: Constipation in Children
Constipation is probably the most common identifiable cause of
recurrent or chronic abdominal pain in children. Even if a child
is not constipated, sometimes understanding what causes constipation
in children can help prevent it in the first place.
How is constipation defined?
In order to understand what constipation is, it's important to
realize that how often a person goes to the bathroom varies tremendously.
Some people go once a day, while others go once a week without
any difficulty whatsoever. Individuals tend to have their own
patterns of bowel movement frequency. Therefore the definition
of constipation is based mostly on the presence of symptoms of
discomfort such as abdominal pain, rectal pain and hard stools
rather than the frequency of passing stools.
Can a child be constipated even without typical symptoms?
Yes, children become constipated over time. In most cases this
happens by holding back the stool often because they're too busy
playing or having fun to go to the bathroom. The rectal area gets
used to this and does not empty as it should. The more the child
holds it in, the more the stool overloads the intestine. It is
this "intestinal overload" that causes pain by "pressing" the
intestines. This is known as stool(fecal)retention. Typically,
the abdominal pain in children who are constipated may worsen
after a meal. This is due to the "gastro-colic reflex", which
is a message from the stomach to the intestine telling it to get
rid of the stool because more is coming down. So in response,
the intestines will cramp down or contract, resulting in pain.
What about babies?
Babies have to learn to the pass stool and during the first few
weeks they may grunt, seem fussy or even seem to be straining
before passing a (usually normal) stool. Often this is a sign
that they are learning to pass a stool rather than of constipation.
A baby is considered to be constipated only if the bowel movements
are hard, painful and/or associated with signs of discomfort such
as abdominal pain or crying while passing a stool. Also the stool
frequency in breast fed babies can vary even more, for example
from 8-12 per day to one bowel movement every few days; This does
not mean a baby is constipated. Generally, once a constipated
baby has been evaluated, and all is found to be normal, the problem
may be treated simply by giving baby more liquid or by adding
some table sugar to the milk.
How is constipation confirmed?
In some cases it is obvious by the history of symptoms and the
physical examination. In other cases a very simple abdominal x-ray
will reveal that the intestines are abnormally full of stool.
Are there any other problems that can arise from constipation?
Constipation most commonly causes abdominal pain and discomfort.
Additionally it can cause small tears in the anal area known as
fissures which can bleed and cause pain. Treating anal fissures
is important, because children may refuse to have a bowel movement
fearing that it will be painful resulting in holding it in, making
the constipation worse. The treatment of fissures is to apply
local creams and importantly to address the constipation. Very
rarely some children are born with abnormalities in the muscle
of the large intestine which can present as severe and/or difficult
to treat constipation. This condition is known as Hirschprung's
disease which only a surgical procedure can cure. Fortunately,
in most constipated children there are no associated intestinal
How is constipation treated? There are 3 parts
to the treatment of constipation:
Emptying the intestine:
This can be achieved by any of the following:
-oral medications or liquids such as mineral oil or oral laxatives,
Although some of these medications(including laxatives)are
available over the counter, they should only be used on prescription
by and under the care/supervision of a doctor. In
certain situations mineral oil may be prescribed for up to several
Because constipation often lasts a long time, children get used
to this situation and they need to retrain their intestines to
get used to going to the bathroom regularly. This is the most
important part of treatment of chronic constipation in children
.To re-establish a routine, the child should sit on the toilet
on a daily basis, preferably after a meal, and at same time each
day, for at least 15 minutes. During this time the child can read
a book or play game. This will help create a routine and "re-train"
the intestines. Consistency, patience and persistence are the
keys to success.
A high fiber diet is very important. Children who have poor fiber
intake and tend to be more constipated. It is important to assure
that children get enough high fiber their diet. High fiber foods
Cereals(high fiber like All Bran)
It is also important to drink between six and eight glasses of
water a day. Avoiding junk food, like chips and chocolates, also
helps. Some children do not like the high fiber cereals so mixing
them up with their favorite cereal may help. Additionally, make
things fun, have your child help in preparing these high fiber
meals. Also, remember to offer your children lots of popcorn which
is a great source of fiber and a favorite snack among kids.
Soiling and constipation
Encopresis is the medical name for stool or fecal overflow or
"soiling. It is currently believed that encopresis is a physical
problem resulting from a large amount of stool in the intestine,
rather than psychological one. Encopresis, in most instances,
is an "overflow" phenomenon in a child with long standing fecal/stool
retention, an extended form of constipation. In some instances
this can develop in the absence of constipation symptoms. The
child's rectal control has been "numbed", and cannot feel the
urge to defecate. The result is that stool "leaks" resulting in
soiling which obviously is embarrassing to the child. The approach
to the problem is to identify the problem and to treat it as we
do with constipation.
For more information on soiling
Other Childhood Illnesses
The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
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