Most children who are significantly constipated become so over a long period of time, and it generally takes a fairly long period of time to completely manage the constipation, so it is wise to expect your child will need to be on treatment for at least 2 months. It is not uncommon to need treatment for over 6 months.
When children develop constipation, their stools are hard, and the walls of the colon dilate significantly. This dilation of the colon can occur at the rectum as well, which stretches the nerve endings and sometimes decreases sensation. This can have the effect of soft stool leaking around the hard stool without any sensation on your child's part, leading to staining and accidents.
While it might seem strange that a child who is having messy accidents has constipation and not diarrhea, most children with soiling simply have it due to the reasons above, and it cannot be effectively managed without medical treatment to soften the stools. It is important to realize that your child is not having accidents on purpose, and at this point, truly has no control over it. It is our job to manage your child's constipation, thereby softening the stools, which over time allows the colon size to return to normal and allows full sensation to return. It may take a few weeks or longer for soiling accidents to completely stop, but if your child is having daily soft stools, he or she is on the right track towards resolving the soiling problem. Our goal is for your child's stool to be so soft that it is completely painless to have a bowel movement. We also want your child to have a bowel movement at least every other day. Once the stool is consistently coming out soft, that is a sign your child is on the right dose of daily medicine. If the stools are loose and watery, the amount of medication might be too much, and we can back down a bit. Conversely, if your child has been on the medicine for a few days and is still having hard stools, additional medication might be needed. Please call the office if stools are still hard or painful or if they are watery.
We recommend that your child stay on treatment at least 2 months after the stools are soft and painless. After this time, we can try to gradually wean the medicine off.
- Once your child is doing well on the medicine, one way to make sure he or she stays regular is to make sure they get plenty of fluid as well as fiber.
- Daily servings of fruits and vegetables (target is 5-9 servings a day) will help ensure your child gets enough fiber. High fiber cereals (look for at least 5-7g fiber per serving) can help as well. Some good brands are Post Raisin Bran, Fiber
- One Honey Oat Clusters. Oatmeal also has fairly high fiber content, particularly if your child has more than 1 serving at a time.
- Remember to encourage your child to drink plenty of water and a little bit of juice each day to make sure stools stay soft.
Miralax 1 capfull in 8 ounces of clear liquid 2-3 times a day for 2 weeks or until there are no more chunks in the stool, then give decrease as needed for 1-2 soft stools per day for a minimum of 2 months.