Constipation is very common in children of all ages. At GI Care for Kids, our doctors recognize that constipation, even if it is not due to a serious disease, can cause a great deal of suffering and needs to be treated properly. Optimal treatment starts with a careful examination and a thorough explanation of the problem. In the majority of children, there are no recognized diseases that cause constipation. In some, underlying neurological problems (eg. Spina bifida), anorectal malformations (eg. Imperforate anus), or innervation problems (eg. Hirschsprung's disease) are present and need to be treated.
Constipation is defined as either a decrease in the frequency of bowel movements, or the painful passage of bowel movements. Children 1-4 years of age typically have a bowel movement 1-2 times a day and over 90% of them go at least every other day. When children are constipated for a long time they may begin to soil their underwear. The medical term used to describe the soiling occurring in chronically constipated children is encopresis.
Reasons for Constipation
In some infants, straining and difficulties in expelling a bowel movement (usually a soft one) can be simply due to an immature system, with the rectal muscles not relaxing at the right time. Later, constipation can start when the child's diet does not include enough fiber or fluids. Once the child has been constipated for more than a few days, the retained stool can fill up the large intestine (the colon) and cause it to stretch. An over-stretched colon cannot work correctly and therefore more stool is retained. To pass a large and hard bowel movement then becomes a painful experience for the child, who would naturally try to avoid going to the bathroom ("withholding behavior").
In children, constipation can begin when there are changes in the diet, at the time of toilet training, following travel, or after a viral illness. Older children can begin withholding when they need to go to the bathroom but are afraid to use the toilet outside of their home. School or summer camps, with facilities that are not clean or private enough, are common triggers for withholding in this age group. In many children, there are a combination of factors which cause constipation, including painful bowel movements, poor sensation (not knowing when to go to the bathroom), and in some cases, children are so busy that they ignore the need to go to the bathroom.
In most cases there is no need for invasive tests to evaluate. However, sometimes, depending on the severity of the problem, your doctor may order X-Rays or other tests to clarify the situation.
Treatment of constipation varies according to the source of the problem and the child's age and personality. Some children may only require changes in diet such as an increase in fiber, fresh fruits, or in the amount of water they drink each day. Other patients may require medications such as stool softeners, or, on occasion, laxatives. Stool softeners are not habit forming and may be taken for a long time without worrisome side effects.
A few children may require an initial "clean-out" to help empty the colon of the large amount of stool. This typically entails the use of laxatives by mouth or even suppositories or enemas for a short period of time.
It is often helpful to start a bowel training routine where the child sits on the toilet for 5-10 minutes after a meal or after the evening bath. It is important to do this consistently in order to encourage good behavior habits.
Additional information can be found at these websites:
Functional Constipation Handouts/Information:
A January 2015 FAQ by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) on the safety of Polyethylene Glycol 3350 (Miralax) :
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