May 17th, 2021


Elimination can occur in many ways including: sweating, defecation, expectorating, vomiting, urinating and exhaling.

In this piece, I am going to focus on defecation and specifically constipation. As a pediatrician, I see more constipation than almost any other disorder save for infectious diseases. Over the years, the number of children suffering from abnormal bowel movements has skyrocketed.

The classical presentation is a child between 2 and 16 years old who complains of intermittent abdominal pain concentrated around the belly button that is sharp and lasts around 10 to 30 minutes before totally resolving. Often they note relief upon having a bowel movement. Stools are usually produced daily or every other day. They are small hard nuggets or abnormally large for the child's size. This is a key because of the great misconception that having a daily bowel movement means that one is not constipated.

What causes constipation? In my practice, the most common problem is a high dairy and low fiber refined carbohydrate diet that leads to a holding behavior in children secondary to the pain associated with passing a large painful stool. Other causes include hypothyroidism, sedentary behavior, medicines, low magnesium levels, dehydration and stress/travel.

When we do not effectively eliminate our bowels, we hold toxins in our system longer than necessary and this can cause cellular and micro biome damage. Elimination is working to prevent damage until it does not.

Think about how smart our body's are at defense. When we have an infection in our intestines, our body changes the intestine's ability to absorb water thus flushing out the bacteria or viral particles and healing after they are gone. We see this same event happening with dairy allergy and intolerance. The classic example is the newborn with milk protein casein intolerance where they have green loose stools associated with colic. If untreated, the intestines become inflamed and breakdown leading to bloody stools. Removing the cow's milk from the maternal diet if breastfeeding or changing formulas is curative. Simple cause and effect and then resolution with action.

The body naturally clears these toxins when the volumes are large as in the two examples above unless the infection is seriously malignant (think cholera) or the human continues to consume the offending protein. Both of these situations need an intervention to resolve the disease.

Back to constipation: In many milk sensitive older kids with moderate disease, they present paradoxically as just constipation. Dairy has been found to be at the root of more than 50% of childhood constipation issues. This is hard for parents to understand since it previously was a diarrheal issue as an infant. It is true.

Chronic constipation predisposes a human being to many issues including fatigue, bloating, an abnormal micro biome, rectal prolapse and potentially increased colon cancers.

Our goal is to have 1-3 soft formed bowel movements daily.

For children that are less than 10 years old, a critical feature of the dysfunction is losing the ability to sense a bowel movement in the rectal vault. They lose the ability to hear the signal that the brain is sending out. It is akin to walking into a room with a buzzing light and hearing the annoying sound for a period of time and then ceasing to notice it any more. You tune it out if it is always there.

Effective management and therapy has to take this fact into account.

What to do?

1) Avoid large volumes of dairy products in all forms especially if you had a history of milk protein intolerance/allergy as an infant.
2) Dramatically reduce low fiber foods which include most breads, cereals, and flour based foods in general.
3) Increase fiber based foods. Especially, fruits, vegetables and legumes.
4) Schedule bowel movement time after meals taking advantage of the gastrocolic reflex.
5) Drink lots of water.
6) Move a lot! Walk, run, play to increase bowel function.
7) Consider a high quality probiotic supplement.
8) Increase foods that contain magnesium - dark leafy greens, nuts and beans. Consider magnesium supplements with the help of your physician.
9) Practice relaxation and meditation.
10) Avoid narcotics, SSRI medicines, and constipating medicines.

If you continue to suffer hard stools, seek medical care and look for other causes!

Dr. M