Constipation means a decrease in a child’s normal number of bowel movements or dry, hard stool that is painful to pass. Some drugs, such as vincristine, slow the movement of stool through the intestines, causing constipation. Pain medication, decreased activity, decreased eating and drinking, and vomiting can all affect the normal rhythm of the intestines. Following are parents’ suggestions for preventing and/or coping with constipation:

• Encourage your child to be as physically active as possible.
• Urge your child to drink plenty of liquids every day. Prune juice is very helpful.
• Serve high-fiber foods such as raw vegetables, beans, bran, graham crackers, whole-wheat breads, whole-grain cereals, dried fruits (especially prunes, dates, and raisins), and nuts.
• Check with the doctor before using any medications for constipation. He may recommend a stool softener such as Colace®. If the doctor suggests liquid Docusate®, be aware that many children don’t like the taste. Senokot®, another frequently prescribed stool softener, comes in a tablet form, chocolate-flavored liquid, and granules that can be mixed into yogurt or ice cream. Metamucil® and Citrucel® increase the volume of the stool, which stimulates the intestines. Milk of Magnesia®, magnesium citrate, and MiraLax® help the stool retain fluid and remain soft.

Vincristine constipation resulted in horrible screaming, bottom itching, constant trips to the bathroom with no luck, for days at a time. It is absolutely frustrating! We now have a preventative routine so that never happens again. Beginning the morning of a vincristine injection, I give one Peri-Colace® (stool softener plus laxative) each morning and evening until things improve—which is usually after about a week or so. Then, I taper down to one a day until things seem to be getting on the too soft side, then stop. The Peri-Colace® is manufactured in a brown “soft-gel” thing, and the liquid inside it tastes horrible. If at any time during our Peri-Colace® phase there are two consecutive days with no bowel movements, I give bisacodyl in the evening of the second day, and things usually get straightened out the next morning. Unfortunately, if it’s a school day, I have to keep him home until mid-morning, as the prednisone diet and laxatives lead to a very busy morning in the bathroom.

Do not give enemas or rectal suppositories. These can cause anal tears that can be dangerous for a child with a weakened immune system. When your child feels the need to have a bowel movement, sipping a warm drink can help the feces come out.

My 4-year-old daughter either had diarrhea or severe constipation for the entire eight months of intensive treatment. Her bowel habits returned to normal during maintenance. When constipated, she would just sob and try to hold it in. This made her stool even harder and more painful. One time she cried, “Why is my anus round and my poop square?” We ended up just putting her in a bathtub full of warm water, gave her warm drinks, and let her go in the bathtub.