Dr Phil Kieran: My daughter gets constipated when she's stressed  

Treating constipation is a marathon, not a sprint, but helping your daughter to manage it by herself will be a life-long skill that will help her in the future

Fluids are important as our large intestine is very good at reabsorbing liquid from our stool, so being well hydrated helps keep bowel movements softer. File picture: iStock 

My nine-year-old child gets constipated whenever she’s stressed. It seems to get worse as she gets older. The latest stressor is a small role in a school play, even though she is excited about joining her friends on stage. What treatment would you recommend?

Constipation is one of the most common causes of abdominal discomfort I see on a daily basis in my GP surgery. In fact, it occurs in up to 30% of all children. Many people have symptoms of it on and off throughout their lives.

A ‘normal’ bowel habit can vary quite a bit, but we usually say that as frequent as three times per day or as infrequent as three times per week is normal.

Bowel movements depend largely on three factors: Fibre, fluid, and physical activity — I like to call them the three Fs.

Fibre is stuff we eat that doesn’t get absorbed into our bodies, and it helps make our stools bigger and softer by holding water, making them easier to pass.

Fluids are important as our large intestine is very good at reabsorbing liquid from our stool, so being well hydrated helps keep bowel movements softer.

Physical activity helps to move stool through our system so it doesn’t get stuck for long periods of time, drying out further.

For kids with significant or longstanding constipation or diarrhoea, seeing the GP is a good idea. I would want to rule out issues with bowel nerves if the constipation was present since birth, or the possibility of coeliac disease or milk intolerance.

In your daughter’s case, I assume any medical issue has been ruled out, and it sounds like she has constipation-predominant irritable bowel syndrome (IBS).

With IBS, stress can make symptoms much worse, and finding out what helps her symptoms individually is very important. You note the symptoms are getting worse as she gets older. I think it would be worth making sure that she is drinking enough fluids, as we sometimes find that as kids become more independent, they drink less. Girls of your daughter’s age are recommended to drink between 1.2-2l per day.

Making sure that she eats enough fibre is also vital. Trying to maintain a good, healthy bowel habit will help reduce the severity of stress.

I would be aiming for your daughter to have one to two soft, effortless bowel movements per day. When she becomes constipated, adding more dietary fibre from fruit like pears, dates, or avocados will help soften the stool. Bananas, which are many children’s favourite fruit, are low in fibre, so not ideal.

You can use a laxative like lactulose, available over the counter, to help relieve symptoms when you notice them starting. This is safe to use for extended periods.

Treating constipation is a marathon, not a sprint, but helping your daughter to manage it by herself will be a life-long skill that will avoid this causing her problems in the future.

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