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Ibelieve that at least once a day when seeing patients I will end up talking about a topic many of the teenagers and children believe to be, in their words: “uuhhgg!! Disgusting!” That is about their bowel movements (stool). The reason we end up talking about it is because many of them come with complaints of this intermittent on- and off-chronic abdominal pain. The pain tends to be all over the abdomen. Sometimes they come with lower back pain. Sometimes it is just lack of appetite and/or nausea. Sometimes it is recurrent urinary tract infections or pain in the pelvic area.
After asking several important questions, as physicians will be able to determine if the likely cause of their symptoms is constipation. The workup can be extensive in some cases; it is very important to check with your physician whenever any of these symptoms present. The list of diagnoses that can present with these symptoms is quite large. So what is constipation? Most people do not think they have this problem, because they have bowel movements every day–but if those are hard, lumpy, painful and hard to pass, with straining, or sensation of incomplete defecation, they have constipation issues. Some even start having blood in the stool, which in the case of constipation is from rectal bleeding. In severe cases sometimes they even start vomiting.
The symptoms, as you can see, are many, the causes too—and there are several. “Primary” constipation can be irritable bowel syndrome, where the stool passes through your intestines at a normal rate but there is abdominal pain and a hard time passing the stool. When the transit of stool in the intestines slows is when you have less frequent bowel movements. I do find, at least in children and teens, that the “Secondary” constipation is the most common one–this is the one that is caused by not drinking enough water, not going to the restroom when they feel the need to (ignoring the urge), not eating enough fiber, and eating too many “constipating” foods. Once the main cause of the constipation has been determined, we can focus on how to treat it.
The most important part when treating constipation is NOT using medicine, but a lifelong change in the way we eat. This is where the recommendation of eight glasses of water a day is used the most. Most of my patients (I have found out) will not be doing nearly half of this at all. The other very important thing is decreasing foods/drinks that make you constipated–some of the big ones are milk, cheese, ice cream, bananas when they are not ripe, teas and coffee. Paired with good water intake, it is very important to have a diet high in fiber. You find fiber in fruits, vegetables, and there are also fiber supplements like psyllium, wheat or methylcellulose; there are even fiber gummies for the little picky eaters we all have. Medications like laxatives should be reserved for the severe cases when we need first to “clean out” the intestines or when the pain or symptoms are becoming severe, and should be used for short periods of times in most cases (there are always exceptions where longer therapies are needed depending on the presentation, cause and symptoms).
Dr. Gomez practices medicine at Pediatrics of Queen Creek, PLLC, 22709 S. Ellsworth Rd, Ste F104, Queen Creek, 480-792-9200; Dr.Gomez@bethesdapeds.com; www.BethesdaPeds.com.
Dr. Gomez is a board certified Pediatrician, who knew from an early age that she wanted to be a “doctor for children and teenagers”. She and her husband moved to Arizona in 2006, shortly after marrying, and then began her pediatric residency program in 2007 at St. Joseph’s Hospital and Medical Center in Phoenix. She took over Pediatrics of Queen Creek upon finishing her residency in 2010. At her graduation she was given the 2010 The Walt Vikram Award, granted to the graduate that had demonstrated the most exemplary compassion in the care of newborns. She has worked with community programs to teach and educate the public on several health topics. She has a special interest in educating parents about healthy eating, breastfeeding and helping those families dealing with asthma. Dr. Gomez is a mother of 2: a very funny and active boy and a loud and happy daughter. They enjoy traveling and their special Friday movie nights at home.
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