When does my doctor need to be involved?
If your baby is in pain, then contact your doctor. Also call if the constipation is ongoing or getting worse. Vomiting or fever with constipation each warrant a call to your doctor.
The first time your baby has blood in the stool, you may find it difficult to tell whether it is from an anal fissure or from elsewhere in the intestines. Either way, call your doctor.
What tests need to be done, and what do the results mean?
For normal constipation that is readily resolved with dietary changes, prune juice, rectal thermometers, or over-the-counter medical treatments, no tests need to be done.
However, if the constipation is not easily treatable or if it worsens despite attempts to treat it, then the cause of the constipation must be sought. An X-ray can show how much stool remains in the intestines. It can also identify some structural abnormalities of the intestinal tract. In extreme cases, a colonoscopy or biopsy may need to be done. These are performed by gastroenterologists – doctors specializing in the intestinal tract. Both techniques can be used to look for a variety of causes of constipation.
Hirschsprung’s disease is the absence of nerves at the end of the colon that are necessary to help keep the bowels moving. This uncommon problem, which can cause severe constipation, can only be diagnosed through biopsy. Constipation resulting from Hirschsprung’s disease requires surgery.
What are the treatments?
The two main treatments for constipation are stool softeners and lubrication. Stool softeners are taken by mouth and are meant to pass through the stomach and into the intestines to soften the forming stool. The most readily available stool softeners are prune juice and pear juice. These fibrous fruit juices are sugary, and this sugar content helps the body draw water into the intestines as the stool is being formed. This works to alleviate constipation because the body likes to dilute sugary substances in the intestines. Therefore water will collect in the intestines along with the sugars, softening the stool. Breast- and bottle-fed babies alike can take one or two ounces of prune or pear juice every 12 hours until the stool softens. This is generally recommended only when the baby has reached at least two months of age; parents of younger babies should contact their doctor.
If juice doesn’t work, then lactulose may help. Lactulose is a nonabsorbable sugar that works much the same way that prunes and pears work. Other stool softeners include milk of magnesia, which can be given to a baby as half a teaspoon every 12 to 24 hours (in lieu of juice), and dioctyl sodium sulfosuccinate (docusate).
The other approach to constipation is lubrication. Lubrication works by greasing up the anus so that the stool can slide by more easily. Any colour-free, perfume-free lubricant – such as Vaseline or other petroleum jelly – may be used. A small amount is applied at the anus using a finger, not a Q-Tip or other narrow tool. This can be repeated every few hours or with each diaper change until a stool is passed with ease. This technique helps to prevent (or minimize) anal fissures.
Sometimes lubrication must be combined with an approach that will help move the stool out of the rectum quickly. This is especially true when a baby is crying with discomfort. The most effective way to do this is to use a suppository or enema. Glycerin suppositories (sized for babies) are gently inserted into the anus. The physical presence of the suppository stimulates the bowels to contract, often pushing stool out.
Suppositories lubricate the anus because they melt inside it, providing a pool of glycerin to coat the stool. The alternative to a suppository is an enema, which is a liquid inserted directly into the anus. Infant enemas can be made with a variety of substances, including premelted glycerin. They stimulate the bowels to move by the same principle as the suppository but often coat the stool better, helping to move things along even more. The glycerin enema sold in markets and pharmacies is called Babylax.
Remember, stimulation of the anus in order to help move the bowels should not be done regularly without speaking with your doctor. You do not want your baby to become dependent on this as a means of moving the bowels.
What are the possible complications?
The most common complication of constipation is more constipation. Once a baby has passed a painful stool, she does not want to repeat the uncomfortable experience. Therefore – especially among older babies (and young children) – constipation begets constipation because they will hold their stool in. Among infants, this is more readily solvable, because once a baby returns to normal, soft, painless stools, she is likely to resume regular pooping.