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Children's Health

hard time having a bowl movement



my four year old daughter has a very hard time having a bowl movement when shen does its like it all comes at once it is huge,round like a ball and the texture is like sand with hair in it(but its not hair)her doc put her on glycolax which does not move her at all. is there any suggestions i am scared she will hurt herself.


This is a relatively common problem among preschoolers usually the result of having had painful, hard-to-pass stools in the past. It is also fairly common that the issue with constipation actually began in infancy only to return in a more problematic way as a preschooler.

This has to be one of the most frustrating problems parents face with preschoolers. It often takes multiple doctor visits to find the solution that works best for any given child while doing as little harm as possible along the way to solving the problem.

Your child's doctor is on the right track with putting her on a strong stool softener. Stool softeners work by helping the bowel to retain water in the stool making it bulkier and soft. The goal is to create stool bulk to trigger stooling and increased moisture to ease passage of stool. It may be that a laxative needs to be added for a week or two in combination with the stool softener to clean out the back up of stool and prepare the bowel to function more normally with the stool softener alone. It's always a good strategy to try to reach the goal of regular stooling without running the risk of creating dependency on laxatives.

Meanwhile, make sure your child has at least 5 servings of fruits and vegetables everyday. Replace refined grain products with whole grain products, for example, replace white bread with whole wheat bread. Be sure your child drinks plenty of water and goes easy on milk. Sixteen ounces of milk per day is plenty. Avoid giving her fruit drinks and pop. Also make sure she plays actively for at least 1 hour per day in short periods distributed throughout the day. All of these strategies will naturally increase fiber in her diet, promote bowel activity, and avoid constipating processes, such as too little exercise, too little water, and too much milk. It's also a good idea to have your daughter sit on the toilet after every meal to take advantage of the natural help of the gastrocolonic reflex that leads to stooling after eating.

Luckily the intestines and rectum are very distensible. So it takes an awful lot of stool to create a problem. I would encourage you to continue working with your daughter's doctor to find a set of strategies that works for her to end the constipation and achieve a comfortable stooling pattern. It's so important to keep to a good program of diet, exercise and the use of stool softeners. Patience wins out sometimes after several months of effort. I hope this information helps.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University