Resolved question:
Hi my 11 month old is constipated and has been since he was 6months. We've tried every formula that says could help him and recently changed to 2% milk and seems like it got a bit worse because there was a few specks of blood. His stools are usually really hard and cause him a lot of pain. We're really desperate at this point.
Submitted:
4 Days
Category:
Pediatrician
Hello. Thank you for your query at DoctorSpring.com
I understand your concerns. This must have been a really difficult phase for you.
Constipation can arise due to multiple factors. It could be functional or organic. The most common cause is however, functional. This is because of inadequate fibre in diet, inadequate fluid intake, excessive milk ingestion, etc.
Chronic constipation is a VICIOUS CYCLE. Unless the cycle is broken, it will perpetuate itself. A child with hard stools has difficulty in passing them. This leads to decal retention (infant/child tends to retain the stools for a longer time). This in turn causes water absorption from the retained stools, hardening them further. Once these hard stools are passed, there is injury/tear of the anal mucosa (the soft lining of anal opening) leading to formation of ANAL FISSURE/trauma. This adds to the pain associated with passing stools and hence, child retains the stools, in order to avoid this pain. In your child, presence of a few specks of BLOOD means exactly that. There is injury to the ANAL mucosa; in fact, it could be an anal fissure.
So to break the vicious cycle, I suggest the following:
1. Decrease milk intake
2. Stop using formula. They may worsen constipation.
3. Use home-made complementary feeds. Use wheat, ragi, barley, vegetables and fruits in various forms to ensure good fibre intake
4. Use Syrup LACTULOSE 1 ml/kg ( a stool softener) thrice daily for at least 4 weeks
5. Give the child, plenty of fluids (water)
6. Use MUCAINE gel (local anaesthetic). Apply it at the anal opening thrice daily.
7. Use SITZ bath. (Tub with warm water. Make the child sit in it for ten minutes twice daily)
8. All these have to be done for at least 2-4 weeks before you see any results. If none of these work, meet a pediatric gastro-enterologist in person.
In any infant with significant constipation, it is advisable to get a barium enema study to look for HIRSCHSPRUNG's disease. Many other children may have forms of gastrointestinal malformations that may manifest with chronic constipation.
Wishing your child a speedy recovery.
Regards
Dr. Saptharishi L G