know it will make them sick if they eat more than what they are given. They are called Yummy Bears I think. I'd give a bottle to the parents and suggest they try it. I don't think a kid can have too much fiber, so even if she eats whole wheat bread, veggies, etc., this supplement won't hurt her. Mineral oil helped my son have easier bowel movements after he had developed an anal fissure (bloody toilet paper, which FREAKED us out a bit!) from hard stools. Now I just give both kids these fiber supplements every other day.   Pdg Citizen Username: Pdg Post Number: 474 Registered: 5-2004 Posted on Thursday, February 16, 2006 - 12:17 pm:        Meandtheboys - I'm interested in the fruit and fiber juice. Does it taste good? I've tried the veggie/fruit juice boxes at whole foods, but my son isn't fooled and won't have it. Can it only be purchased online?   Meandtheboys Citizen Username: Meandtheboys Post Number: 3040 Registered: 12-2004 Posted on Thursday, February 16, 2006 - 12:35 pm:        CLK, Tyshkov is who we used too. I love him. Pdg, my kids seem to like the fiber juice, and they're just as picky as any other kid. You really only need one juice box a day. I forget how many grams of fiber are in the juice. It comes in apple, fruit punch and orange (I think). I don't have a website, I've always ordered by phone. Once they have all your info it's pretty simple to reorder. I think they will even call to remind you if you want them to.   peteglider Citizen Username: Peteglider Post Number: 1800 Registered: 8-2002 Posted on Thursday, February 16, 2006 - 1:09 pm:        the juices have 10 grams of fiber per serving -- is that alot? doesn't sound like it... and they do have a web site... http://www.fiberjuice.com/ /p   Meandtheboys Citizen Username: Meandtheboys Post Number: 3044 Registered: 12-2004 Posted on Thursday, February 16, 2006 - 1:15 pm:        Yes, 10 is a lot to get in one little juice box.   Hoops Citizen Username: Hoops Post Number: 808 Registered: 10-2004 Posted on Thursday, February 16, 2006 - 1:35 pm:        I have bowls older then that, but they dont move too much.   Heather Citizen Username: Heater33 Post Number: 17 Registered: 8-2005 Posted on Thursday, February 16, 2006 - 2:54 pm:        I appreciate all of the info - I am copying many post to put in an e-mail over to her family. The problem is that her mother takes a very laid back attitude as if it's too much work to deal with this because she also has a one year old. Trying to convince her that this is a huge problem has been very difficult. I'm only a sis-in-law and only the "in-law" side of the family is saying anything about it. The mom just finds it annoying that we butt in...   Heather Citizen Username: Heater33 Post Number: 18 Registered: 8-2005 Posted on Thursday, February 16, 2006 - 2:57 pm:        Oh yeah - one other thing - they do order the fiber juices, but there is no "checking up" to make sure she's drinking it throughout the day and her main diet consists of pasta with cheese, grilled cheese, or cheese and crakers...notice a pattern? All constipating foods - no veggies, no fruit. I really have learned what NOT to do through all of this.   Arsenal Citizen Username: Arsenal Post Number: 66 Registered: 8-2004 Posted on Thursday, February 16, 2006 - 3:08 pm:        This is a very common problem. My son just went a week without pooping and finally let loose over the weekend. Very impressive amount and smell. Coincidently, he had his 3 year check up today and confirmed much of what everyone posted about. Her recommendation was making sure he drinks 8oz of Apple Juice a day. Never would have though Apple Juice. We tried the prune juice and had minimal effect, so we will give the Apple juice a whirl and see what happens. I think the rest of the advice she offered was if nothing shakes out increase to 16oz per day and if he still does not poop after 7 days to bring him in.   Purplebug Citizen Username: Purplebug Post Number: 46 Registered: 10-2005 Posted on Thursday, February 16, 2006 - 4:35 pm:        'This is a very common problem' Are you serious? And I do not mean it as a joke. I always thought that you could count on kids to eat, make noise and poop. Finiky eater kid and constipated kid seem like oxymorons to me. Once the constipation is fixed. Diet is very important. Heck, even as an adult, I had some issues. But once I changed my diet, not just relying on fiber supplements, but cutting back on the junk food, eating more vegetables, more fruit, drinking more water. Eating like a person instead of a junkie. A good movement can do wonders for a personality.   