Stories & News Blog The things I wish I’d known about childhood constipation This guest post is from Sarah. Sarah’s nine-year-old daughter Pip has had a poo problem for about four and a half years. Sarah’s discovery of the book ‘The Ins and Outs of Poop’ helped her learn a lot about her daughter’s condition and how to manage it. She wanted to share her experience and the knowledge she gained with others. Who ever dreamed they would buy a book called ‘The Ins and Outs of Poop’? No, not a book aimed at toilet-training toddlers, but a fantastically practical book for parents and health professionals which I bought from the ERIC shop. I can’t tell you how much I wish I’d read it four and a half years ago when my nine-year-old daughter's poo problems first started. It’s an American book written by a Clinical Psychologist, Dr Thomas Duhamel, with over 30 years’ experience in treating clinical constipation. The word ‘poop’ seems a little absurd to us Brits but the messages of the book are extremely clear and not at all patronising. It offers the clearest explanation I've seen of the gastro-intestinal system, including issues such as transit time, enlargement of the bowel, and the properties of different laxatives (although it uses the American names). It covers behaviours such as withholding, hiding and denial. It proposes a six step programme, where education of parents is paramount and laxatives are initially used aggressively to ‘clear out’ the bowel, then reduced gradually to reduce withholding. It suggests availability and time is made for parents for collaboration with health practitioners and a diligent approach to treatment. It makes you feel this is a problem you can solve with time, patience and medication. The things I wish I’d known about childhood constipation include: There is a world of difference between ‘occasional constipation’ and ‘functional constipation’ Dietary advice and drinking water alone are nowhere near enough to treat chronic functional constipation ‘Withholding’ of poos is not a deliberate act of behaviour by a child but a physiological response beyond their conscious control Some common ‘signs’ of functional constipation – tiptoe walking, arched back, poo leaking out, hiding underwear, blatant denial, irritability and difficult behaviour How to even talk about poo and the value of the Bristol Stool chart Disapproval, punishments and incentives for clean pants are all counter-productive There are toilet techniques such as ‘rock and roll’ which can help you to have a bowel movement. Buy ‘The Ins and Outs of Poop’ from the ERIC shop for £9.99. Read Sarah's story of trying to manage her daughter's stool withholding on our Parents' Stories page. Take a look at our information about bowel problems to learn more about constipation in children.