Constipation Treatment: Bowel Maintenance

This video explains the maintenance phase of treating functional constipation. It also offers signs to know if your plan is working, and what to do if it’s not.

If you have been prescribed a cleanout (or want more information about cleanouts), check out our video, “Acute Phase Constipation Management: The Cleanout” first.

Associated Resources:

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 is Kelly Savitri, and I’m a nurse with the Vermont Continence Project. Welcome to our video about treating constipation through ongoing bowel maintenance. In our video about acute phase treatment, I described why a clean out is an essential first step in treating constipation. This video is about what to do after a clean out to prevent your child from becoming impacted again.

Recall from our previous videos that chronic constipation causes your child’s colon to become overstretched and the nerve receptors stop communicating the signal when it’s time to poop or pee. That overstretched colon can easily fill back up again. So you need to be vigilant about preventing constipation for many months after the initial clean out. Most children need daily laxative medication to prevent constipation in the initial months after a clean out.

Your child’s health care provider should provide you with specific instructions about medication for ongoing maintenance. Medication recommendations vary between providers, but it usually involves a stool softener such as Miralax to make sure that poop is soft and easy to pass. They might also suggest a stimulant laxative like Ex-Lax to help those stretched out intestinal muscles push poop along more effectively.

The most important thing as a caregiver is to create a routine so that you remember to give the medication every day. Keep in mind, if your child becomes constipated, their colon is being stretched out again. It is much more effective to prevent constipation before it happens, rather than waiting to treat it when you think it is getting bad.

The shape, size, consistency and frequency of your child’s poop offer helpful clues to what is going on inside their body. So it is important to monitor your child’s bowel movements. To do this, we recommend using the Bristol Stool scale. The goal is for your child to have a type four bowel movement daily. It’s okay to miss a day occasionally, but remember that poop that stays in too long gets dry and hard. If your child is having hard poops like type one or type two, you may need to talk to their health care provider about increasing the laxative dose or combining an additional medication. If their poop is very soft, like type six or seven, it might be okay to discuss decreasing the dose a little, but we would rather see poop that is too soft than poop that is too hard.

Now we know that it can be difficult to rate your child’s poop on the Bristol stool scale when it is squished in the diaper or pull up, but just do the best you can. If you have an older child who’s changing themselves or using the toilet independently, it can be difficult to get them to talk about their poop, especially if they are embarrassed. We have had success by creating systems where an older child can communicate in writing instead of verbally. Consider making a chart where they can check a box or circle a picture to tell you what they observe.

Many parents have found success using our Traffic Lights Action plan. This is a document that your health care provider can customize for your child. It is a visual reference that you can use to adjust your child’s medication according to their bowel movements. A certain amount of variability is expected depending on what your child eats and what’s happening in their life. We can expect events like illness, travel or changes in routine to affect their bowel function. A written plan like this can help you make decisions about when to increase or decrease their medication according to how much they’re pooping and whether that poop is hard or soft.

After a clean out is a great time to start implementing some changes in your child’s nutrition and lifestyle. Our dietitian consultant has created a great video all about this topic, and I highly recommend you watch that after this if you haven’t already. The quick summary is that we want to promote hydration, increase fiber and encourage active play to support the natural mechanisms that move food along your child’s digestive tract.

The more you can integrate these adjustments into your child’s life, the easier it will be to wean them off the laxatives when the time is right. If you have successfully gone through a clean now and have consistently followed your maintenance plan, then we expect that you will see bowel movements of even consistency that usually start to occur in a predictable pattern at certain times in the day, depending on how thorough the cleanout was.

It may take up to a month to settle into a consistent bowel routine. If you’re not seeing positive results after that first month, you should follow up with your child’s provider. So what do I mean by positive results? I mean daily soft bowel movements. If at any point you start to feel like you are back on that constipation carousel that I described in the clean out video where your child’s poop is always either too hard or too soft, or they show signs of straining or belly pain.

Then you should talk to your child’s PCP. Some children have more complex needs that require the help of a pediatric gastroenterology test, which is a doctor who specializes in treating children’s digestive issues.

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 health care provider.