Tom Reingold Supporter Username: Noglider Post Number: 12562 Registered: 1-2003 Posted on Thursday, February 16, 2006 - 4:46 pm:        No, it is common. Toilet training is the first time when there can be a big control struggle between parent and child and the child can have the upper hand. It's because the parent wants very badly for the kid to do something, and the kid has the power to refuse. Unless this is at the medically dangerous stage, and I can't tell froom this far, let the kid have her way. She'll do what she needs to, and it will be easier without as much pressure placed on her. Mineral oil can cause her to lose control a bit, and it may be beneficial. Some kids that age get scared to poop. They have received the message that it's bad, even when their parents tell them to go ahead. One problem with the mineral oil is that she can have a rather constant drip of "poop juice" in her pants, which could upset her. Another problem is getting her to drink it, because it's rather unpleasant.   las Citizen Username: Las Post Number: 985 Registered: 10-2003 Posted on Thursday, February 16, 2006 - 4:55 pm:        A good movement can do wonders for a personality. Amen!   Meandtheboys Citizen Username: Meandtheboys Post Number: 3047 Registered: 12-2004 Posted on Thursday, February 16, 2006 - 4:59 pm:        Constipation may be a "common problem" but encopresis is absolutely not, and is a result of chronic constipation. The behavior Heather describes in this child sounds exactly like what my children have done. Rather than push the BM out, they clench their little butt cheeks together and hold it in for as long as humanly possible, and cry and scream and sweat because they know it's going to hurt, because past experience has taught them so. When I first started seeing the gastroenterologist for this problem and he'd ask about my son's BM's since our last visit, he could not conceive of the fact that my son had not gone all week! When I finally made him understand that "no, he has not gone at all", the Dr. was quite taken aback, and remarked that that was indeed very unusual. As I said, a visit to the gastroenterologist couldn't hurt. If it's not a serious problem, it will have been ruled out, and if it is, she will get help and feel better. Heather, is this child potty trained, or even showing any interest?   Tom Reingold Supporter Username: Noglider Post Number: 12564 Registered: 1-2003 Posted on Thursday, February 16, 2006 - 5:09 pm:        Right, your kids had an extreme case, where the effects snowballed. It isn't clear that Heather's neice is going through this, so the best approach may be different. In other words, a behavioral approach may be better than a medical one. One of my kids held it in as much as possible. It was difficult for her, but she was determined. I don't remember how many days she held it in. And I don't know if she did any damage, but it's been a few years, so I guess not. My daughter's problem was the common one, and I suppose it starts out that way and has the potential to get as bad as it was for your son.   Jgberkeley Citizen Username: Jgberkeley Post Number: 4436 Registered: 5-2001 Posted on Thursday, February 16, 2006 - 5:09 pm:        Hi, Just happen to know that Dr. Judith Bernstein, a child Psychologist here in Maplewood has professional experience with this exact problem. If interested call her at (201) 602-5354, 1859 Springfield Avenue, Suite 5, or email her at jbernsteinPsyD@comcast.net.   Meandtheboys Citizen Username: Meandtheboys Post Number: 3050 Registered: 12-2004 Posted on Thursday, February 16, 2006 - 5:12 pm:        Isn't it generally accepted procedure to rule out all underlying medical/physical issues before trying to modify behavior? That was the mistake I made and I would strongly recommend against making the same mistake I did.   Tom Reingold Supporter Username: Noglider Post Number: 12566 Registered: 1-2003 Posted on Thursday, February 16, 2006 - 5:20 pm:        No, I don't think it's necessary to check out medical conditions first. You could end up going to the doctor a lot, and sometimes you will go unnecessarily. Of course, in your case, you wish you had, but it's a judgement call, and as parents, we're bound to make some mistakes, only because we don't know everything, and neither does anyone else. Some problems really do go away. And some need immediate attention. And there's stuff in between, too.   Heather Citizen Username: Heater33 Post Number: 19 Registered: 8-2005 Posted on Thursday, February 16, 2006 - 6:50 pm:        She is potty trained, out of diapers since about Thanksgiving, but even in diapers, she was trying not to go. I'm just worried her folks are doing more harm then good by waiting for the "phase" to be over.   