Bad Belly Pain-Is It Really Just Constipation?

It happens more than you think: the child clutches his belly, cries, rolls around on the floor, in obvious pain.  Mom and Dad get worried- is this appendicitis?   Is something terrible happening to our baby?  They rush to the Emergency Department and about the time they finish registering and get put in a bed, he is all better.  ”Honestly,” the folks tell me, “he was really looking bad!”  I believe you, I tell them, this happens all the time.

Belly pain is a common reason for Emergency Department visits, and usually it is because of …constipation?   A recent study in the major journal Pediatrics confirms what we have suspected for years: constipation is the most common diagnosis for kids who come in for abdominal pain.  And I don’t blame the parents for bringing their child in- the pain can be really scary-looking.  It is sometimes so bad that parents worry major surgery is needed.

What is happening to cause so much pain?  Simply put, stool builds up inside the intestines and doesn’t pass.  One day the stool is so much or dries out and is so hard, that the intestines cannot move it through, and out.  The intestines push and push, and that is the terrible cramps the child experiences.  Eventually the intestines relax, and the pain goes away.  But the intestines have a job to do, and later they try again, and the pain returns.

Why this build up?  Often it is because the child does not use the bathroom enough.  In school-age kids, they don’t want to use the yucky school bathroom and hold it all day. Then they get home, want to play, and get too busy to bother with the bathroom at home.  Also, today’s low fiber diets and low activity levels don’t help.  Fiber helps stool hold on to water and stay soft and mobile.  Kids who run and climb shake the goods down to where it wants to come out.  Kids who sit all day help stool stay put too. When stool stops moving inside, it dries out.

By now the keys to constipation prevention should be clear.  First, a healthier, higher fiber diet.  This means a fruit with every meal: breakfast, lunch, and dinner.  Vegetables with lunch and dinner.  No more white breads.  No more chips and cookies for snacks.  Kids should be eating wheat bread and bran cereals, granola and fiber bars for snacks.  And as you are now hearing again and again, in these days of kids getting fatter and fatter, get them off the couch and moving!  Less TV and video gaming, less sitting with the phone, more play with running and jumping and climbing.  Finally, have a regular time to go, like before school. Guts can be trained to get the job done!

We also need to talk about newborn and infant constipation.  Many of the babies I see with worries of constipation are not really constipated.  The new moms come in because baby has not pooped in 3 to 4 days.  I will ask, does the baby poop soft when it does come, and often the answer is yes.  This is normal for babies.  Babies will sometimes go days without stooling, but as long as it is soft, then it is okay.  What if baby seems crampy, pulling up her legs and crying?  This is not constipation, it’s colic.  Colic has little to do with how often baby poops.

If the baby’s poop comes out hard though, like rabbit pellets, that is constipation.  The best prevention for constipation, and colic, is breast-feeding.  Breast feeding is so much better for baby than formula in so many ways, and this is just one more reason to breast feed.  Breast milk keeps stool very soft so constipation is quite unlikely.  Breast milk is also much easier on baby’s guts, and therefore colic is less bad too.

So as I tell parents day in and day out, week after week, start buying healthier foods.  Don’t buy junk.  Turn off the screens and get those kids up and active.  Getting them moving in that way, gets them moving in the other way too.