Question:
My 2 1/2-year-old son has been having problems with constipation since August. Sometimes he does not make a bowel movement for 7 days or more. Usually he announces its imminent arrival 3 days before it actually happens. This is accompanied by cries of "OW, OW, OW, I'm pooping!" He wants to be held and comforted intermittently for hours! Our pediatrician has recommended a combination of mineral oil and Senokot to loosen and hasten the bowel movements. He says that my son is holding it in. Is this kind of treatment is wise or should I let my son try to work this out on his own? I want to help him but I don't want to make more of an issue of this than it already is. He is not potty trained and I am very mellow about that. My only agenda is to make him more comfortable. Is this problem interfering with his nutrition?

Answer:
Constipation is one of the most uncomfortable and perplexing problems in the young child. This is how the system is normally designed to work: The presence of a lot of stool in the large intestine signals an urge to defecate. The child either responds to this signal or chooses to ignore it if he is too busy playing. Unlike the urge to urinate, which a child usually cannot control for long, he can choose to ignore his signal to defecate. The longer he ignores it, the more the fluid in the retained stool is absorbed and the harder the stools become. It then hurts to go to the bathroom, causing the child to hold onto his stools even longer, and the vicious cycle begins -- he holds onto his stools longer and longer and becomes more and more constipated.

Try the following with your child: Make a diagram of the large intestine, showing large "golf balls" of stool at the end of the large intestine. Show your child that voluntarily holding onto his stools makes them harder and that is why it hurts to pass them. Encourage him to have a bowel movement at set times during the day, mainly after breakfast. Encourage him to respond to his urge to go promptly. Convey to him that he should "go when you have to go."

If your child has had this problem for a long time, the intestinal muscles may be somewhat weakened and a month of stool softening may be needed before this problem is corrected. Begin with natural laxatives such as prunes and prune juice, bran flakes, psyllium husks (similar to bran flakes but more effective). The following foods also act as laxatives: fruit, vegetable roughage and bran cereal. Also, give your son more water. This is the most often forgotten, least expensive, and most readily-available stool softener. Potentially constipating foods are rice, cheese, bananas, chocolate and sometimes milk; these foods should not be eaten in large quantities. Also, try a high-fiber, stool-softening smoothie that consists of yogurt, fresh fruit (blueberries, organic strawberries, papaya, bananas), and a tablespoon of flax oil.