My daughter suffers from constipation — how can I help her to remedy this?

I have an eight-year-old daughter who suffers from constipation, and it sometimes results in faecal incontinence. My GP has given me the usual advice — more fluids, fibre etc. I was wondering if I could give her psyllium husks in the mornings and evenings. And also, is there a probiotic that could be useful? I don’t want to inadvertently make things worse for her.

To date, there is no major scientific evidence that taking a probiotic supplement will improve overall bowel health in an otherwise healthy person. Safe to say that taking a probiotic and psyllium husk fibre supplement daily will do no harm.

I assume your daughter is suffering from idiopathic (cause unknown) chronic constipation and all major medical conditions associated with constipation have been ruled out.

Straining to pass a stool is never a good thing. First off, I suggest you buy a ‘squatty potty’ as this will raise the knees above the hips and allow a more direct line for the stool to exit the rectum. Before toilets were invented, everyone had to squat to pass a stool.

Secondly, remember to take advantage of what nature designed for us in the gastrocolic reflex. As you fill your stomach, several bodily systems stimulate the rectum to move and open. Morning time is when this reflex is most prominent. Never ignore the call to pass a stool — you should always go when you need to go.

I firmly believe management should always begin with patient education and strict adherence to the recommended behavioural, dietary and lifestyle modification followed by laxative therapy (if necessary).

Thirdly, exercise is key, as generally, the more you exercise the better your body will function overall. If someone sits around all day long, it’s obvious their bowel habits will be sluggish.

Fourthly, you must encourage your daughter to drink two litres of plain water per day. Not sugar-sweetened or caffeinated liquid, but some low-fat milk/ dairy-free milk can be included in this. On that note, caffeine can aid bowel movements, but I would not give caffeine to a child.

There are two main types of laxatives: bulk-forming laxatives and non-bulk-forming (or stimulant) laxatives. You should increase dietary fibre as much as possible by eating prunes, fruit, vegetables, legumes, bran (but avoid cereal as these are too high in sugar) and of course, beans!

Consider adding bulk-forming laxative such as psyllium husk which acts primarily by absorbing water and increasing faecal mass. Stimulant laxatives such as sodium picosulfate or bisacodyl (Dulcolax) and senna (Senokot) primarily act on electrolyte transport within the intestinal mucosa, thereby increasing intestinal motility. These medications should not be taken long-term.

In cases of severe constipation, sometimes manual disimpaction may be necessary, followed by rectal suppositories or a rectal enema. Other medications can be added, such as secretory or prokinetic agents.

Management of chronic constipation in an adult may be due to pelvic floor dysfunction and often involves suppositories or biofeedback. In short, always get the basics right and everything should flow naturally.

Most western diets are too low in fibre, often resulting in one bowel movement per day or less. In an ideal world, you should be aiming for more than one bowel movement per day. Most healthy vegans and people living in second or third world countries (who eat less processed food) will have over two bowel motions per day as their diet tends to be very high in fibre. Everyone should consider increasing dietary fibre as this reduces your LDL cholesterol and potentially your risk of type 2 diabetes. Fibre is your friend and will also improve your natural gut microbiota.

Dr Jennifer Grant is a GP with Beacon HealthCheck