Childhood Constipation

At your appointment, your child’s provider will ask about their medical history. If your child is a newborn, they’ll want to know if they’ve pooped in the first 24 to 48 hours after birth. If your child is an infant or older, they’ll want to know how often they poop and if their poop is soft or firm. They’ll ask if your child is toilet training and how active they are. And they’ll want to know what they eat, if they take any medications and if they’ve been sick lately.

They may also ask questions like these:

• Does it hurt to poop?
• Is the poop dry, hard or lumpy?
• Is there blood in the poop?
• Does it feel like the poop is stuck?

Then they’ll do a physical examination, which may include checking your child’s belly for lumps, swelling or tenderness, and your child’s rectum to look for blood or blockage.

The physical exam will most likely give your child’s provider a good idea of what’s going on. But if they think another health condition might be causing their constipation, they may order more tests, such as:

• Blood tests to look for things like anemia, celiac disease or thyroid disease.
• Urine test to check for bladder inflammation or infections.
• Contrast enema, which uses X-rays and a special dye to look at blockages or narrowed areas in your child’s rectum.
• CT scan and ultrasound to see any blockages in your child’s belly and to rule out other conditions.
• Marker study (or transit study), which uses X-rays to show how special markers move through your child’s intestines and colon.

If your child’s provider wants to dig a little deeper into what might be going on, they may order one or more of these tests:

• Anorectal manometry, which shows how well your child’s rectum and sphincter muscles are working.
• Colon manometry, which shows how well your child’s colon muscles are working.
• Colonoscopy, which uses a flexible camera to see inside your child’s large intestine (colon and rectum).
• Rectal biopsy, where we take out a small sample of tissue from your child’s rectum to test the nerve cells.
• Flexible sigmoidoscopy, where we put a short, lighted tube (sigmoidoscope) through your child’s rectum to see inside their large intestine.

Depending on your child’s age and symptoms, we can often treat their constipation by suggesting small changes, like:

• Eating more fiber and drinking more liquids
• Getting more active
• Postponing potty training until constipation goes away
• Using the toilet on a regular schedule, especially after eating

For really bad cases of constipation, we may recommend:

Stool (poop) softeners

These medications are taken by mouth and help make the poop soft. The dose will depend on your child’s age, how much they weigh and how bad their constipation is.

Stimulant laxatives

These medications are taken by mouth and help the colon move to get the poop out.

The dose will depend on your child’s age, how much they weigh and how bad their constipation is.

Enemas or suppositories

If your child has a blockage, their provider might recommend an enema or suppository (inserted into their rectum) to loosen things up. They’ll let you know the right dose your child needs to make their poops more regular.

Surgery

In rare cases, your child may need surgery if some other health condition is causing their constipation, such as Hirschsprung disease or pseudo-obstruction (when their colon doesn’t contract normally).

Hospitalization

If typical softeners, enemas and laxatives aren’t doing the trick, your child may need to stay in the hospital for a few days so we can completely clear out their bowel.

Treating complications of childhood constipation

Did constipation cause another problem you hadn’t planned on? Here’s how we solve those unexpected issues:

• Anal fissure: Sometimes pushing too hard to poop can cause a small tear in your child’s anus, which can hurt and even bleed. If this happens, we’ll use a cream to protect the torn tissue and a stool softener to make it less painful to poop.
• Rectal prolapse: If your child feels like there’s something left inside even after they poop, their rectum might have slipped down and is sticking out of their anus. If this happens, we’ll simply push their rectum back into place.

Poop School

If your child has problems pooping, you might want to check out Cleveland Clinic’s Functional Constipation-Shared Medical Appointments — or as the kids call it, “poop school.” It’s easy to feel alone when your child is struggling in the bathroom. Toilet troubles can cause major stress on kids and their families. Poop School offers the opportunity to meet with others who are going through the same issues.

Designed for children ages 3 to 7, you and your child will meet weekly as a group with six or seven families for four weeks. Led by experts in pediatric gastroenterology and child psychology, you’ll learn about:

• What causes constipation
• Steps of toilet training
• How the body poops
• What can prevent progress in toilet training

In a nearby room, your child will meet with the other kids and a child life specialist and child psychology assistant. They’ll play games, do activities and learn about the same things you are but in a way they can easily understand.

When the four weeks if finished, you’ll continue to meet for group follow-ups for as long as you need to. We’ll stay the course with you until your child is 100% toilet trained and pooping like they should.

Taking the Next Step

With the right treatment, your child should start pooping on the regular. The specialists at Cleveland Clinic Children’s will follow up with you and your child about six weeks after treatment starts to see how they’re doing. If your child is still constipated, or if some other health condition is making it hard for them to poop, we’ll go over treatment options with you and put together an ongoing care plan that best meets their needs.