You had so many questions about constipation, it was too hard to get everything out in one sitting (or was that setting)… This Straight, No Chaser addresses treatment considerations, complications and constipation in children.

For a condition associated with hard stools, treatment can lead you down a slippery slope if you’re not careful. The best treatment of constipation involves many of the same efforts you should be taking to prevent it. For most, drinking plenty of fluids, eating a high fiber and otherwise healthy diet, and engaging in regular exercise is all that’s needed.

What exactly is a high-fiber diet?
Consider the following foods:

• Beans (e.g. kidney, navy and pinto)
• Bran (more specifically, unprocessed wheat bran – ask your grocer)
• Cereals (more specifically, unrefined breakfast cereals)
• Dried fruits (e.g. apricots, figs and prunes)
• Fresh fruits and vegetables: aim for at least 2 cups of each per day
• Whole grain breads and brown rice

What about laxatives?

In two words, avoid them (except as discussed below). There are at least four good reasons to not use laxatives.

• You don’t need them. Constipation in most children and adults can be addressed by the simple measures already discussed. Natural is better.
• You can’t be trusted. Even when recommended, laxatives aren’t for long-term use. However, those that use them rapidly seem to use them as a crutch and forget about the fundamentals.
• They become addictive. With prolonged use, your bowels will become addicted to laxatives, and you will find it increasingly difficult to have a stool without one. You can however retrain your body to return to normal, although this can take months.
• They can cause vitamin deficiencies. In the example of mineral oil, it cause cause deficiencies of vitamins A, D, E and K. Unless prescribed by a physician, it should be avoided.

What about bulk laxatives?

Bulk-forming laxatives are the exception to the above considerations. Bulk-forming laxatives are natural. They stimulate both stool formation (“bulking”) and the addition of water to your stool, both of which facilitate easier passage of stool through your intestines. If you have ongoing problems with constipation, taking a daily supplement of this type (e.g. flaxseed, methycellulose, oat bran, polycarbophil or psyllium – I’ll leave it to you to figure out the brand names) is safe and effective.
What about enemas?

no. No. NO. Don’t try this at home. Unless prescribed by a physician, you shouldn’t be using them. In the overwhelming majority of cases, they are not necessary to relieve constipation.
Are there other problems or complications associated with being constipated? Here are four complications seen with chronic constipation.

• Anal fissures are extremely painful tears in the skin around the anus. These represent scratches from the hardened stools passing by. They perpetuate a cycle of pain and constipation by creating fear of the next stool, thus fostering stool retention with subsequent hardening, etc.
• Hemorrhoids occur from the straining associated with trying to pass hard stools. Hemorrhoids create their own set of problems.
• Impaction is the state you’re in once stools are too large to pass. Manual extraction may be required.
• Rectal prolapse is the expulsion of the end of the intestine through the anus as a result of straining.

Are there special considerations for children?

Here are four considerations regarding your child.

• The causes of constipation are typically the same as they are for adults. Make sure your child is getting enough fluids and fiber. The time when you’re switching from breast milk or formula is an especially susceptible period. Also, be mindful of the habit of some kids to voluntarily withhold bowel movements as to avoid embarrassment or play interruptions. These activities can start a cycle that worsens once stools become harder and larger, making it more difficult to pass stool when the effort is made.
• Symptoms should be roughly the same, but as children are learning to master language, they might not able be able to tell you the problem or could simply be expressing “not be feeling well,, having colic or other nonspecific symptoms.
• The presence of a skin scratch or tear (anal fissure) could be a tell tale sign. These fissures can be so painful that they become prohibitive to passing stool.
• Children may not be as regular as adults. Pay attention to the quality of the stools when they occur as much as the stool interval. As long as the stool is normal when it passes, the child is likely just fine. 

Don’t let treatments create more problems than already exist. Here’s another example of why your fundamentals of diet and exercise keep you healthy. Don’t let medicine get in the way of the amazing function of your healthy body.
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