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Pediatric Constipation

Constipation is one of those unpleasant topics to talk about. If you've suffered from this problem, though, you know it can be both painful and frustrating. Almost everyone has constipation some time during his or her life. Though not serious, constipation can be a concern.

What is constipation?

Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movements (also known as "stools") ranges widely from person to person. Some people have bowel movements three times a day; others only one to two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool becomes harder and more difficult to pass.

What causes constipation?

Constipation is most commonly caused by inadequate fiber in the diet, or a disruption of the regular diet or routine. Chronic constipation may be due to a poor diet, dehydration, certain medications (such as antidepressants and narcotics), stress or the pressure of other activities that force you to ignore the urge to empty the bowel.

Rarely, various medical conditions can cause or aggravate constipation. Some of the more common medical conditions that cause constipation include endocrine problems, such as poor function of the thyroid gland or diabetes. Colorectal cancer is another medical condition that can cause constipation. Common causes of constipation include the following:

  • A diet low in fiber
  • Not drinking enough water
  • Lack of exercise
  • Travel or another change in routine
  • Eating large amounts of milk or cheese
  • Stress
  • Resisting the urge to have a bowel movement
  • Antacid medicines containing calcium or aluminum
  • Other medicines (especially strong pain medicines such as narcotics, antidepressants and iron pills)
  • Irritable bowel syndrome (IBS)
  • Pregnancy

How is constipation evaluated?

Most people do not need extensive testing to evaluate constipation. Only a small number of patients with constipation have a more serious medical problem (such as poor function of the thyroid gland, diabetes or colorectal cancer).

If you have chronic constipation for more than two weeks, you should see a doctor so he or she can determine the source of your problem and treat it. For a patient who has colorectal cancer, early detection and treatment may be life-saving.

Standard evaluation for constipation includes performing blood tests and examining the colon by barium enema or colonoscopy, a procedure in which a special instrument is inserted into the rectum to view the rectum and colon.

Most patients with serious constipation, and without any obvious illness to explain their symptoms, suffer from one of two problems:

Colonic inertia (also called lazy colon): a condition in which the colon contracts poorly and retains stool.

Obstructed defecation: a condition in which the colon contracts normally, but the patient is unable to expel stool from the rectum. This condition can be confirmed by special tests that measure pressure and muscle function in the rectum and anus.

How can I prevent constipation?

  • Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes and whole-grain bread and cereal. Fiber and water help the colon pass stool. Most of the fiber in fruits is found in the skins. Fruits with seeds you can eat, like strawberries, have the most fiber. Bran is a great source of fiber: eat bran cereal or add bran cereal to other foods, like soup and yogurt.
  • Drink 1 1/2 to 2 quarts of water and other fluids a day. (Note: Milk can cause constipation in some people.) Liquids that contain caffeine, such as coffee and soft drinks, seem to have a dehydrating effect and may need to be avoided until your bowel habits return to normal.
  • Exercise regularly.
  • Move your bowels when you feel the urge.

How is constipation treated?

  • Drink two to four extra glasses of water a day.
  • Try warm liquids, especially in the morning.
  • Add fruits and vegetables to your diet.
  • Eat prunes and/or bran cereal.
  • If needed, use a very mild stool softener or laxative (such as Pericolace or Milk of Magnesia). Do not use laxatives for more than two weeks without calling your health care provider, as laxative overuse can aggravate your symptoms.

When should I call my health care provider?

Call your health care provider if:

  • Constipation is a new problem for you
  • You have blood in your stool
  • You are losing weight even though you are not trying to lose
  • You have severe pain with bowel movements
  • Your constipation has lasted more than 3 weeks

Where can I learn more?

National Digestive Diseases
Information Clearinghouse
900 Rockville Pike
Bethesda, Maryland 20892