Bettina Citizen Username: Bettina Post Number: 108 Registered: 8-2004 Posted on Thursday, February 16, 2006 - 7:34 pm:        Please do not, as Finnegan suggested, go on the internet and google "impaction". Impaction is an extremely unusual side effect of constipation and internet searches on almost all medical problems usually result in extreme and unnecessary increases in anxiety. The child sounds like she is going through a very common, normal glitch in potty training. I agree with Tom Reingold. She'll more than likely be perfectly okay when she figures it all out. It is very stressful for the parents, however, and frankly, Aunt, I know you're speaking only out of concern and love, but I think you need to back off.   finnegan Supporter Username: Finnegan Post Number: 291 Registered: 6-2001 Posted on Friday, February 17, 2006 - 8:14 am:        Yes, Bettina, you are so right. Whatever you do Heather, do not seek advice from sources like Contemporary Pediatrics, http://tinyurl.com/7kfe7 Better to just take advice from anonymous folks on-line. FWIW, I think meandtheboys offers much helpful information, and makes a good suggestion when advising seeking medical help, but encropesis is actually defined as bowel movement accidents, associated with but not the same as with holding the stool: http://www.nlm.nih.gov/medlineplus/ency/article/001570.htm   Meandtheboys Citizen Username: Meandtheboys Post Number: 3059 Registered: 12-2004 Posted on Friday, February 17, 2006 - 8:28 am:        From KeepKidsHealthy.com: "Encopresis is a complication of chronic constipation, and it is fecal soiling with the loss of semi-formed or usually liquid stools, which may be foul smelling, into a child's underwear. Once a child becomes constipated and has hard and painful stools, he will then begin to hold in his bowel movements to prevent it from hurting again. This creates a cycle that makes the constipation continue and become worse, eventually leading to a large fecal impaction and rectal distention (which can make the rectum less sensitive and unable to hold even small amounts of stool). Stool behind the impaction begins to leak around it, and eventually leaks out of the rectum, without the child noticing it or being able to hold it in. Your child may also have very large, infrequent, hard bowel movements that are painful or may even plug up the toilet. Or he may have very small, ball-like bowel movements more frequently, but which are still very hard and difficult to pass. After a very large bowel movement, soiling may improve, until enough time passes and the impaction builds up again. The treatments for encopresis must include treatment for the underlying constipation. This may include a 'clean out' regimen of enemas, suppositories or high dose mineral oil to remove the backed up or impacted stool. Other treatments are aimed at improving your child's diet. A diet low in fiber or fluids can contribute to constipation. So can drinking too much milk. Some steps to improve your child's diet include: * Increasing fluids: Increase the amount of water and fruit juices (minimum of 2-3 glasses) that your child drinks each day. * Increasing fiber: Increase the amounts of fruits and vegetables that your child eats. Raw, unpeeled fruits and vegetables (especially beans, sweet potatoes, peas, turnip greens, raw tomatoes and corn) have the most fiber. Popcorn also has lots of fiber in it. Give enough grams of fiber to equal their age in years plus 5 each day (check the nutritional label for high fiber foods and snacks with at least 3-4g of fiber per serving). Vegetable soups are especially high in fiber and also add more fluid to your child's diet. * Increasing bran in your child's diet by offering bran cereals, bran muffins, shredded wheat, graham crackers, or whole wheat bread. * Decreasing constipating foods: These include milk, yogurt, cheese, cooked carrots, and bananas. Drinking too much milk (your child may only be drinking 2-3 cups a day, but it may be too much for his system to handle) is heavily associated with being constipated. Switching to soy milk has been shown to soften stools. If your child is unable to drink milk, then offer a daily multivitamin or other sources of calcium. Until your child's constipation has improved with a non-constipating diet, your child will most likely also be on stool softeners. Most of these medicines are available in the pharmacy over the counter and do not require a prescription. They include Metamucil, Milk of magnesia, Citrucel, or mineral oil. Unlike laxatives in adults, they are generally not considered to be habit forming. You should use them once or twice a day and work up on the dose until your child is having a soft BM each day. If you child starts to have diarrhea, then you are giving too much and you should cut back on the dose. See the table in our Guide to Constipation for dosing information. Another important treatment of encopresis and constipation is behavior management so that your child learns to have a bowel movement each day. You should encourage your child to have regular bowel patterns. Have your child sit on the toilet for about five to ten minutes after meals 2-3 times each day. The use of simple rewards or a daily calendar with stars or stickers for days that your child takes his medicine and has a bowel movement may be helpful. Your child doesn't necessarily need to have a bowel