The rationale for long-term laxative therapy for kids with constipation

Dr. K here from naturopathicpediatrics.com. Today, I want to talk about the rationale for long term laxative therapy for kids with constipation, while we are addressing the underlying cause.

So I mentioned in my last video, which was really more about naturopathic medicine, how we should not just swap one therapy for a natural version of the same therapy. But I want to get to like backtrack a little bit and talk about why sometimes kids actually do need long term laxative therapy.

Conventional treatment vs. naturopathic treatment of constipation

But it’s super important in this that we actually address the underlying cause at the same time. Kids with constipation in the conventional medical world are typically given long-term Miralax, sometimes with Ex-Lax, and this is to stimulate a bowel clean-out. The thing is, in conventional medicine the treatment is pretty much Miralax, Ex-Lax and nothing else. Now again, this is conventional medicine. This is not naturopathic medicine. But I want to explain like the bridge between the two and why it’s in some ways, this actually makes sense. (I just wouldn’t do it like this – with just Miralax).

Treating fecal impaction

For kids who have long term chronic constipation, most of them end up with fecal impaction. That means there’s still like a bolus or a ball or a mass of poop sitting in the rectum. **For this part it is essential to watch the video to see where the ball of poop is sitting in the middle of the rectum! See time marker 1:30.**

The rectum is like a tube, and there’s poop sitting in the middle of it. And sometimes there is space between the poop and the bowel wall. Sometimes these kids are actually having daily bowel movements, and parents don’t even know that they’re chronically constipated. (They may say “oh they’re super regular”) But maybe they have bedwetting problems or maybe they have stomach aches, or maybe they have something else going on. Or maybe they’re really grumpy all the time. Because they have a massive stool sitting there.

Stimulating a bowel clean-out

The rationale in conventional medicine is to use heavy dose laxatives to treat. This would be something like an osmotic laxative (like Miralax, which is pushing water into the colon), plus a stimulating laxative (like Senna or Ex-Lax, which forces the muscles to squeeze). So the point of the large dose of laxative is to get rid of that fecal impaction. It’s pretty uncomfortable for children, because the senate does typically create like a cramping effect, but it’s very effective.

So the whole idea behind this is to just clean everything out. And then the rationale rationale of the long term laxative therapy is to help the help have really soft bowel movements, so that that the diameter of the rectum can close down over time.

The goal of a bowel clean-out is to allow the diameter of the rectum to return to normal so it can squeeze effectively

So let me explain that a little bit. When there’s a large fecal impaction, over time, that the diameter of the rectum and the colon themselves dilate like this, which it can no longer have an effective muscle contraction any longer. **Again – see the video for this one (time marker 3:50)** It’s sort of like trying to have an arm wrestling contest with your arms straight, it can’t, there’s no like force left in it. When those muscles and nerves stretch out a lot, they can’t squeeze very well, and they can’t squeeze out a bowel movement well.

So doing one bowel clean out isn’t going to be enough to prevent the chronic constipation cycle, because the bowels just can’t squeeze.

Treat the CAUSE

While we are working on the underlying cause, (this is the key here), we need to add long-term laxatives to keep the stools soft and let the diameter of the rectum come back to normal. They key is we have to do it while we’re working on the underlying cause! Otherwise, these kids are going to be kind of like chronically addicted (so to speak) to laxatives, whether they’re natural laxatives or conventional laxatives.

Unfortunately, working on the underlying cause without long-term laxatives may lead to a treatment failure. Like say kids have a dairy intolerance, and we get rid of dairy, they may still be chronically constipated until we can achieve the bowels shrinking down to this. So that is the rationale for long term laxative therapy, and it can take months!

Laxative use is typically long-term (for months)

The conventional medicine guidelines are typically six to 12 months of laxative therapy, depending on how long the kids have been chronically constipated. Now I find with naturopathic medicine we can often do it faster because we are working on that underlying cause. But still, kids should be on long-term naturopathic laxatives for at least a few months. (Say, magnesium citrate or magnesium citrate plus vitamin C). I like adding ginger, or other natural prokinetics to keep bowels moving. Probiotics work great too.

So I don’t want naturopathic doctors to ignore the effect of long term laxative therapy! You may get treatment failures if you don’t do long-term laxatives. Example, we take kids off of dairy and they maybe get better for a little bit, and then they get worse again, and we’re confused. And the whole reason for that might be that that that just the diameter of that colon and rectum is still too large.

Mashed potato poops (!)

The goal for long term laxative therapy is to have mashed potato consistency poops. Really nice, soft poops, for at least a few months before discontinuing laxatives. When in doubt, keep kids on them for longer.

I think that’s something that is really misunderstood in the naturopathic medicine community in the natural medicine community. And again, we’re not talking about just just doing it for symptom relief. Shrinking the rectum is part of treating the cause!

I hope this helps!

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Erika Krumbeck, ND
Erika Krumbeck, ND
Erika Krumbeck, ND is founder of NaturopathicPediatrics.com and the owner of Montana Whole Health, a naturopathic clinic in Missoula, Montana. She received her Doctorate of Naturopathic Medicine from Bastyr University and is a licensed physician in the state of Montana. Dr. Krumbeck is one of few physicians specializing in the treatment of chronic health conditions in children. 

Dr. Krumbeck likes to practice her own healthy lifestyle with her wonderful husband Jason, a physical therapist, and their children Annika and Leopold. 

She is a professional member of the Pediatric Association of Naturopathic Physicians.

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