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February 2018

How Long Does a "Clean Out" Take?

When we are doing a "clean out" by increasing the laxative dose as you describe in your book, how do we know the stool has been sufficiently cleaned out to reduce the laxative dosage? 

As part of their initial assessment, some healthcare providers will obtain what is called a lower abdominal x-ray to determine if there is excess stool anywhere in the large intestine. If this was done, a second post-cleanout x-ray can help determine whether the cleanout was successful.

When x-rays have not been done, which is typically the case, the answer to this question is based on the quantity and the consistency of the stool that was moved during the 3-4 day cleanout, compared to the amount and consistency of stool moved in the 3-4 day period prior to the cleanout. Ideally, in about two to four days, the higher dose of a  laxative will enable the child to produce considerably more stool than in the days prior to the cleanout, and the consistency of the stool will become very loose or watery.

At this point we assume that the rectum has been cleaned out and we gradually begin to lower the dose of the laxative until the stool consistency becomes more like apple sauce or pudding. Once this has been accomplished, you then continue on into Step #3 of my Six-Step Program which is to "End Withholding."

Why are laxatives almost always necessary?

I read an article that says that laxatives could be bad for kids. Why do you say that "they are always necessary" (on the back of your book)?

Children who have occasional constipation, the kind that we all experience from time to time, rarely need laxatives. Occasional constipation is relieved with natural remedies such as adding more fiber to a child's diet or encouraging exercise. In my book, I devote a whole chapter to the treatment of occasional constipation with natural remedies.

Children with functional or long-term constipation, often referred to as encopresis, almost always do need one or more laxatives as part of their overall treatment. Without laxatives, it is not possible for these children to produce sufficiently soft, large stools every day long enough to end their stool withholding and soiling. With regard to the safety of laxatives, the fact is that research and clinical experience over the past 25 years has clearly shown that, when used properly, laxatives are safe for children.

In my book, I discuss how and when to safely introduce, maintain and then remove laxatives.

But he poops! How can he be constipated?

Our doctor says my 5-year old can't be constipated because he poops every day! But he has frequent "poop accidents."  Any ideas?

This is a very common misconception about constipation even among pediatric healthcare professionals. The fact is that a child can have a fairly large, soft stool every day and still be constipated.

In my book, I talk in more detail about the two types of withholding: complete and incomplete. With incomplete withholding a child may go to the bathroom every day but still not fully evacuate his or her rectum. Over time, this results in a gradual backup of stool which slowly, but surely, stretches the rectum to the point where a child begins to have stool accidents.

Incentives can make a big difference

 It is not a coincidence that one of  the longest chapters in my book is the one on the use of incentives. The right incentive, when used correctly can make a big difference in the treatment of encopresis. This is especially true when you ask a child with a history of painful bowel movements to “practice” sitting on the toilet or to “try” to poop on the toilet.

One mother, who had been reluctant to use candy as an incentive, was amazed when her 4 y/o son immediately began to poop on the toilet after she offered to give him "just one" Skittle for every poop.

Equally amazed, was the mother of a 6 y/o girl who began to sit longer on the toilet to poop, only after her mother offered to let her play a game on her iPhone every time she made a “big poop." I’ll talk more about incentives in my next post.