movement each of these times, and you shouldn't punish him if he doesn't. It is more important that he gets in a regular habit of trying to have a bowel movement. And remember that the leakage of stool is involuntary. Your child is not doing it on purpose and he shouldn't be punished or shamed when it does happen. The distention and stretching of his rectum from the impacted stool can take a lot of time to get back to normal, and until it does, he may not be able to sense or voluntarily hold in all of his bowel movements, and so leakage may continue even with proper treatment. Encopresis can sometimes be difficult to treat, and your Pediatrician may consider referring you to a Pediatric Gastroenterologist for further management if he is not improving on his current medical regimen."   Bettina Citizen Username: Bettina Post Number: 109 Registered: 8-2004 Posted on Friday, February 17, 2006 - 9:18 am:        I'm sorry, Finnegan. I didn't mean to be so obnoxious about your advice - it's just that I really see that so many problems like these get parents so overly anxious (including myself) and it's really not helpful to the kids, or the parents. I have been through this problem myself and somebody mentioned bowel impaction to me and my anxiety shot through the roof, totally unnecessarily. My son worked this difficult period out himself over a few months. It was awful for me, but the more distance I could keep from the problem the better. I think so many difficult phases that kids go through are like this. Furthermore, I know that there are many excellent and reliable web sites for medical information but as a psychologist, I see internet searches for things such as this as a very mixed bag in terms of helpfullness. There are so many horror stories everywhere.   CLK Supporter Username: Clkelley Post Number: 1943 Registered: 6-2002 Posted on Friday, February 17, 2006 - 9:53 am:        I don't think meandtheboys (or I) am suggesting that Heather should go hysterical over this - rather, that the parents should probably get the kid evaluated by a pediatrician. That's a heck of a lot better advice even than looking at the online resource that finnegan suggested. My feeling is always that if you are in doubt, ask a doctor. Not because you're freaking out, but because you don't want to freak out. I, too, know a kid who has suffered from encopresis & stool impactions, and she has been very ill from it. Is it rare? Yes. But is it worth checking out? Yes.   finnegan Supporter Username: Finnegan Post Number: 292 Registered: 6-2001 Posted on Friday, February 17, 2006 - 11:46 am:        What a kind reply to my very sarcastic response to you, Bettina. Thank you. Please accept my apology for the sarcasm. Meandtheboys - Heather reported that her niece was holding in bowel movements, she did not report any staining or leakage, but you said in your first post, "it's called encopresis." I was trying to kindly make a small clarifying point, after praising your overall advice, and basically agreeing with you, fwiw. And CLK, in my first post in this thread I did mention consulting a doctor. Heather asked for medical info, and I suggested some links. If this offended you somehow, I'm sorry. I guess it's good for us all to know that your advice is "a heck of a lot better" than any link I would offer. Thanks for sharing that. Good luck sorting out the advice, Heather.   CLK Supporter Username: Clkelley Post Number: 1945 Registered: 6-2002 Posted on Friday, February 17, 2006 - 1:19 pm:        Finnegan, I apologize for not having re-read the whole thread before posting - I did not note that you had suggested a pediatrician. I was reacting only to your post advocating looking at on online resource. That's not bad advide - it's just even better to contact a pediatrician. I was not offended, and I am surprised that you seem to be.   finnegan Supporter Username: Finnegan Post Number: 293 Registered: 6-2001 Posted on Friday, February 17, 2006 - 4:50 pm:        Well, I guess I was just overly sensitive given that two posters cited me by name in encouraging Heather to disregard my advice. I suppose this wouldn't bother some people at all. Perhaps you are one of them and it could be that you are simply a better person than I am. From the tenor of your other helpful MOL posts, this wouldn't surprise me at all. But, Bettina wins the prize in my book for "kind posting" because she wrote a sincere and lovely apology, that didn't need to suggest I was in the wrong for seeming annoyed. Peace.   Bettina Citizen Username: Bettina Post Number: 110 Registered: 8-2004 Posted on Friday, February 17, 2006 - 10:34 pm:        Yeah, it's so easy to get snarky on these boards under cover of anonymity. I'm trying to avoid that. Thanks, Finnegan.   Tom Reingold Supporter Username: Noglider Post Number: 12588 Registered: 1-2003 Posted on Saturday, February 18, 2006 - 10:57 pm:        Group hug, everyone!