Treatment of Chronic Constipation


  1. Empty the large intestine
  2. Establish regular bowel movements
  3. Eliminate the pain associated with passing bowel movements

Early on, constipation can often be treated by changing a child’s diet. But once the constipation becomes chronic, laxatives are usually needed to re-establish regular bowel movements and eliminate the pain associated with passing bowel movements.

Step 1:  How do we empty the large intestine?

Three methods are commonly used to empty the large intestine:

  1. Enemas
  2. Suppositories
  3. Laxatives




  • Glycerine
  • Dulcolax®
  • BabyLax®

Powerful Laxatives “flush out” the lower intestine. This generally keeps lots of water in the intestine, softening any stool there, and causing diarrhea. Laxatives commonly used to flush out the intestine include:

  • Magnesium citrate
  • Golytely® or Colyte®
  • Fleet’s Phosphosoda®
  • Miralax® or Glycolax®




  • Milk of Magnesia® and Haley’s M.O.®
    Contain magnesium salts. In high doses, often produce diarrhea.
  • Lactulose (Chronulac® and Duphalax®)
  • Sennokot®, Fletcher’s Castoria®, Ex-Lax®, Aloe Vera
  • Polyethylene glycol 3350 (Miralax® or Glycolax®)
  • Mineral Oil
    A non-absorbable oil digested by bacteria living in the large intestine. By-products of this digestion stimulate the intestine to secrete salt and water. Many people believe mineral oil works by “lubricating the intestine”. In high doses, often causes some orange seepage and some itching at the anus.

Can diet accomplish the same thing as these laxatives?


Are laxatives safe?


  • Children may become “dependent” on laxatives if they use them too long?

How long does treatment need to continue?

Length of treatment varies from child to child. In general, we must treat younger children for longer periods of time than older children.

  • Children 5-6 years of age and older: 3-4 months of continuous laxative therapy is usually sufficient to reverse many of the problems described above
  • Children under 5 years of age: we usually recommend continuous treatment with laxatives for at least 6 months, sometimes as long as 1 year

Younger children need to be treated longer than older children not because the problem is more severe, but because of their developmental stage. Young children are “magical thinkers” . . .they don’t associate cause and effect the same way older children or adults do, so we need to treat them long enough that they lose the association between passing bowel movements and pain . . . they need to forget the pain. Toddlers are like elephants, they never forget!

Step 3:  How can we eliminate the pain associated with bowel movements?

The key to eliminating pain associated with bowel movements is to be sure the bowel movements are soft and not particularly large. In children who have chronic anal fissures, it may be necessary to administer some form of medicine that is soothing and promotes the healing process.

Are there other things we can do to make treatment easier and more effective?

Almost all treatment regimens revolve around evacuating the intestine and using laxatives to keep the stools soft. A number of behavioral techniques can also be quite helpful:

Establish regular “bathroom times”

photo of child using restroom

Children who are toilet trained should get in the habit of sitting on the toilet for 5-10 minutes after breakfast and again after supper. Many families have very busy schedules and their children are not in the habit of “making time” to pass bowel movements. Establishing regular “bathroom times” after meals takes advantage of intestinal contractions that occur after we eat. These contractions are often called the “gastro-colic reflex” and explain why some people pass bowel movements every morning after breakfast or every evening after supper. Establishing regular bathroom times is also helpful because many children are completely unwilling to pass bowel movements at school (just as many adults are unwilling to do at work).

Biofeedback therapy


Behavioral therapy

In older children, we often find that in conjunction with the use of laxatives and enemas, the aid of a behavioral psychologist to enlist the child’s help in his or her own cure is very worthwhile. At the UVA Children’s Hospital we have a program called “enhanced toilet training”. With the assistance of behavioral psychologists, we use modeling and other behavior modification techniques to help children understand how to use their muscles correctly while straining.