Childhood Constipation

Constipation means that a person has three or fewer bowel movements in a week. The stool can be hard and dry. Sometimes it is painful to pass. At one time or another, almost everyone gets constipated. In most cases, it lasts a short time and is not serious⁷.

Constipation affects approximately one in 10 children worldwide⁸. It occurs most commonly in toddlers⁹, often presenting at the time of transition to solids, toilet training, or starting school¹⁰.

Overview

Though constipation is quite common in children, it is usually temporary¹¹. Some people experience chronic constipation that can interfere with their ability to go about their daily tasks²³. Chronic constipation however can lead to complications or be the result of an underlying condition²³.

Constipation can be distressing for families; parents may feel isolated and have concerns about possible underlying medical causes¹². Long-standing constipation can cause soiling (repeated passing of stool, usually involuntarily into clothing). It can be frustrating for parents and embarrassing for the child.¹³

Chronic constipation may also cause people to strain excessively to have a bowel movement and lead to complications or signal an underlying condition¹¹.

If you or any member of your family have fewer than three bowel movements a week combined with difficulty with your bowel movements or other discomfort, it may be worthwhile to talk to a doctor¹⁴.

Causes and risk factors

Many factors can contribute to constipation in children, including¹⁵:

Your child may ignore the urge to have a bowel movement because he or she is afraid of the toilet or doesn’t want to take a break from play. Some children withhold when they’re away from home because they’re uncomfortable using public toilets.
Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience.
Toilet training issues. If you begin toilet training too soon, your child may rebel and hold in stool. If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that’s tough to change.
Changes in diet. Not enough fibre-rich fruits and vegetables or fluid in your child’s diet may cause constipation. One of the more common times for children to become constipated is when they’re switching from an all-liquid diet to one that includes solid foods.
Changes in routine. Any changes in your child’s routine — such as travel, hot weather, or stress — can affect bowel function. Children are also more likely to experience constipation when they first start school outside of the home.
Various medicines can contribute to constipation.
Cow’s milk allergy. An allergy to cow’s milk or consuming too many dairy products (cheese and cow’s milk) sometimes leads to constipation.
Family history. Children who have family members who have experienced constipation are more likely to develop constipation. This may be due to shared genetic or environmental factors.
Medical conditions. Rarely, constipation in children indicates an anatomic malformation, a metabolic or digestive system problem, or another underlying condition.

Signs and symptoms

Signs and symptoms of constipation in children may include¹⁵:

Less than three bowel movements a week
Bowel movements that are hard, dry, and difficult to pass
Pain while having a bowel movement
Stomach pain
Traces of liquid or pasty stool in your child’s underwear — a sign that stool is backed up in the rectum
Blood on the surface of hard stool.

In normal cases, stools should have a soft consistency and a long cylinder shape. The stool should be easy to pass, without any pain¹⁶. The Bristol Stool Chart (Figure 1) was created to help standardise the evaluation of stools¹⁶. Types 1 and 2 indicate constipation, types 3 and 4 are healthy stool, while types 5–7 suggest diarrhoea and urgency¹⁶.

Type 1 stools are usually small hard lumps that evacuate individually and are usually difficult to pass. Type 2 stools are usually compacted into one single mass, but with a lumpy appearance.

Call your child’s healthcare provider if you have any questions or concerns about your child’s bowel habits or patterns.

Diagnosis - when to see a doctor

Constipation in children usually is temporary. However, chronic constipation may lead to complications or signal an underlying condition¹¹. Make an appointment with your doctor if your child or any member of your family experiences unexplained and persistent changes in your bowel habits or if constipation is accompanied by fever, not eating and blood in the stool.

Impact on quality of life

Constipation is distressing for children and their parents. Studies¹⁸ show that parents rate Quality of Life (QoL) lower than their children, particularly in the domains of emotional and social functioning. The goals of treating constipation in childhood are to produce soft, painless stools and to prevent the re-accumulation of faeces¹⁹. These outcomes are achieved through a combination of education, behavioural modification, daily maintenance stool softeners and dietary modification²⁰.

Treatment

Laxatives are a type of medicine that can treat constipation. It is important that you drink plenty of fluids when taking any laxative. This means drinking at least two litres per day (8-10 cups)²¹.

There are several types of laxatives²²:

Bulk-forming laxatives

Bulk-forming laxatives work by increasing the “bulk” or weight of the stool, which in turn stimulates your bowel.

Osmotic laxatives

Osmotic laxatives draw water from the rest of the body into your bowel to soften the stool and make it easier to pass. An osmotic laxative can make you dehydrated so it is important to drink plenty of fluids.