FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[CHILDHOOD CONSTIPATION OFTEN HAS EMOTIONAL COMPONENT ]

Question: My eight-year-old daughter holds her bowels, sometimes for days. I took her to the doctor because of this. He recommended giving her Metamucil and also prune juice. This doesn't seem to work too well. Do kids outgrow this, and is there a reason for concern?

Answer: I assume "holds her bowels, sometimes for days means that your daughter has a bowel movement only every few days. This itself is not unusual or a problem. If her bowel movements are soft and formed, even though they don't occur daily, there is no need for concern. This is true for adults as well as children. If, on the other hand, her bowel movements are very firm and dry, then this is a sign of chronic constipation.

Constipation is often a consequence of having a diet with insufficient amounts of fiber. Fruits and vegetables are the best sources of fiber, but supplemental amounts can be added with Metamucil and similar fiber laxative products, just as her doctor suggested.

Constipation may also result from the body's need to conserve water. In this situation the body absorbs every available drop of water from the food. This leaves the bowel movements quite dry and firm. The treatment for this malady is drinking more liquids, particularly water. The best way to judge if sufficient water is consumed is by observing the color of urine. When it is colorless, sufficient water is being consumed. Dark yellow urine indicates that the body is conserving water, thereby contributing to constipation.

Children have relatively few methods for controlling their environment. Parents tell them what to do and when to do it, as do teachers and most other adults and bigger children. Some children delay having bowel movements because a parent expresses too much concern about their "regularity." Managing their bowels in this manner gives them some level of control over the parent. Perhaps your daughter is "holding her bowels" because of some emotional stress. In all likelihood her symptoms are caused by a combination of emotional and physical factors.

Most children outgrow childhood constipation and only rarely does it cause any lasting consequences. However, there are a few underlying medical conditions that cause infrequent bowel movements and chronic constipation that are not due to diet and emotional stress. I assume that your daughter's doctor has checked for these things.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.