Constipation: Cleanout Action Plan

The first step to treating your child’s constipation is a good cleanout with a stool softener and a stimulant laxative.

Then, in the “maintenance phase”, your child will take a daily dose of stool softener for at least several months to a year. Treating constipation can take a long time, but we’ll follow along with you to be sure your child gets back to a normal stool pattern of passing soft stools comfortably every day or every other day.

Part One: Cleanout Phase

• Do the clean out when there is access to a bathroom for 24-48 hours.
• The goal is to have several bowel movements that are loose or watery.
• Your child will take two medicines.
• Start on Friday if your child is in school.
• Give the first dose on Friday afternoon and the second dose on Saturday morning if needed.

• Cleanout medicine 1: Stool softener – polyethylene glycol (Miralax, Glycolax or PEG)

• Polyethylene glycol brings water into the bowels.
• Mix the polyethylene glycol with the amount of clear liquid recommended.
• You may use clear liquid such as juice, water or tea.
• Have your child drink lots of liquids when they are on these medications to prevent dehydration.

• Cleanout medicine 2: Stimulant laxatives – Senna or bisacodyl

  See the charts on the next page for your child’s medicines and doses. Give as directed.

Plan to repeat this cleanout in one week.

Part Two: Maintenance Phase to keep bowels regular

Long-term daily stool softener given for at least 6 to 12 months

As soon as your child completes the first cleanout, give polyethylene glycol once daily (not twice), in the same single dose you used for the cleanout. It needs to be taken daily for at least 6 to 12 months and often longer. Mix the medicine with liquid, such as juice, tea or water. It’s very important to mix the medicine with the full amount of liquid suggested. You can increase or decrease the dose as needed to achieve mashed potato consistency stools.

Toileting Routine and Diet Recommendations

To help make stooling comfortable and regular, we recommend you help your child with this routine:

• Toileting habits: If possible, sit on the toilet 2-3 times a day after meals for at least 5 minutes without lots of distractions .. avoid games, books and electronics as much as possible.
• Toileting position: Knees should be hip level and feet flat against the ground or on a footstool to relax buttocks.
• Diet: Your child does not need excess fiber or water, but should drink enough water or liquids so that the urine is clear and eat a healthy diet with 5 servings a day of fruits/vegetables plus 2 servings of fiber (whole grains, bran, barley).

To help your child understand all of this, Watch “The Poo in You” video on You Tube with your child. It’s great!

This Can Be Challenging!

Please don’t hesitate to call our office if you have any questions or concerns.

First Part: 2 day Cleanout Phase – Use stool softener and a stimulant laxative

Cleanout Medicine 1: Stool softener – polyethylene glycol (Miralax, Glycolax or PEG) Stool Softener

Cleanout Medicine 2: Stimulant laxative – choose either Senna or bisacodyl Stimulant Laxative

Medicines you can buy at the drugstore come in many strengths. Be sure to check the strength of the medicine on the bottle - usually written as milligrams per ml or mg alone.

Second Part: Maintenance Phase – Use a stool softener

Stool Softener

This action plan was developed with Children’s National Hospital and Pediatric Specialists of Virginia Gastroenterologists