Constipation among Children

Constipation is very common in children of all ages. Of all visits to the pediatrician, 3% are in some way  related to this complaint .25 percent of visits to a pediatric gastroenterologist are due to constipation.

Millions of prescriptions are written every year for laxatives and stool softeners.

What Causes Constipation?

Constipation is mostly functional. This means it is not due to any medication or anatomic abnormalities .Ninety percent of the causes of constipation come under this category

.

· Immature system: In some infants, constipation can be due to an immature system,improper relaxation of the rectal muscles.

· Some breast fed infants can go without a bowel movement for several days. However it is important to look for signs such as

 Distension of the tummy

  Persistent vomiting especially

 Inconsolable crying

If any of these are seen then it is important to contact your primary care provider or visit the emergency room. It is important to rule out obstruction of the intestines, ileus, Mal-rotation, Volvulus.

 

 Fiber: Lack of fiber can also cause constipation later on in life. Once the child has been constipated for more than a few days, the retained stool can fill up the Large intestine (the colon) and cause it to stretch. This overstretched intestine then does not work efficiently to expel stool.

 
Then constipation becomes a behavioral issue. The bowel movements are hard and painful .Most of the times children withhold their stools due to fear of pain. (Withholding Behavior)

In some children, constipation can begin when

· there are changes in the diet

· the time of toilet training

 Following travel, or after a viral illness.

· Older children can begin withholding the stool .Even if they have an urge to use the bathroom. They may be afraid to use public toilets. School or summer camps, with facilities that are not so clean, are common causes of stool withholding in this age group.

There are some causes that may be due to a problem with the muscles of the stomach, anatomic abnormalities, endocrine problems, drugs. These causes are not so common.

Hence it become extremely important to talk to you primary care provider with regard to the consistency of the stools, when and at what age did your child start having hard stools. It is also important to know if your child had difficulty passing the first stool. This may not be functional and may need to be further looked into.

When does constipation become a problem?

 

· If your child has Hard painful stools that are difficult to pass

· If your child consistently skips days without having normal

  Bowel movements

· If your child has symptoms such as constipation stomach pain, poor appetite, and  crankiness

· If you see bright blood in the stool or on the toilet paper after wiping. This hard stool can tear the lining of the anus which is also called a fissure. These fissures are very painful and bleed.

· If your child has Problems with passing the stool in the underclothes. Most of the times  the child is not aware of this soiling. The child does not feel the urge to have a bowel movement and has an accident. These stool accidents are often mistaken as diarrhea.

· Pain-abdominal or rectal

· Daytime or night time urinary incontinence and recurrent attacks of a urinary tract infection

In most cases there is no need for testing prior to treatment for constipation. However sometimes the doctor may need to do an X-ray of the tummy or perform other tests to asses the degree of stool or rule out other causes of constipation.

How do you treat constipation?

The goal of treatment is soft, regular stools. Positive results requires time and patience

Diet rich in fiber and fluids are important in the treatment of constipation. Fiber such as fruits, vegetables, whole grain breads, cereals.

Many a time’s behavior modification becomes extremely important. It is often helpful to start a bowel training routine where the child sits on the toilet for 5 – 10 minutes after every meal or before the evening bath. It is important to do this consistently in order to encourage good behavior habits. After every successful bowel movement a reward such as a sticker may be given that reinforced this positive behavior.

A few children may require an initial “clean-out” to help empty the colon of the large amount of stool. This typically entails the use of laxatives by mouth or even suppositories or enemas for a short period of time.

Please feel free to post any comments or questions

Comments

[Name (deepa)]

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[Chrissy Christodoulou]

Hi my 2 year old daughter Evelin is constipated every few days. It has been on going for awhile. I feel that she is holding it. She doesn't have the urge to push. She doesn't like to drink water. I have to give her orange juice instead. I've started toilet training and still doesn't want to do a poo. Please help me!

[Sinead Donaghy]

My son is 5 1/2 and he has suffered constipation from he has been 1 yr old. Initially he was given lactoluse but this made no difference and he just gave him severe cramps and a very cut sore bum. When he was about 2 yrs he was given movicol which he would have taken regularly for about 1yr but I still could not get him regulated to go each day or every second day. He is now in P2 in school and I am at my wits end as he will not do a poo in the toilet and he regularly does not do a large poo for 14 - 16 days. He constantly soils his pants and he keeps insisting that he does not have to go to the toilet even though his stomach is swollen and I know he has not gone in well over 2 weeks. When I up the movical I have to keep him at home from school as it becomes so runny that he can't get to toilet in time and ends up running down his legs. Has anyone any suggestions on how to get him regulated or if there could be an underlying problem which has been overlooked.

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