Hello doctor, My daughter is 12 years old. She is constipated. Has not been able to have a bowel movement for about 10 days. She has been taking Metamucil, plus lots of prunes, pears, veggies, and generally healthy diet. Also drinking lots of water. Now she has been leaking grainy, liquid stool. This used to happen to her sometimes when she was younger and got constipated but has not happened for years. This morning I had her try a glycerin suppository but it did not help. She spoiled her underwear 5 or 6 times today. She will not be able to go to school tomorrow. I am wondering whether to try an enema or whether that could make things worse. She is incredibly frustrated and upset about missing school.
Hi. This is due to severe constipation. We need to find the cause of constipation in this kid. Common causes are functional (irregular bowel habits), less common causes are urinary tract infections-anatomic abnormalities. Patients who have anatomical abnormalities, present in early childhood, we need to do barium studies to rule out anatomical abnormalities. As we know that functional constipation is the most common cause. We need to clear her bowel with an adequate dose of laxatives (acute clearing and maintenance dose of laxatives) and modify the lifestyle to regularize the bowel habits. Most of the patients respond with our regimen. If does not she may need further evaluation in form of colonic motility studies. I will not recommend any investigation straight away. I want to see previous routine reports if already done. To follow. Polyethylene glycol (130 gm), one packet in two liters water over four hours, monitor stool consistency, it should be clear water at the end, if it is not clear, repeat same again on same day. Most of the children require 3 to 4 packers in two days duration. No need to worry about loose stools, that will stop after stopping of medicine. By the second day give Polyethylene glycol (17 gm sachet), three sachets at night time. Do not push with force while defecation, pass stool twice in a day, sit for 15 minutes (preferably after food intake). Continue high fiber diet and plenty of water. Local anesthetic gelly (Lignocaine gel) to apply locally (perianal region, before defecation), if she had pain. We need to see her blood hemoglobin profile, urine routine examination. According to that we may need to do tTGA, IgA. Follow up with the response details and previous reports if done.