Managing Constipation With Laxatives
Question: My son had anorectal malformation with a rectoprostatic fistula repaired ... should we expect he will always need laxatives?
My son had anorectal malformation with a rectoprostatic fistula repaired and is doing well, but to keep bowel movements regular must still eat two jars of baby food prunes a day, plus take a laxative and sorbitol syrup.
Should we expect that our son will always need laxatives or will he eventually be able to do without them? Is there a typical age where they aren't needed? In my son's case, what part of his 60 percent chance of continence includes taking laxatives the rest of his life?
Answer: A patient like your son, born with a rectoprostatic fistula type of defect, has a 60 percent chance of having voluntary bowel movements.
Most patients who need laxatives will need them for many years, although some patients, for reasons not clearly understood, may have less need for laxatives as time goes by. Perhaps these patients become sensitive to certain kinds of food and the patients themselves or family members learn what foods work, avoiding the need for laxatives.
The majority of patients, however, need higher and higher amounts of laxatives as time goes by. After all, a laxative is a stimulant medication and physiology studies show that when you take a stimulant, you will need higher and higher amounts to keep the stimulant working.
Laxatives are used because better alternatives are not available. The consequences of not taking a laxative when indicated are much worse than any potential secondary effects of the long-term use of laxatives.
A patient like your son, born with a rectoprostatic fistula type of defect, has a 60 percent chance of having voluntary bowel movements. However, if he suffers from constipation and does not receive adequate treatment (laxatives), the 60 percent chance may become 0 percent because he will suffer from fecal impaction and overflow pseudo-incontinence.
Question: Are there any tips on timing, quantity, or combinations of laxatives?
Are there any tips on timing, quantity, or combinations of laxatives? For example, given that the goal is one bowel movement a day, how do you achieve this with diet? In general, is it better to try to control the diet to manage his bowel movements, or just feed him like the rest of the family and add more prunes, sorbitol, or other laxatives?
Answer: There are very few tips to offer with regard to timing, quantity or combinations of food laxatives.
There are very few tips to offer with regard to timing, quantity or combinations of food laxatives. Some foods do have a tendency to produce laxative effects, while others tend to have a constipating effect.
Most important, however, is what works for the individual. You will become the expert on your own child and will know exactly what type of food will provoke a laxative effect and how many hours after the ingestion of that particular type of food the effect will occur. It is a long process of trial and error.
The goal, as you mentioned, is to provoke one or two big bowel movements each day and nothing in between. Sometimes this is impossible to achieve. You have a better chance to achieve that goal if you give three meals per day and no snacks.
Every time we eat something, we produce a gastrocolic reflex, meaning that the colon moves. Therefore, try to give only three meals of the same quality and preferrably at the same time of the day, every day.
We recommend that laxatives be given at a single, specific time every day. Again, those are our general recommendations. You have to learn about the individual way your child responds.
Constipation should usually be managed by giving laxative food and laxative medication, if necessary, and let the child otherwise eat freely. Put on the table what you know is laxative but don't try to make your child eat something. Let him eat whatever he wants from a variety of laxative foods and then give medication if that food is not enough.
Below is a very general list of laxative and constipating types of foods. Keep in mind, however, that every patient responds in a very different way.
| Laxative | Constipating |
|---|
| Apple juice | Apple |
| Most fruits | Banana |
| Most vegetables | Rice |
| Milk and dairy meals | Broiled or boiled meat (chicken, beef, fish) |
| Fats | White bread |
Question: Is all-dairy constipating or just high-fat dairy foods?
Is all-dairy constipating or just high-fat dairy foods?
Answer: Milk and fats generally produce a laxative effect, but in some patients produce the opposite effect.
Milk and fats generally produce a laxative effect, but in some patients produce the opposite.
Question: Would a sigmoid resection be an alternative to taking laxatives?
Would a sigmoid resection be an alternative to taking laxatives?
Answer: A sigmoid resection is indicated to reduce the amount of laxatives and sometimes to eliminate laxative use, but it is only recommended in patients who have demonstrated bowel control.
A sigmoid resection is indicated to reduce the amount of laxatives and sometimes to eliminate the use of laxatives, but is only recommended in patients who have demonstrated bowel control. Keep in mind it is much more difficult to treat a patient with fecal incontinence and diarrhea than fecal incontinence and constipation.
Removing the sigmoid in a patient who suffers from fecal incontinence, without the ability to have voluntary bowel movements, would be a mistake.
Patients suffering from fecal incontinence are subjected to our bowel management program, which keeps them clean and makes them socially accepted.
Removing the sigmoid colon in such patient could result in incapacity to form solid stool (diarrhea). The implementation of our bowel management program is much more difficult in a patient suffering from diarrhea.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
