A mild bout of constipation in children is common, and usually lasts
just for a few days. A good diet and plenty to drink is often all that
is needed. However, some children develop chronic constipation
(persistent and severe constipation). Regular soiling (often mistaken
for runny diarrhoea) may indicate that a child has chronic
constipation. A long course of laxatives is usually needed to treat
chronic constipation.
What is constipation?
Constipation in children means:
- Difficulty or straining when passing stools (sometimes called motions, faeces or 'poo'). And/Or
- Pain when passing stools. And/Or
- Passing stools less often than normal. Note: there is great
variation in the normal frequency of passing stools. Anything from
three times a day to once every other day is common and normal. Less
often than every other day means that constipation is likely. However,
it can still be normal if when the child goes to the toilet he or she
does not strain much, is not in pain, and the stools are soft and well
formed.
It is useful to divide constipation in children into two broad categories:
- Mild and/or temporary constipation that lasts just a few days. This is very common and can recur from time to time.
- Chronic (persistent and severe) constipation. This is less common.
Treatment is different to the more common temporary constipation.
Details are given later in the leaflet.
What causes constipation in children?
Food and drink
A common reason why children become constipated is because:
- they do not eat enough foods with fibre (the roughage part of the food that is not digested and stays in the gut); and/or
- they do not drink enough.
Stools become harder, drier, and more difficult to pass if there is little fibre and fluid in the gut.
Holding stools in is a common cause
This
means the child has the feeling of needing the toilet, but resists it.
This is quite common. You may see your child crossing their legs,
sitting on the back of the heels, or doing similar things to help
resist the feeling of needing the toilet. The stool then gets bigger,
and even more difficult to pass out later. There are a number of
reasons why children may 'hold on' to stools.
- A previous stool that they passed may have been a struggle or painful. So, they try and put off doing it again.
- Their anus may be sore or have a crack (anal fissure) from passing
a previous large stool. It is then painful to pass further stools. So,
the child may resist the urge to pass a stool.
- They may have a dislike of unfamiliar or smelly toilets, such as at
school or on holiday. The child may want to 'put things off' until they
get home.
- Emotional problems may play a part in some children.
Medical conditions
A medical condition is an uncommon cause of constipation.
- Various
diseases can cause constipation. For example, an underactive thyroid,
and rare bowel disorders. Allergy to cows milk may be a factor in some
children. Other symptoms are usually present if there is a 'medical'
cause for the constipation. A 'medical' cause is unlikely if the child
has developed normally, and is otherwise well.
- Some medicines can cause constipation as a side-effect.
How can constipation in children be prevented?
Eating foods with plenty of fibre and drinking
plenty makes stools that are bulky, but soft and easy to pass out.
Getting plenty of exercise is also thought to help.
Food and fibre
Ask your practice nurse for a
list of foods high in fibre if you are unsure which foods contain
fibre. Some examples are: fruit, vegetables, cereals, wholemeal bread.
A change to a high fibre diet is often 'easier said then done', as many
children are fussy eaters. However, any change is better than none.
Have you tried such things as:
- A meal of jacket potatoes with baked beans, or vegetable soup with bread.
- Dried apricots or raisins for snacks.
- Porridge or other high fibre cereals for breakfast.
- Offering fruit with every meal.
- Perhaps do not allow sweets until your child has eaten a piece of fruit.
Another tip for when children are reluctant to eat high fibre
foods is to add powdered bran to yoghurt. The yoghurt will feel grainy,
but powdered bran is tasteless.
Drink
Encourage children to drink plenty.
However, some children get into the habit of only drinking squash,
fizzy drinks or milk to quench their thirst. These may fill them up,
and make them less likely to eat proper meals with food that contains
plenty of fibre. Try and limit these kinds of drinks. Give water as the
main drink. However, fruit juices that contain fructose or sorbitol
have a laxative action (such as prune, pear, or apple juice). These may
be useful from time to time if the stools become harder than usual and
you suspect constipation may be developing.
Some other tips which may help:
- Try and
get children into a regular toilet habit. After breakfast, before
school or nursery, is often best. Try and allow plenty of time so they
don't feel rushed.
- Some kind of reward system is sometimes useful in younger children
prone to 'holding on' to stools. For example, a little treat after each
successful toilet trip. However, try not to make a fuss over the toilet
issue. The aim is to be 'matter of fact' and relaxed about it.
Mild constipation in children and it's treatment
Most bouts of constipation in children last just a few days. Many
children strain to pass a large or hard stool now and then. It is of
little concern, so long as a normal pattern soon returns. Treatment of
temporary constipation is the same as for preventing constipation. That
is, a diet with plenty of fibre, lots to drink, and perhaps a fruit
juice which contains fructose or sorbitol. In some cases your doctor
may advise a laxative for a few days.
With a temporary bout of
constipation, the function of the lower bowel (rectum) is not altered.
Therefore, you can stop any laxatives that are used once the stools
become easily passed again. This may be after just a few days. This is
different to chronic constipation (below) where the function of the
rectum is altered and long-term laxatives are used.
Chronic (persistent and severe) constipation
Chronic constipation in children means that the constipation is
severe and has lasted some time. It most commonly develops in children
between the age of 2 and 4 years, but older or younger children can be
affected. Symptoms and features of chronic constipation include:
- Recurrent times when the child is uncomfortable or distressed trying to pass a stool.
- The child soils their pants regularly with very soft faeces, or
with faecal stained mucus. This is often mistaken by parents as
diarrhoea.
- The child may also become irritable, not eat much, feel sick, have
tummy pains from time to time, and may be generally out of sorts.
- A doctor can often feel a backlog of hard, lumpy stools when he or she examines the child's abdomen (tummy).
The following tries to explain how a child may develop chronic
constipation, and the symptoms this may cause. In particular, why
soiling is a symptom of chronic constipation.
