What is constipation in children?
Children who are constipated have fewer than two bowel movements in a week. When they do have a bowel movement, the stools are hard, dry, small, and difficult or painful to pass.
Which children are affected by constipation?
Up to 10% of children will be constipated at any given time. Other factors include the following:
- Constipation is slightly more common in boys.
- Children who have developmental delays, behavioral issues or problems affecting the anus or rectum may suffer from chronic (long-term) constipation.
- Older children and teens may become constipated if their diet does not include enough high-fiber foods and water.
- Children who are at toilet training-age may be holding in their stool.
Symptoms and Causes
What causes constipation in children?
Children often become constipated because they hold in stool. As a result, the colon absorbs too much fluid and the stool becomes dry and hard to pass. Children may hold in stool because they:
- Don’t want to stop whatever activity they’re doing, such as playing.
- Are embarrassed to use a public bathroom.
- Are worried the bowel movement will be painful.
- Are nervous about learning to use the bathroom or are not ready developmentally for toilet training.
Other causes of constipation in children include:
- A low-fiber diet
- Not getting enough fluids
- Certain medications, including antacids, anticholinergics for muscle spasms, narcotics for pain, and some treatments for depression
- Health problems that make the stool move slowly through the colon
- Problems with the way the gastrointestinal system works
- Irritable bowel syndrome (the colon muscle tightens quickly)
- An illness that causes a loss of appetite
- Stress caused by school or by changes in routine, weather or travel
What are the symptoms of constipation in children?
Symptoms of constipation in children include:
- Several days without normal bowel movements
- Painful, hard stools that are difficult to pass
- Unusual postures and movements, such as standing on tiptoes or appearing to be dancing (caused by trying to hold in a bowel movement)
- Pain or bloating in the abdomen
- Soiled underwear caused by leaking from fecal impaction (stool is trapped in the colon). This may look like diarrhea.
- Urinary incontinence (leaking urine) because stool in the colon is pressing against the bladder
- Bleeding from the rectum
- Poor appetite
- Unusually cranky behavior
Diagnosis and Tests
How is constipation in children diagnosed?
To diagnose constipation in a child, a doctor will perform a physical exam and take a medical history. The doctor will ask about the child’s:
- Bathroom and bowel movement patterns
- Diet and eating habits
- Potty training
- Health problems (if any)
- Medications (if any).
During the physical exam, the doctor will check the child’s abdomen to see if it is swollen or tender, or has any masses or lumps. The doctor may also examine the child’s rectum to look for blood or blockage.
The doctor may also order tests, such as an X-ray, which can show stool that is still in the colon. Sometimes lab work is needed to help with diagnosis of an underlying health problem.
Management and Treatment
What are the complications associated with constipation in children?
Complications of constipation in children include:
- Fecal impaction (hard stool packs the intestine and rectum too tightly to push out)
- Anal fissures (small tears in the anus that cause bleeding, itching or pain)
- Rectal prolapse (the rectum sticks out of the anus)
- Encopresis (inability to control passage of stool, which leads to stool accidents)
How is constipation in children treated?
Children who are constipated can often be treated at home. Treatments include:
- Changes in diet, including drinking enough liquids and eating fruits and vegetables to get extra fiber;
- Encouraging the child to use the bathroom regularly, especially after eating, through a reward system;
- Holding off on potty training until the constipation goes away.
(Do not use enemas or laxatives to help the child pass the stool without a doctor’s approval.)
For children with complications of constipation, the following are common treatments:
- Anal fissures can be treated with creams, stool softeners and warm baths.
- Rectal prolapse may be treated by a doctor manually pushing the rectum back in place.
- Under a doctor’s direction, Miralax or a glycerin suppository may be used.
Children who are constipated should avoid eating or drinking foods with little or no fiber, such as:
- Ice cream
- Fast food
- Prepared foods
- Processed foods
- Excessive amounts of whole milk
If these treatments do not help the child, he or she should be seen by a doctor.
How can constipation in children be prevented?
The following measures may help prevent constipation in children:
- Changes in the diet, including increasing water intake and switching to lower fat dairy products (if age appropriate). Check with your doctor to see if he or she recommends any juice. A doctor can help plan a diet with the appropriate amount of fiber to treat or prevent constipation. Increasing the intake of fresh fruit and vegetables is helpful.
- Scheduling a regular toilet routine
- Encouraging regular physical exercise
Outlook / Prognosis
What is the prognosis (outlook) for children with constipation?
Constipation is usually temporary and treatable. With the proper diet and fluid intake, the child can have more regular bowel movements.
If it is not treated, constipation can become worse. If the stool stays inside the lower intestinal tract, it keeps getting larger, firmer and drier. This makes it more painful to pass, and the child will be more likely to hold back the stool.
When should I take my child to a healthcare provider for treatment of constipation?
A child should be seen by a doctor if the symptoms of constipation last for more than two weeks. Contact your doctor right away if your child has any of the following symptoms:
- Blood in the stool
- Swollen abdomen
- Weight loss