Constipation Support for Parent Carers

The most effective approach will depend on your child’s needs, feeding method, and medical condition.

What may help?

Some foods and drinks can naturally help stimulate bowel movements, including:

• Orange juice
• Prunes
• Apricots
• Dried fruits

For children who eat orally

Dried fruits and other foods containing sorbitol may help soften stools and support bowel movements.

For children with a gastrostomy

These foods may be incorporated into a blended diet where appropriate.

For children receiving jejunal feeds

Dietary options may be more limited because feeds are often milk-based. You may wish to consider other methods such as:

• Gentle movement and activity
• Abdominal massage
• Warm drinks, room-temperature or warm water, if tolerated

Further support

It may be helpful to discuss dietary strategies with your dietitian.

See Slide 10 for additional natural approaches.

Managing constipation in children with dystonia often requires a combination of dietary measures, medication, and physical strategies.

What may help?

• Constipation medications as prescribed
• Gentle movement where possible
• Massage
• Other natural methods outlined in Slide 10

Important considerations

You may wish to discuss the following with your clinical team:

• Whether current dystonia medications could be optimised
• Whether Botox treatment may be appropriate
• Whether alternative medication options should be explored

Management should always be tailored to the individual, as symptoms and underlying causes can vary significantly.

What may help?

• Reviewing current bowel management strategies
• Exploring feeding methods and feeding regimes
• Discussing medication options with the specialist team

Important considerations

If symptoms significantly affect quality of life, more intensive interventions may considered and discussed with your child’s specialist team, including:

• Gut rest
• Total parenteral nutrition (TPN)
• Surgical intervention

This depends on your child’s individual situation and how you feel about these methods.

Yes. Constipation can lead to trapped wind and abdominal discomfort.

You can think of it like plumbing: when stool builds up in the bowel, gas can become trapped behind or around the blockage, making it difficult to pass.

What may contribute to trapped wind?

• Constipation itself
• Some osmotic laxatives
• Stool softeners
• Stimulant laxatives

What may help?

• Peppermint oil or other suitable natural remedies
• Position changes and gravity-assisted positioning where tolerated. If your child is able to get into as much as an upside down position as possible that will help

For children who are non-mobile

• Lying on their left side
• Gentle abdominal massage
• Encouraging fluid intake where possible
• Trying to make the stools as much as possible

For children receiving enteral feeding

Some children may need to be on free-drainage from their gastrostomy to let that trapped wind out. You could discussed this with your child’s healthcare team if appropriate.

Important considerations

Increasing laxative doses specifically to treat trapped wind can sometimes make symptoms worse.

Where appropriate, it may be better to maintain current constipation treatments and focus on relieving the trapped wind through other methods.

For many people, thinking about options beyond medication can feel daunting. The most important consideration is the extent to which constipation is affecting quality of life and whether it is causing significant distress for the individual and their family.

What may help?

Finding the right treatment combination often involves trial and error. It may take a little while to find the sweet spot. You could explore all the suggestions discussed in the video, such as:

• Different stimulant laxatives
• Different stool softeners
• Alternative medication brands
• Dietary changes
• Natural approaches such as massage and movement

If constipation remains difficult to manage

• Consider how much the symptoms are affecting daily life, comfort, and wellbeing.
• Look at other methods of feeding to reduce pressure on the bowels and intestines.
• You could consider surgical interventions if it’s something that’s really been troublesome their whole life.

The most important thing is that toileting remains a positive experience.

A toilet sit of approximately 10 minutes is usually sufficient.

If your child hasn’t passed a stool after 10 minutes they are probably not going to. They may then have an accident when they get off the toilet, but that is to be expected when they are trying to disimpact and learning to toilet. The key is maintaining a positive experience.

What may help?

• Sit on the toilet at the same time each day
• Give prescribed laxatives at consistent times
• Develop a predictable toileting routine

Regular routines help train the bowel and can make bowel movements more predictable.

If Movicol isn’t working

It may be worth reviewing:

• Whether amount of sachets being used is right for your child
• Whether your child needs to be disimpacted. That involves going up to 12 or 8 sachets (depending on age) and then gradually come back down.

It is possible that disimpaction has happened but there was some left and so your child is reimpacted. If this has happened you may need to do disimpaction again or increase the sachets or swap to something else to include a stimulant.

When should further advice be sought?

If your child sits comfortably but is consistently unable to pass a stool, they may need additional support, such as a stimulant laxative. Discuss this with the healthcare professional managing their constipation.

Bisacodyl is a stimulant laxative, similar to senna. Oral stimulant laxatives work by encouraging the bowel to move stool through the digestive system.

If a large amount of stool is already sitting lower down in the bowel, oral medicines may only move it part of the way and may not clear it completely.

What may help?

If oral stimulant laxatives have not been successful, treatments that work directly in the rectum may need to be considered, including:

• Suppositories
• Bowel washouts. These use fluid to soften and flush impacted stool from the bowel

Important considerations

GPs often follow National Institute of Clinical Excellence (NICE) and British National Formulary (BNF) guidance, which does not usually recommend suppositories as a first-line treatment.

Suppositories can also be uncomfortable or distressing for some children, particularly when used regularly.

When should further advice be sought?

If oral treatments have not been effective, ask about referral to a consultant-led paediatric gastroenterology service. This may be locally or tertiary depending on where you are. Specialist teams can assess whether treatments such as bowel washouts or suppositories may be appropriate.

Yes. Very large stools, particularly those large enough to block the toilet, can indicate constipation.

What may help?

If your child drinks mainly milk and does not accept water, increasing fluid intake can be challenging but remains important.

Foods containing sorbitol may help support bowel movements, including:

• Prunes
• Apricots
• Other sorbitol-containing fruits

Fresh orange juice may also help if your child will drink it.

Increasing fluids

Alternatives to water may include:

• Diluted squash
• Flavoured water
• Fresh orange juice
• Prune juice

Milk provides important nutrition but is not as effective at softening stools as other fluids.

If your child drinks formula milk or a supplement

If your child drinks formula milk or a supplement, the ones that are pre-made often have laxative properties. Therefore the pre-prepared formula milks may be more helpful than the powder ones.

Medication options

A macrogol laxative such as Movicol may help soften stools by drawing water into the bowel.

The plain, unflavoured version may be easier for some children to take. It should always be prepared according to the manufacturer’s instructions.

If macrogol is not tolerated, alternatives such as lactulose may help.

Yes. Bisacodyl suppositories can be used long term if they are prescribed, monitored, and reviewed appropriately by a healthcare professional.

Important considerations

If suppositories are the treatment that enables your child to open their bowels regularly and comfortably, it is better that they take this than the alternative of not opening their bowels.

The priority is ensuring your child remains comfortable and avoids complications associated with ongoing constipation.

When should further advice be sought?

The treatment should be reviewed regularly, ideally at least once a year.

This review may be carried out by:

• Your GP
• A paediatric gastroenterologist
• The healthcare professional who prescribed the treatment

Regular reviews help ensure the treatment remains appropriate and effective.

Madeleine Bradley

madeleine.bradl​[email protected]

Rachel Carluke, Family Information Officer

[email protected]

First published: July 2026

Review due: July 2027