Stephen J. Schueler, M.D.

Overview Symptoms Evaluation Treatment enemas fiber lubricant laxatives saline laxatives specialist stimulant laxatives stool softeners suppositories Home Care children dietary fiber enemas laxatives warning signs Prevention Underlying Cause

Hard Stool Home Care

Home care for constipation includes:

Hard Stool Children

Home treatment for constipation in children mainly involves general measures and diet changes. Medications such as laxatives or enemas are usually not necessary.

General Measures

  • Avoid foods that seem to give your child constipation. Some cheeses, white flour, and white rice can trigger constipation.
  • Avoid straining on the toilet, this can cause hemorrhoids and complicate things further.
  • Encourage drinking plenty of water.
  • Encourage regular activity and exercise.
  • Encourage your child to use the bathroom when the urge occurs.
  • Give your child a high-fiber diet every day.

Care for Constipation with Rectal Pain
For constipation with rectal pain consider the following treatments:
  • Have the child soak in a tub of warm water with 2 ounces of baking soda per tub. This can help the child to relax and release a bowel movement.
  • If the above is not successful, try one or two glycerin suppositories to smooth the way.
  • Try 10 seconds of gentle rectal stimulation using a lubricated rectal thermometer.
  • Fleet enema (normal saline enema) should only be administered with physician approval.

Care for Infants Under 1 Year
  • Infants younger 2 months: give one teaspoon of Karo syrup per day.
  • Infants older than 2 months: give 2-4 ounces of fruit juices (e.g. grape, pear, cherry, or apple) per day. Prune juice can be tried last. Orange juice and citrus juices are not as effective (contain lower levels of sorbitol).
  • Infants older than 4 months: try adding higher fiber baby foods such as peas, beans, cereals, apricots, prunes, pears, and spinach.
  • No enemas in children under 1 year of age.

Care for Children Over 1 Year
  • Make sure your child eats more fiber. The easiest way to do this is to include more fruits and vegetables in the diet.
  • Raw, un-peeled fruits and vegetables are best. Fruits include prunes, figs, dates, raisins, pears, peaches, apricots, and bananas. Vegetables include broccoli, cauliflower, peas, beans, and cabbage.
  • Bran is a natural stool softener and is high in fiber. Consider oatmeal, bran muffins, shredded wheat, graham crackers, and whole wheat bread. Popcorn is also high in fiber for those children who are over four.
  • A normal saline or Fleet enema may be considered in children over 2 years of age with your doctor's consent. Do not give an enema to any child with abdominal pain.
  • Anal fissures are a common problem associated with straining. They can also contribute to constipation. Symptoms include pain with defecation as well as blood on the surface of the stools.
    • Treat anal fissures with 20 minute sitz baths in a warm, saltwater tub three times per day. Apply a non-prescription 0.5% hydrocortisone cream to the fissure three times per day (after soaking).
  • Stool softeners can be considered if a change in the diet is unsuccessful. These medications can be given with dinner every night for one week.
    • Examples of stool softeners used in children include Colace, Haley's M-O, Metamucil, Citrucel, and mineral oil (1-2 tsp or 5-10 cc)
  • Stimulant laxatives are generally avoided in children. Your doctor may recommend one of these when diet and stool softeners are unsuccessful. These medicines work by irritating the intestinal lining of the intestines.
  • Popular stimulant laxatives include:

Enemas are occasionally used in cases of constipation or to prepare the bowels for an x-ray. An enema works in two to fifteen minutes. One of the most commonly used is Fleet Enema, which contains sodium phosphate. Great care should be taken when giving enemas, since the nozzle could damage the anal canal.

Most commercial enemas contain phosphate compounds. Use in children may lead to toxic levels of phosphorus in the blood. Children should use no more than 1 ounce per 20 pounds of body weight. Pediatric Fleet enemas contain 2.25 ounces, while an adult Fleet contains 4.5 ounces. Mineral oil enemas come in 4.5 ounces. Children 2-6 years old can be given 2 ounces, while those older than 6 can be given a full, 4.5 ounce enema.

Instructions for a Fleet enema:
  • Place the child in a comfortable position on the left side with the knees bent.
  • Remove the protective shield from the enema tip.
  • Gently insert the enema tip into the anus. K-Y jelly may be used for lubrication. Slight bearing down as if having a bowel movement may help. Do not force the enema tip as this may cause injury.
  • Gently squeeze the bottle until the liquid has entered the rectum.
  • Remove the enema tip.
  • Retain the enema as instructed or for 10-15 minutes if possible.
  • Have the child drink plenty of fluids to avoid dehydration.

Hard Stool Dietary Fiber

It is important to follow a healthy diet if you have constipation.

Dietary fiber is a plant material that humans cannot digest. Fiber absorbs water, which keeps the stool soft and promotes rapid passage of material through the intestines. This may reduce exposure to toxic substances and improve the health of the intestines. Fiber also binds fat and cholesterol, and reduces the risk for heart disease. As an added benefit, high fiber foods usually contain important vitamins and minerals.

Fiber comes in two forms, based on whether it will dissolve in water. Soluble fiber dissolves in water and insoluble fiber does not dissolve in water. About 3/4 of fiber in the diet should be the insoluble fiber.

