Planning for Setbacks

Did you know that 40-50% children treated for constipation will have a relapse in the first 1-5 years? We encourage parents to do what you can to prevent relapses, but also to prepare yourself for what might happen. This video from Vermont Continence Project nurse consultant, Kelly Savitri, RN, offers helpful suggestions to keep things moving smoothly.

A full transcript of the video appears below.

Hello, my name is Kelly Savitri, and I am a nurse with the Vermont Continence Project. Throughout this series, we have been discussing the importance of treating functional constipation as part of the solution for childhood incontinence. In this short video, I will offer you some tips about anticipating and responding to relapses of constipation and/or incontinence during your child’s toilet learning journey.

Hopefully, at this point, you’ve identified whether constipation or incomplete evacuation is a concern for your child’s incontinence, and you have initiated a treatment plan. It’s important to know that maintaining healthy bowel function is a lifelong process. Occasional episodes of constipation are a normal part of life for most people, and studies have shown that 50% of children who are treated for functional constipation have at least one relapse in the first one to five years after initial recovery.

But don’t despair. Anticipating and responding to setbacks as quickly as possible can prevent you from having to start back at square one again. In the video called The Constipation Cycle, we discussed the common triggers for constipation, including travel, major transitions, such as the start of summer vacation or the beginning of the school year, moving to a new house or a new school, or dehydration, which can be triggered by hot weather or vigorous exercise. Even highly emotional events like a fight with a friend or a stressful test or assignment at school can cause changes in digestion or even withholding. It’s helpful to identify which of these have affected your child in the past, so that you can pay extra attention whenever one of these events occurs.

Even if your child tapered off laxatives months ago, make sure to bring some medication with you when you travel. If you are moving, be sure to pack it in a place that is easily accessible. When our routines get disrupted by travel or major transitions, we might forget to monitor our kids’ bowel patterns or even miss a dose or two of their medication. That’s completely understandable, but as soon as you observe any sign of constipation, treat it right away. Some signs to look out for are: strain or pain with bowel movements, belly discomfort, excessive gas, decreased appetite, or incontinence, which we define as a poop or pee accident after they have been successfully toileting for a while.

As children become more successful with toileting and start to use the bathroom independently, caregivers eventually stop monitoring their kids’ bowel movements. It’s important to teach children about the signs of constipation and make it clear that you want them to tell you if they go more than one day without pooping, if their poops are hard or painful, or if they feel like they need to poop but can’t. Some parents have found it helpful to post a printed version of the Bristol Stool Scale in the bathroom. There are lots of fun versions of this chart on the internet where poops are depicted as different foods or types of candy, so feel free to get creative.

Once you’ve identified that a setback or relapse is happening, go back to your traffic lights action plan to help you determine how much medication to administer. You might need to follow the recommendations for the yellow zone a bit longer than usual before going back to the green zone. Along with administering a medication, revisit some of the other things that support healthy bowel function. These are all interventions that we’ve talked about before, but they might have been pushed to the back-burner if your child has been successful with toileting for a while. Try making fluids tastier and more appealing to encourage your child to drink more. Build regular times for your child to sit on the toilet into your schedule. Pay attention to their diet and make sure they’re getting fruits and vegetables, and try to have a balance of both physical activity and times of rest.

A relapse of constipation is not the end of the world, but it can cause a step backward in your child’s toilet learning. Allow for a period of recovery after a relapse. During this time, you’ll probably need to step up the medical management until you and your child reestablish your routine. Consider reinstituting the use of scheduled sits or rewards if necessary, and remind your child of things like positioning and breathing. Remember that setbacks are a normal part of the toileting journey, and you have lots of tools to help you get back on track.

Thank you for taking the time to watch this. I look forward to helping you further along the path to achieving the continence goals for your child. 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.