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Dr. A. Clark
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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My son 16 states his poop wont come out he has to use his

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My son 16 states "his poop won't come out he has to use his hand to "dig" it out??? he is not consitpated, he is lactose intolerent but continues to eat cheese, milk, yourgart etc. any ideas?? Also he has ocd, could that really be the problem? or/and aspergers?
I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you. Despite the fact that you say he is not constipated, thick, firm, large stools are not normal, especially if he clogs the plumbing regularly. If he were very lactose intolerant and continuing to eat dairy products you probably would not be having this problem at all since he should be having loose stools. What is going on with him is known as chronic constipation where his rectal vault and colon have become distended due to the large volume of stool that has accumulated over time. The kids still have BMs but only pass hard stools that should have been passed days or weeks before. In younger kids this becomes a more serious problem as they lose control of their anal sphincter and have accidents all the time as the stool basically overflows into their underwear.

I don't know that OCD plays a role in this but my advice would be the same anyway. First, he needs to be cleaned out from below with a couple of days of Fleet's Enemas as until his rectal vault is really empty he will continue to have problems. However, the key to treating this is from above and that is accomplished by increasing his fiber intake. The best way to do this is to put him on Miralax (17 grams, or one capfull) each day, plus lots of extra juice or water to help soften his stools. This over the counter constipation medication is perfectly safe, once his colon has been emptied with the enemas, and will help of many weeks of use to make his stools softer and easier to pass, plus will get him back to a more regular schedule. As far as his diet, he should avoid dairy for now as the extra calcium is likely causing problems due to its affect on the intestine's motility since it slows it down and leads to constipation, as any woman on calcium supplements (for osteoporosis prevention) can attest. Also, he needs to sit on the toilet after each meal when possible to help him begin to re-learn the natural process of colon contractions after filling the stomach, called the gastro-colic reflex, and he should learn to drink more fluids to help keep his stools soft as well.

Depending on how long he has been having this problem you can expect it to take at least twice as long to fix as it has been going on, perhaps weeks to months of treatment.
Customer: replied 6 years ago.
Many times it is diareha sp?
Constipation to most people means hard stools but medically speaking, especially with chronic constipation, it refers to infrequent or hard to pass stools that sometimes may include loose stools and even "overflow incontinence" where soft stool passes around the impacted hard stool in the rectal vault. This confuses lots of people since they only think of constipation as hard stools and thus don't really consider the unique problem of chronic constipation as I'm sure your son is experiencing. That is why the treatment is twofold: clean him out first with the Fleet's and then begin a regimen of Miralax, increase fluids, sitting on the toilet after every meal, etc. I am confident that if you try this protocol he will be successful in getting over this, but don't expect instant results as it will take weeks of being diligent in sticking to the treatment.
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