Am Fam Physician. 2006;73(3):479-480
See related article on constipation.
What is constipation?
Constipation is when bowel movements happen less often than every two days.
Constipation also can mean that stools are hard or painful to pass, even when bowel movements happen more often than every two days.
Constipation is called “chronic” if it is present for two weeks or more.
How common is chronic constipation?
Chronic constipation happens in up to 4 percent of preschool-age children and 2 percent of school-age children. In most children, constipation is not caused by a serious medical condition.
Why does my child have constipation?
When constipation happens because of a change in normal bowel function, this is called “functional constipation.”
These children have pain with every bowel movement. They often want to avoid passing another painful stool, so they resist the urge to have a bowel movement. They may squeeze their buttocks together and stand very straight until the urge to have a bowel movement goes away.
If children keep trying to avoid bowel movements, stool builds up in their lower bowel. The stool becomes larger and harder. Passage of the stool can tear the anus (the rectal opening). This causes pain and makes the children want to avoid having bowel movements even more.
Over time, the muscles and nerves of the bowel change in these children. The lower bowel stretches because of the amount of stool stored in it.
An impaction (hard stool lump) may build up in the lower bowel. Liquid stool may leak around the impaction and into the child’s underwear. Children with impaction cannot keep this from happening.
What else causes constipation?
Diet can be an important cause of chronic constipation. Children can become constipated if they do not eat enough high-fiber foods, such as whole grains, fruits, and vegetables.
Constipation also can happen when children do not drink enough liquids.
Some children who drink a lot of milk become constipated.
Certain medicines can cause constipation.
How can the doctor tell if my child has constipation?
The pattern of your child’s bowel movements may show that he or she has constipation. You can help the doctor by keeping a day-by-day list of your child’s bowel movements.
It also is important to note unusual changes in your child’s stools or behavior. Here are some things to watch for:
Stools that are large in diameter
Stools that are very hard
Small amounts of bright red blood on the toilet tissue after your child has a bowel movement
Stomach pain and bloating
Loss of appetite
Crying or screaming during bowel movements
Avoiding the toilet or resisting toilet training
The doctor also will do a physical exam. This may include an exam of your child’s rectum. The doctor also may order an x-ray of your child’s abdomen (stomach).
How is chronic constipation treated?
Your child’s bowels need to be cleaned out. This can be done with enemas or oral medicines.
After the cleanout, your child may need to take medicine every day. The medicine helps make your child’s stool soft, so that bowel movements do not hurt.
When your child is having three or more soft stools per week with no soiling, the medicine is decreased slowly. After some time, your child may not have to take any medicine.
Your doctor may ask that you limit your child’s milk intake to 2 to 3 cups a day.
The doctor may ask you to add more fiber and liquid to your child’s diet.
A patient information handout called “Help for Your Child’s Constipation” gives more information on what you can do if your child has chronic constipation.
When will my child be better?
Chronic constipation takes time to develop. It also takes time to treat.
Even with the best treatment, chronic constipation can come back. Sometimes, constipation only partly improves, and children may never have daily, soft bowel movements.