The following Guide will tell you what you need to know about the symptoms of constipation in children, and how to prevent or treat the condition.
Mild 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.
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.
- 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. For example, some cough medicines.
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.
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 include: 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:
- giving dried apricots or raisins for snacks.
- jacket potatoes filled with baked beans for tea.
- porridge or other high fibre cereals for breakfast.
- vegetable soups with bread.
- 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. So try and limit these kinds of drinks, and 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 mild and 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.
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.
- Normally, stools build up in the lower bowel (the lower part of the colon).
- When stools accumulate, they start to pass into the rectum (the last part of the bowel) which widens. This sends nerve messages to the brain which say 'you need to go to the toilet'.
- To go to the toilet then takes a little bit of effort to 'push out' the stools.
- However, if the messages are ignored, and the child 'holds on', then stools remain in the rectum.
- Large hard stools may then build up in the rectum.
- The rectum may then widen and enlarge (dilate) much more than normal.
- A very large stool may develop and get stuck (impacted) in an enlarged rectum.
- If the rectum remains enlarged then the normal sensation of needing the toilet is reduced. Also the 'power' to pass out a large stool is reduced (the rectum becomes 'floppy').
- More stools build up in the colon behind the impacted stool in the rectum.
- The lowest part of an impacted stool lies just above the anus. Some of this stool liquefies (becomes 'runny') and leaks out of the anus. This 'soils' the child's pants or bedclothes. Also, some softer, more liquid stools from higher up the colon may 'bypass' around the impacted hard stool. This also leaks out and soils the pants or bedclothes and can be mistaken for diarrhoea. The child has no control of this leaking and soiling.
- When a stool is eventually passed, because the rectum is distended and weakened, it simply fills up fairly quickly again with more hard stool from the backlog behind.
