“Mommy, my tummy hurts” is a complaint that parents hear frequently. If the tummy pain is a new symptom or is associated with other symptoms such as fever or vomiting, the child needs to be seen by his caregiver right away. If the child has had the pain off and on for a longer time and is otherwise healthy, the most common cause for tummy pain is constipation. Parents will often say: “My child couldn’t be constipated! He goes to the bathroom every day!” or “ He has runny stools”. But any child can be constipated no matter how often they stool or what their stool looks like. There are certain signs that signal constipation. Constipation pain can occur anytime, but commonly occurs during or immediately after a meal. Food in the stomach causes the colon to contract and if the colon has a lot of stool in it, that contraction causes pain. The child may say, “I’m full” after just a few bites. The child may have dull pain off-and-on through the day or severe cramps. The stools may be large and hard (often clogging up the toilet), or the stool could be liquid – the hard, large stool stays in the colon and the contraction of the colon only moves liquid stool around it. The child may go to the toilet often but complain that he “can’t poop”. The stool can be uncontrollable causing the child to soil his underwear. This is called encopresis. The child has held back the stool so long that the muscle of the rectum stretches and becomes weak. The child may be unaware that he has stooled. Sometimes these children get mistakenly sent to psychiatrists thinking that they are lying or being stubborn.
The only cure for constipation is to get the colon cleaned out and to keep it cleaned out. By the time the child is having tummy pain or cramping, simply increasing the fiber in the diet with either liquid fiber products or eating more fruits and vegetables isn’t going to resolve the problem. There are powders available in the pharmacy containing a compound called polyethylene glycol. These powders are available without a prescription. They are mixed with water to create a laxative solution. When the child drinks this solution, the polyethylene glycol brings more water into the colon and makes the stool liquid. If the stool is not liquid in a day or so on the laxative, the parent can increase the dosage until the stools are liquid. If constipation was the reason for the child’s tummy pain, the pain should go away totally when the stools are liquid and the child is stooling frequently. If the child has been taking the laxative and having loose stools for a few days and still has tummy pain, the child needs to see his caregiver. There are many other causes of tummy pain and they need to be investigated.
If the constipation was caused by a single episode of stool-withholding (for instance, after a camping trip) one bowel clean-out should be all that’s necessary. If the constipation is the result of a long-term stool-holding habit, it needs a long-term solution. The child needs to stay on the daily medication until the stool habits change. If the child has had no tummy pain while taking the polyethylene glycol solution but starts to have large stools and tummy pain again a few days after he stops taking the medication, he wasn’t on it long enough to eliminate the holding habit and he needs to start taking the laxative again.
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