Childhood Constipation can be Painful, Costly and Dangerous

I am writing as a mother, not a nurse, about a personal failure I experienced in my dual role as a mother and a nurse. By the time I became a mom, I’d had some pediatric nursing experience, but not much. Never, while in nursing school or on the job, was I made aware of the potentially serious ramifications of something that seems so innocuous—pediatric constipation.

So, what’s the big deal you may ask? A dose of laxative, maybe some prune juice or an enema should take care of the problem, right? It’s not quite that simple, as I learned through painful experience—physical pain for my daughter, emotional pain for my husband and me.

I’ll get to the details in a minute but first I have to mention the results of a recent study that investigated the occurrence of pediatric constipation and how it affects medical costs. The study determined that the burden of illness in children suffering from constipation, and the costs associated with this condition, are roughly of the same magnitude as those for asthma and attention deficit hyperactivity disorder (ADHD).

Results show that children with constipation use more health services than children without the condition, amounting to an additional cost of $3.9 billion each year for children with constipation. Despite this significant cost impact and its prevalence during childhood, constipation has not received the amount of attention in public health campaigns that similarly occurring asthma and ADHD have.

Our experience began when our daughter was 14-months old, still in diapers and being diapered by her mother, the nurse, who didn’t notice anything unusual in the diapers. The bowel movements were regular and the stools were not hard. I saw no cause for alarm.

Then, one evening she was standing, holding onto a doorframe, screaming in obvious pain, red-faced and appearing to strain as though trying to have a bowel movement. I was upset and my husband didn’t help anything by saying (loudly and pleadingly), “You’re a nurse, do something!” Honestly, all I could think to do was to use a glycerin suppository, and it did help.

But, that episode was followed periodically by others and we began making the rounds to pediatricians. A correct diagnosis of a rectal fissure as a result of constipation was made from the onset. An effective treatment, however, was eight months in coming.

It took an examination by a pediatric gastroenterologist to yield the magic bullet that eliminated my child’s pain.

The specialist confirmed the diagnosis and then handed me a pre-printed treatment regimen. It was so simple. Daily doses of mineral oil for a sufficient length of time (3 months) to allow the fissure to completely heal, no ABCs (applesauce, bananas and carrots), a footstool (rather than dangling legs) when sitting on the toilet and increased water intake. And, it worked!

I was happy that the solution was so easy to put into practice but the simplicity of it caused me to wonder why the other pediatricians we’d seen didn’t know about it. I photocopied the short list of instructions and sent it to them. I hope they kept it at hand.

A couple months ago I read a report that persons who have suffered rectal tears or fissures are vastly more at risk for developing rectal cancer. So, now, thirty years after my daughter’s bout with a fissure, I am left to worry about her developing something even more serious as a result.

I want my story to stick with those of you who work with children in the hope that you might help avert this painful and potentially dangerous aspect of pediatric constipation. It isn’t as benign a condition as it seems on the surface.