Acute Phase Constipation Treatment: The Cleanout

This video explains what a cleanout is and why it is the suggested starting point for managing chronic functional constipation. It also gives lots of tips for how to make it as smooth and successful as possible.

Before you watch this video, we suggest that you watch “Elimination Basics” and “Could it Be Constipation?“ “The Constipation Cycle,” and “Talking to Your Child’s Healthcare Provider About Incontinence.”

Associated Resources:

• The Cleanout (pdf) is a printable handout that covers the same points from this video. You can fill in your provider’s plan on the back.
• The Constipation Traffic Lights (.doc) helps you plan your maintenance phase treatment. Remember to plan this before your cleanout, so your child has no gap in treatment.

A full transcript of the video appears below.

Hello, my name’s Kelly Savitri, I’m a nurse with the Vermont Continence Project. Today, I’m going to offer you some information about the first step in treating constipation, the cleanout.

Impaction is the word we use to describe hard, dry stool that is blocking the colon. So, the medical term for clearing this blockage is disimpaction. Practitioners often refer to this as a cleanout.

There are two steps to successfully treating constipation. The first step is clearing out the impacted stool. Once this has been accomplished, the second step is to keep stool soft and moving to prevent becoming impacted again. T

o perform the cleanout, your child’s healthcare provider will prescribe a medication or a combination of medications to soften and move the impacted stool. This usually involves a stool softener, which brings more water into the stool, and it often involves a stimulant laxative, which stimulates the muscles of the large intestine to push the stool along. During the cleanout, these medications may be prescribed in higher doses than they would be for routine use. Your child’s healthcare provider will give you specific instructions about the medication regimen for your child.

So, why is a cleanout necessary? Why can’t we just use a lower routine dose of a laxative to get the bowels moving? In our elimination basics video, I described a condition called encopresis. This occurs when there are two different consistencies of stool in the colon. When a person is constipated, there’s usually hard, dry stool blocking the colon and then there’s soft or liquid stool behind the blockage. Sometimes the softer stool sneaks around the impaction and causes leakage, often the form of smears or streaks or numerous small bowel movements throughout the day. This is important to remember because when we administer a stool softener such as MiraLax, it affects both types of stool simultaneously. The hard, dry impacted stool slowly starts to soften, but the already soft or liquid stool also gets even softer and more liquid, and that liquid starts to leak out even more. This is why some children immediately experience diarrhea when they start taking a stool softener.

In order to achieve an even stool consistency, the old dry poop needs to get cleared out of the way first. We often work with families who express frustration that they’ve tried treating their child’s constipation with a daily laxative like MiraLax, but it just gave their child diarrhea. In these situations, the caregiver usually either reduces the dose or stops the laxative, and within a few days or weeks the child is constipated again. We call this “the constipation carousel”. It is so frustrating because the child’s stools are always either too loose or too hard. If this is happening to you and you know your child is having periods of constipation, that is a sign that your current treatment isn’t working. It’s really time to talk to your provider.

So, what will a cleanout be like? Expect your child to pass a lot of poop. Often the poop starts out more solid and becomes progressively softer. Your child will likely not be able to control when and where bowel movements happen. Some children experience some uncomfortable sensations in their belly when the medication starts working. Of course, it is different for everyone and some people find that it’s not nearly as bad as they expect. But depending on how long the constipation has been going on and how severely backed up your child is, you might be surprised by just how much poop comes out.

We find that this experience is easier when families are properly prepared. Stock up on disposable diapers or pull-ups and wipes even if your child has been transitioning to cloth underwear. Don’t worry, it won’t cause a regression and it will make your life so much easier. Choose a time when you can stay close to home for a few days. Long weekends and school vacations are ideal. It’s fine to start the medication in the afternoon or evening on a Friday so that you can maximize your weekend time. Have a heating pad or hot water bottle handy to relieve any abdominal discomfort. Your child is going to need to drink a lot of liquid to take the medication and to stay hydrated so try to stock up on something that they prefer. Explain to your child what is going to happen in the most age-appropriate way. Many children are quite willing to drink lots of their favorite beverage.

But if your child is anxious or resistant, consider giving them a small reward for each cup of medicine that they finish.

Also, you’re going to want to start your bowel maintenance plan as soon as the cleanout is over. So, we suggest watching our video about that topic and discussing the plan with your provider before you do the cleanout.

So, how do you know when it’s time to stop? Follow your provider’s specific instructions, but generally, we advise families to keep administering the cleanout dose medication until their child’s poop is completely liquid, like brown rusty water or lemonade with flecks of brown in it. At that point, you can trust that the impaction is cleared. After a full day of that liquid consistency, you can transition to following your child’s maintenance plan.

Remember, the cleanout is only the first step. Afterwards, you need to make sure to keep administering medication to keep your child’s stool soft and moving to prevent them from getting impacted. Again, please watch my video about the maintenance plan for more details about that. Remember, constipation causes a child’s colon to become stretched out and weak. It can easily fill back up again if you’re not vigilant.

Depending on how long and how severely your child was constipated, it can take three months to a year for their colon to shrink back to its normal size and regain normal function. But that doesn’t mean that you won’t see some improvement right away. If your child had been experiencing gassiness, bloating, or abdominal discomfort, those symptoms should be the first to improve. Over time, your child’s bowel movements should become more consolidated, so soiling episodes will become less frequent. Be patient and persistent. It may take some time before your child can successfully recognize and respond to their body’s poop signals.

Thank you for taking the time to watch this. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider.