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What is constipation in children?
Constipation is a very common reason parents bring children to see a gastroenterologist (accounts for more than 30% of visits to a pediatric gastroenterologist worldwide).
Although constipation is common, it can be difficult to define as the frequency and type of bowel movements vary from child to child. Simply put, constipation is defined as painful or difficult pooping, and the child might not go as often or as much as is typical for them. Going several days without a bowel movement, straining a lot when trying to go, and having poop that looks like pebbles are common signs of constipation. Sometimes when children are constipated and stool gets backed up (impacted), they may even start having stool accidents in their underwear.
At GI Care for Kids, our doctors recognize that even though the cause of constipation is usually not a serious illness or an underlying disease, it still affects quality of life and can cause a great deal of suffering, so it needs to be treated properly.
When does constipation happen?
Optimal treatment starts with a careful history and physical examination to rule out rare causes of constipation which happen only in a very small number of children (less than 5%), such as underlying neurological problems (e.g., spina bifida), anorectal malformations (problems with the anus and rectum (e.g., imperforate anus), or innervation problems (problems with nerves in the bowel (e.g., Hirschprung’s disease).
For more than 95% of children, there is no underlying disease or abnormality causing constipation, and this is called functional constipation.
Reasons for functional constipation
For some babies, straining and having trouble passing a bowel movement (even if it is soft) can simply be because their system is still developing, and they are learning to coordinate the muscles needed to poop. Formed stools can be even harder for infants to push out.
After infancy, childhood constipation may occur after dietary changes, travel, viral illness, toilet training, or starting school. Many factors can lead to constipation in children, including painful bowel movements, poor sensation (not feeling the urge to go), and, in some cases, children are so busy that they ignore the urge to go to the bathroom.
Younger children may hold back the stool because they are afraid it will hurt. Older children may begin withholding when they need to go to the bathroom but are worried about using the toilet outside their home, like at school or summer camps (especially if the facilities aren’t clean or private enough).
The cycle of constipation
Whatever the initial reason for stool not being expelled, when it stays in the gastrointestinal tract, it continues to absorb water. This makes the stool harder and bigger. When the child finally passes this hard stool, it can be uncomfortable or painful, which can reinforce negative pooping behaviors and make the child want to hold it in even more. This leads to more stool buildup, which can stretch the bowel, decrease the sensation of needing to go, and create a vicious cycle. In some children, this large amount of stool in the intestines can even cause stool to leak in their underwear.
Treatment for constipation
In most cases, there is no need for tests to evaluate the cause of a child’s constipation. However, your doctor may order X-rays or other tests to clarify the situation.
Treatment for constipation depends on the child’s age and how the child is presenting. Some children may only need changes in their toilet habits. Others might need medications like stool softeners or stimulant laxatives. It’s important to know these medications are not habit-forming and may be taken for an extended time under your doctor’s guidance without causing worrisome side effects.
Many children will need an initial “cleanse” to help empty their colon of a large amount of built-up stool. This might involve using laxatives taken orally or even suppositories or enemas.
Helpful resources
Constipation (by GI Kids, the public education arm of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)
Functional Constipation, Stool Withholding, and Encopresis handout from GI Care for Kids
Miralax Stool Softener handout (from GI Care for Kids, the MiraLax website, and FAQs regarding its safety)
Nutrition4kids.com, a resource for parents who want to feed their kids well, regardless of medical challenges or allergies. Subscribe for updates personalized for you and your child.