Constipation in older children and adolescents still happens. The most common presentation is not a complaint of hard stools but of chronic or recurrent abdominal pain. I have found that asking broad questions such as “are you having regular bowel movements” or “is your poop hard, large or painful to pass” are always answered, “Yes” and “No.” The reality is that the kid is unlikely to be looking. They are wiping, flushing, and moving on. In these cases, we often must have the patient do a stool diary using a stool firmness chart such as the Bristol Stool Chart. This can be easily googled. Physical exam may help us diagnose constipation, but in the older child it is usually only helpful in the case of massive constipation. Occasionally we can use x-ray to determine the presence and burden of constipation but at the risk of radiation exposure.
With a modern American diet very few tweens and teens can be hurt with the usage of a daily stool softener. Polyethylene-glycol (MiraLAX) is a reasonable empiric treatment. It is odorless colorless and tasteless. It can be mixed in multiple fluids, juice, water, milk, Gatorade. It is safe and well tolerated. It acts osmotically bringing water into the bowel without stimulation of the bowel that might cause embarrassing accidents. In fact, when accidents occur it is usually caused by a large stool in the end of the colon than because of the MiraLAX.
Certainly, dietary changes and exercise help with constipation. Increasing intake of fresh fruits and vegetables and decreasing cheese and starch will certainly aid in decreasing constipation. Unfortunately, like treating high cholesterol in adults, we can treat with diet and exercise, but many patients cannot make or sustain those lifestyle changes. Like younger children, constipation may worsen with changes in the situation. Camps, going off to college, studying for finals can all cause changes in diet, activity, and bowel habit leading to constipation, so be alert to this. Abdominal pain before finals might be nerves, but it could be poop! I hope these series of blogs helps you in the challenge of dealing with constipation. Talking poop is a big part of what I do. I have hundreds of funny poop stories, but I will leave that up to your imaginations.