Using Laxatives To Clear Impacted Stools In Toddlers: A Step-By-Step Guide For Parents

If your toddler is constipated, it's important to seek medical advice. Your doctor will be able to advise on the best course of treatment, which may include the use of laxatives. It's important to never give your child a laxative without a doctor's approval.

Laxatives are often used to treat constipation in toddlers. They can help to soften the stool, making it easier to pass. This is important, as constipation can lead to impacted stool, where a large stool becomes stuck in the rectum. This can cause further symptoms such as tummy pain and loss of appetite.

There are different types of laxatives available, and your doctor will recommend the most suitable option for your child. It's important to follow the doctor's instructions for dosage and duration of treatment.

Using laxatives to clear impacted stool

If your child is constipated, it is important to consult a doctor. They will advise on the type and strength of laxative needed, depending on factors such as the child's age, the severity of the constipation, and the response to the treatment. Laxatives for children usually come in the form of sachets or powder that can be mixed into a drink, or as a liquid/syrup.

Types of laxatives

There are two main types of laxatives:

• Macrogols (also called polyethylene glycols): These laxatives pull fluid into the bowel, keeping the stools soft. They are also known as osmotic laxatives. Movicol® Paediatric Plain is one brand that is commonly used first.
• Stimulant laxatives: These encourage the bowel to pass the stools out. There are several types of stimulant laxatives, including sodium picosulfate, bisacodyl, senna, and docusate sodium. Docusate also works as a stool softener.

Treatment of impaction

For treating impacted stools, higher doses of laxatives are needed initially to clear the large amount of faeces blocking the rectum. Laxatives are also needed for longer as maintenance treatment to prevent a build-up of hard stools from recurring.

Important considerations

• Do not administer laxatives without a doctor's approval: Never give your child a laxative without the doctor's go-ahead and instructions on the proper dose.
• Gradually reduce the dose: Do not stop prescribed laxatives abruptly. Your doctor will advise on gradually reducing the dose over time, depending on how the stools' consistency and frequency have improved.
• Prepare for possible side effects: Treatment to clear impacted stools can be challenging. Your child may experience more tummy pains and soiled pants. It is important to persevere as these problems are temporary, and clearing the impacted stools is essential.
• Hospital treatment: In rare cases, if treatment of impacted stools at home fails, a child may need to be treated in hospital with stronger medicines or, in very hard-to-treat cases, a general anaesthetic and manual clearance of the bowel by a surgeon.

Using enemas to clear impacted stool

Enemas are sometimes a necessary treatment for children with colorectal conditions such as constipation and impacted stool. If your child is suffering from impacted stool, a doctor may recommend an enema to help clear the blockage.

Preparing to Give the Enema

First, explain to your child why they are being given the enema. You may tell an older child that they will feel like they need to go to the bathroom while the solution is flowing in. If this happens, ask them to take deep breaths and breathe out through their mouth. Place a towel on a bed or on the floor under your child's hips. It is preferable to give the enema on a tiled floor.

Positioning Your Child

Have your child lie on their left side with their right leg flexed toward their chest. This position, along with lying on their stomach with their knees pulled up under their chest, is the most effective for giving enemas as it allows the fluid to be instilled easily into the colon with the help of gravity.

Giving the Enema

• Clamp the tubing to stop liquid from getting out. Remove the cap from the tip.
• Lubricate the tip of the rectal tube.
• Pour the exact amount of solution as ordered by your healthcare provider into the bag.
• Unclamp the tubing and allow a small amount of the solution to run into a measuring container.
• Test the temperature of the solution by dripping a few drops on your wrist. It should feel warm, not hot.
• Clamp the tubing and gently put the open end of the tubing into your child's rectum at an angle pointing toward the navel. For infants, insert 1 to 1.5 inches; for older children, insert 2 to 3 inches; do not insert more than 4 inches. If there is any resistance, carefully take out the tip and try another angle. If you still encounter trouble, stop the process and call your doctor.
• Hold the enema bag about 12 to 15 inches above the child's hips. Allow the solution to run into the rectum slowly (about 100 ml/min). If the solution starts to run out of the rectum, briefly squeeze the child's buttocks firmly together around the tube.
• If cramping occurs, shut off the flow of the solution for a few seconds by pinching the tubing together, then restart the enema when the child is feeling better.
• When all the solution has run in, clamp the tubing and remove it from the child's rectum.
• Ask your child to remain in the same position until the urge to have a bowel movement is strong (usually within two to five minutes).
• Have your child sit on the toilet or potty chair to pass the solution. Check the type of bowel movement they had (hard, formed, or runny) and the amount of solution that comes out. Most of the enema solution should come out.

Important Considerations

• Never give your child a laxative or enema without a doctor's approval and instructions on the proper dose.
• Call your child's doctor if the enema did not make your child have a bowel movement, if the solution from the enema did not come out, if the child experiences pain that does not stop after the enema and bowel movement, if there is blood in the bowel movement, if the child keeps having a large volume of liquid stool after the enema, or if the child has vomiting, changes in alertness, or seizures.
• It is important that your child is hydrated before receiving an enema.
• Infusing the solution too fast may cause dizziness.
• If your child has not had a bowel movement after one hour of the enema infusion, you can reinsert the Foley catheter to drain the enema fluid.
• If an enema has been working and your child suddenly starts to have stool accidents, inform your child's doctor as the bowel management may need to be adjusted.

How to prepare for a bowel cleanout

Bowel cleanouts are used to treat constipation in children. It is important to recognise constipation early to prevent it from becoming a long-term problem. Constipation can cause a child to withhold their poop, leading to a buildup of stool in the rectum. This can result in stool accidents, also known as encopresis, and a distended and painful stomach.

