The Cleanout Worked. So Why Are We Doing Another One?

I had several conversations with parents this past week about cleanouts. Different kids, different ages, different histories, but almost the exact same story.

“We've done the cleanouts. We're giving the laxatives. The dose keeps going up. Things get better for a while, and then we're right back where we started.”

These parents are exhausted. And here's the frustrating part: most of them have done exactly what they were told to do.

So when their child gets backed up again, they understandably think the cleanout didn't work.

But what if it did?

A cleanout has a job. It clears the stool that has accumulated in the colon. For a child who is significantly backed up, that can be necessary and important.

But a cleanout is not a long-term solution to chronic constipation.

It addresses what's already there.

It doesn't automatically change withholding or the patterns that have developed around pooping. It doesn't change what happens in the bathroom every day. And it doesn't change the everyday conditions surrounding that child's body simply because the colon is now empty.

That's where I think we're missing a huge part of the conversation.

I work with families every day who have followed the typical constipation path. They've done the cleanout. They've stayed on the maintenance laxative. The dose gets increased when things slow down again. Sometimes another medication gets added. Then, eventually, they're being told it's time for another cleanout.

And somewhere along the way, everyone becomes incredibly focused on getting the poop out while far less attention is being given to a much bigger question:

What does this child actually need so we stop ending up here in the first place?

That's the question I'm interested in.

Medical care has an important role. If a child is impacted, needs medical evaluation, medication, testing or treatment, that's the medical team's job.

My work with families is different.

I'm looking at what happens between the appointments and long before another cleanout should ever be needed. I'm looking at the withholding, bathroom patterns, food and fluid, movement, daily rhythm, environment, nervous system and the everyday conditions surrounding that particular child.

Because none of those things magically change when the colon gets emptied.

And every child is different.

One child may be withholding because pooping hurt months ago and they've learned to fight the urge. Another may barely drink throughout the day. Another may have bathroom patterns, food habits, routines or environmental factors that are working against them. Often, it's several pieces interacting at once.

That's why I'm not looking for another thing to give the child.

I'm trying to understand what that child needs.

There's a big difference.

Clearing the backup and understanding what keeps leading a child back to the backup are two different jobs.

Sometimes the first one is absolutely necessary.

But the second one is where the long-term work lives.

I don't want families waiting until cleanout number three or four before someone starts asking these questions. I want us asking them much earlier—before another backup, another dose increase, another miserable weekend spent trying to get a child cleaned out.

Because the goal shouldn't be to become really good at managing the next crisis.

The goal should be to understand the child well enough that we're changing the conditions that keep leading them toward one.

That's the part of childhood constipation I believe we've overlooked for far too long.

A cleanout can clear what's already there.

But the best cleanout isn't the one we get really good at doing. It's the one the child never needs.

Keep building,

Nicole

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