Water Soluble Fiber

ExamplesDietary Sources
Pectins, gums, & mucilagesfruits, vegetables, oats, bran, barley, legumes

Insoluble Fiber
ExamplesDietary Sources
Cellulose, hemicellulosevegetables, wheat bran, & whole grains

Use of a High Fiber Diet
A healthy diet should include more than 25 grams of fiber each day.

A high fiber diet can prevent and treat the following:

General Guidelines
Fruits, vegetables and whole grains are high in fiber, but peeling the skin from fruit and vegetables removes fiber. Dried fruits, beans, black-eyed peas, bran and oatmeal are high in fiber. Bran is the outer layer of the wheat grain.

Strategies for adding bran to the diet:
  • Add 2-3 teaspoons of bran per serving, in order to increase the fiber content of casseroles, meat loaf, and baked goods.
  • Use whole grain flour: it has 6 times the fiber of bleached flour.
  • Use oat bran to replace of 1/3 of the flour in recipes.
  • Use fiber supplements, such as Citrucel and Metamucil.

Change your diet slowly. Rapid changes in the diet can cause bloating, gas and diarrhea.

Example High-Fiber Diet
Eat 3 to 10 servings of whole grain food every day.

Examples include:
  • Barley
  • Brown rice
  • Oatmeal or oat bran
  • Rye bread
  • Wheat germ
  • Whole grain bagels
  • Whole grain breads
  • Whole grain muffins
  • Whole grain or bran cereals
  • Whole grain pita bread
  • Whole wheat crackers
  • Whole wheat pasta

Eat 3-4 servings of fruit each day.

Examples include:
  • Apple
  • Banana
  • Berries
  • Grapefruit
  • Nectarine
  • Orange
  • Peach
  • Pear

Eat at least 3-5 servings of raw, unpeeled vegetables per day.

Examples include:
  • Asparagus
  • Broccoli
  • Cabbage
  • Carrots
  • Green beans
  • Green pepper
  • Onions
  • Peas
  • Potatoes with skin
  • Snow peas
  • Spinach
  • Squash
  • Sweet potatoes
  • Tomatoes
  • Zucchini

Meat substitutes:
Meat has no fiber, and contains cholesterol and saturated fat. Many high-fiber foods can replace meat in the diet.

Examples include:
  • Almonds
  • Brazil nuts
  • Cashews
  • Garbanzo beans
  • Kidney beans
  • Lentils
  • Lima beans
  • Peanut butter
  • Peanuts
  • Pinto beans
  • Sesame seeds
  • Soybeans, but not tofu
  • Split peas
  • Sunflower seeds
  • Veggie burgers
  • Walnuts

Hard Stool Enemas

Enemas should not be used in those with abdominal pain, vomiting, or recent abdominal surgery.

Steps for giving an enema include:

  • Assume a comfortable position, either on the left side with the knees bent, or leaning on a firm surface such as a bathroom counter top.
  • Remove the protective shield from the enema tip.
  • Gently insert the enema tip into the anus. K-Y jelly may be used for lubrication. Slight bearing down as if having a bowel movement may help. Do not force the enema tip as this may cause injury.
  • Gently squeeze the bottle until the liquid has entered the rectum.
  • Remove the enema tip.
  • Retain the enema as instructed or for 10-15 minutes if possible.
  • Drink extra fluids to avoid dehydration.

Hard Stool Laxatives

Laxatives cause your intestine to push stool through the bowels quickly. Laxatives come in the form of pills, liquids, suppositories, or enemas.

There are four main types of laxatives:

  • Stimulant laxatives: These medicines work by irritating the intestinal lining. Most of these contain bisacodyl. Stimulants should not be used more than once or twice a month. Popular stimulants include:
  • Saline laxatives: These are used to empty your bowels quickly and completely. This may be helpful before abdominal X-rays, special tests, or surgery. These laxatives contain magnesium. A common brand name is Phillips Milk of Magnesia. Saline laxatives should not be used for chronic constipation or in people with kidney disease.
  • Lubricants: Mineral oil and olive oil coat and soften stools. This makes the stool move through the bowels easier. Mineral oil should not be taken with meals because it can stop normal digestion. Mineral oil can prevent the absorption of certain vitamins. It can also cause anal leaking and itching.
  • Stool softeners: These medicines help when stools are too hard. Examples include:

Hard Stool Warning Signs

Notify your doctor if you have constipation and any of the following:

Continue to Hard Stool Prevention

Last Updated: Feb 15, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Hard Stool References
  1. Bleser S, Brunton S, Carmichael B, Olden K, Rasch R, Steege J. Management of chronic constipation: recommendations from a consensus panel. J Fam Pract. 2005 Aug;54(8):691-8. [16061057]
  2. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol. 2005;100 Suppl 1:S5-S21. [16008641]
  3. Clayden G, Keshtgar AS. Management of childhood constipation. Postgrad Med J. 2003 Nov;79(937):616-21. [14654570]
  4. Lembo A, Camilleri M. Chronic constipation. N Engl J Med. 2003 Oct 2;349(14):1360-8. [14523145]
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