Dr Phil Kieran: Is my daughter’s constipation due to stress or diet?

I would see at least one to two children with constipation per week in my surgery, so it is not unusual.

I separate children’s constipation into two categories: Recent onset (less than four to six weeks) and longer-term (more than six to eight weeks). This helps me determine the care plan I recommend.

Early intervention is best, as the duration of treatment will be shorter. A gastroenterologist in Crumlin told a parent that for longer-term constipation, the treatment needs to last at least as long as the symptoms did.

A high-fibre diet and sufficient water are essential for a healthy bowel and avoidance of constipation, so encourage your daughter to do both.

Other than fibre and fluids, exercise is overlooked in avoiding or treating constipation. 60 minutes of daily activity is strongly advised and will help your child.

Constipation can be triggered by stress or anxiety. If this is the case and the anxiety is likely to blow over soon, allow your daughter to talk to you about her feelings and discuss the constipation. The longer this goes on, the harder the stool gets and the more painful passing it will become. This can lead to small tears and increase the desire to hold, out of fear.

Consider treating her constipation with a mild, over-the-counter laxative, like lactulose. Alternatively, you could give her prune juice, which can be effective. I would caution against using stimulant laxatives, such as senna, as an over-reliance on these can cause problems. If she has very painful stools, due to their hardness, using a stool softener like Microlax or a glycerine suppository, once or twice, can help get everything moving again without trauma.

After a week, if her symptoms aren’t improving, see your GP to rule out other causes. These could include coeliac disease or an underactive thyroid. (These conditions often have other symptoms, so your GP may be able to rule them out on discussion and examination.)

For children with functional constipation, or constipation without a structural cause, teaching them the importance of a healthy bowel habit early on can go a long way to preventing worsening symptoms in later life.

• If you have a question for Dr Phil Kieran, please send it to parenting@examiner.ie