Choose the Right Time:

Start the cleanout when your child will be at home for a couple of days, such as over the weekend. This will allow them to stay close to a familiar bathroom until the stool has passed, which can take up to 24 hours.

Consult a Doctor:

Always consult your child's doctor before proceeding with a bowel cleanout. The doctor will advise on the type and dosage of medication needed, taking into account factors such as your child's age, the severity of constipation, and their response to treatment.

Medication Options:

There are several over-the-counter medication options available for bowel cleanouts, including:

• Miralax®: A powder that is mixed into a drink to soften the stool. It can be purchased at pharmacies or stores like Walmart or Target, or obtained through a prescription from your child's doctor.
• Ex-Lax®: A small, chocolate-flavoured chewable square that stimulates the bowels to help move the stool. It is available over the counter at pharmacies and stores.
• Dulcolax®: If your child prefers pills, Dulcolax® is an alternative to Ex-Lax® and can be found at similar retailers.

Administration:

The specific administration instructions will depend on the medication chosen and the advice of your child's doctor. Here is a general outline:

• Morning: Give your child the prescribed amount of Ex-Lax® or Dulcolax® 30 minutes before breakfast.
• Breakfast: Start your child's day with a meal that includes plenty of fluids. After breakfast, mix the recommended amount of Miralax® into a drinkable solution, such as juice or Gatorade.
• Throughout the Day: Have your child drink half of the Miralax® mixture in the morning and the other half in the afternoon.
• Repeat: Continue this process for a second day, or as advised by your doctor.

What to Expect:

During the cleanout, your child may experience stomach pain or cramping, which can be alleviated by explaining the process and offering a warm bath. Expect your child to pass a large amount of stool, including watery stools, within 24 hours.

Post-Cleanout Care:

After the cleanout, it is essential to implement a daily bowel routine. Encourage your child to drink plenty of fluids, eat a fibre-rich diet, and consider adding probiotics and prebiotics to their diet. Maintain this routine for at least 1 to 2 months to ensure full treatment.

Remember, the goal is for your child to have a soft bowel movement every day to promote bladder and bowel health.

Signs your toddler needs to go to the bathroom

It can be challenging to determine when your toddler needs to use the bathroom, especially if they are not yet verbal or are reluctant to communicate their needs. Here are some signs that your toddler might need to go:

• Fidgeting and restlessness: Your child might start moving around, squirming, or crossing their legs when they need to go. They may also clench their buttocks to hold in the stool.
• Behavioural changes: Toddlers who need to use the bathroom may become more irritable, unhappy, or fussy. They might also withdraw from their usual activities or interactions.
• Physical discomfort: Abdominal pain or a tummy ache is a common sign of constipation. Your child might also experience nausea or a general feeling of being unwell.
• Toilet resistance: If your child has previously had a painful bowel movement, they may start avoiding the toilet or resisting toilet training. They might hold in their stool, leading to larger and harder stools that are more difficult to pass.
• Soiling accidents: If your child is experiencing long-term constipation, they may accidentally leak stool into their underwear. This is called encopresis and usually occurs in children aged 4 and older who have already been toilet trained.
• Changes in stool: Pay attention to changes in your toddler's stool frequency and consistency. Constipation can result in passing stools less often than usual (generally less than three complete stools per week) and harder, drier, and more challenging to pass.

Remember, it's important to consult your healthcare provider if you have concerns about your toddler's bowel habits or if they are experiencing constipation. They can provide guidance and recommendations tailored to your child's needs.

How to treat encopresis

Encopresis is a condition where a child leaks stool into their underwear. It is also called stool soiling and is usually the result of long-term (chronic) constipation. Encopresis can be very embarrassing for children and can cause both physical and emotional problems.

Clearing the Colon of Impacted Stool

• Rectal suppositories: Your child's doctor may recommend this method and close follow-up to monitor the progress of the colon clearing.
• Abdominal X-ray: This test checks the amount of stool in the large intestine and can confirm the presence of impacted stool.
• Barium enema: This test checks the intestine for blockages, narrow areas, and other problems. It uses a fluid called barium that shows up on X-rays.

Encouraging Healthy Bowel Movements

• Dietary changes: Increase your child's fibre intake by adding more fruits, vegetables, whole grains, and other high-fibre foods to their diet. Fibre helps form soft stools.
• Drink more water: Encourage your child to drink plenty of water to prevent stool from hardening. Other fluids may help, but be mindful of the calories.
• Regular toilet time: Have your child sit on the toilet for 5-10 minutes at regular times every day, preferably after meals as the bowel is more active after eating.
• Footstool near the toilet: This may make your child more comfortable, and changing leg positions can put more pressure on the abdomen, aiding bowel movements.
• Stick to the program: It may take months to resume normal bowel function and develop new habits, so be patient and consistent.
• Positive reinforcement: Be encouraging and positive. Offer unconditional love and support instead of blame or criticism if your child has an accident.
• Limit cow's milk: In some cases, cow's milk may contribute to constipation. Consult your doctor about the right amount of dairy in your child's diet, as it contains important nutrients.

Behaviour Modification

Behaviour modification or bowel retraining techniques can be discussed with your child's doctor or a mental health professional. This may include teaching your child to have regular bowel movements and addressing any emotional issues related to encopresis. Psychotherapy may also be recommended if your child is experiencing shame, guilt, depression, or low self-esteem related to the condition.

Frequently asked questions