Constipation

What is constipation?

Constipation is a condition in which a person has painful or infrequent bowel movements that result in the passage of small amounts of hard, dry stool. Constipation is common in children, accounting for 5% of full general pediatric visits and 25% of pediatric gastroenterology visits each yr.

More than 90 percent of constipated children have "functional" constipation, which is constipation without any underlying disease. One time children pass hard, painful bowel movements, they larn to withhold stool to prevent further hurting. When stool is withheld in the colon and rectum, it hardens due to water absorption, causing the rectum to become increasingly distended. This results in decreased rectal sensations and overflow of stool and causes accidents in the underwear. Parents sometimes misinterpret these soiling episodes as diarrhea.

What causes constipation in children?

Constipation is typically caused by an external factor or alter in diet/lifestyle, but more severe or chronic cases of constipation can exist due to an underlying condition. Some of the almost common causes of constipation in children include:

  • Medications
  • Lack of exercise
  • Not enough liquids
  • Not plenty fiber in the nutrition
  • Irritable bowel syndrome
  • Ignoring the urge to take a bowel movement
  • Changes in habits or lifestyle
  • Problems with intestinal function.

Mutual life events that are linked to episodes of constipation in children include:

  • Irresolute from breast milk to formula
  • Introduction of solid foods
  • Starting cow's milk
  • Toilet training
  • Travel or camping
  • Viral illness.

What are the symptoms of constipation in children?

Although each child may experience constipation differently, symptoms tin can include:

  • Less than three bowel movements per week.
  • At least one episode of stool leakage per calendar week.
  • Withholding behavior: A child actively tries not to go the bath. When needing to utilize the restroom they will clench their bottoms, cross their legs, get red in the face, hide, weep, shake or trip the light fantastic toe around. Parents sometimes misinterpret this behavior and think that their child is in pain.
  • Hard, painful or hard bowel movements
  • Stool that is small and "ball like"
  • Feeling bloated or uncomfortable
  • Large diameter stools that could clog the toilet
  • Presence of a large stool mass in the abdomen or rectum.
  • Abdominal hurting: The most common crusade of intestinal pain in children is constipation. Pain is typically intermittent (off and on) and is relieved after a bowl movement.
  • Urine accidents: Constipation takes up a large amount of infinite in the abdomen, which oft leads to dysfunction of the bladder. Along with that, nearly 10% of children with constipation have recurrent urinary tract infections that can besides cause daytime or nighttime urinary accidents. Learn more than about urinary tract infections.
  • Claret-coated stools: Passage of hard stools can crusade anal tears (fissures) leading to blood streaked stools or blood on the toilet paper.
  • Behavioral issues: Behavioral bug can result from the pain due to constipation, or the social embarrassment that a child faces due to soiling of their underwear at schoolhouse or in public places.

Ideally, children should accept soft bowel movements each day that resemble Types 3 through half-dozen on the Bristol Stool Chart.

Bristol Stool Chart, showing range of poop textures from hard and lumpy to watery

The symptoms of constipation may resemble other medical weather or problems. Always consult your child's physician for a diagnosis.

How is constipation diagnosed?

The following tests and procedures are used to diagnose and discover the crusade of a child's constipation:

  • Medical history analysis: Your child's md will ask about duration and severity of constipation, equally well as whatsoever changes in weight, bowel habits or ambition.
  • 10-ray: Some children may need an abdominal X-ray so that the doc can see the extent of the constipation inside the patient'southward torso.
  • Blood tests: Blood tests may be ordered for some children to wait for signs of infection or other underlying illness.

How is constipation treated?

Balmy constipation may be treated with dietary changes. Increased fiber in the nutrition forth with normal water or fluid intake may soften the stools. Fruit juices made from prunes, apples, peaches and pears can be used due to their loftier sorbitol content. Sorbitol works as a balmy osmotic (water retaining) laxative. It is important to annotation that most of the h2o we drink is reabsorbed in the colon and is not available to soften the stools; therefore it is not necessary to drink tons of h2o. Learn more virtually the amount of h2o children should drink each twenty-four hour period. Children with soiling or more severe constipation ordinarily require medication. However, making changes in your child'southward diet at the same fourth dimension may help wean them from medications more rapidly. Getting children, especially toddlers, to change their diet may be a tough task just the extra endeavour volition lead to happier symptom-complimentary children.

What are proficient fiber sources?

There are a diverseness of foods that tin be great sources of fiber in a child'south diet:

  • Fiber-enriched cereals
  • Whole grain items
  • Whole wheat items (such as whole wheat bread)
  • Fiber-rich granola confined or cereals
  • Oats
  • Beans
  • Vegetables, especially green leafy vegetables
  • Fruit, especially apples, raisins, pears, prunes and figs.

Why is information technology of import to treat constipation?

Constipation results in much more than a child non beingness able to "become." Therefore, eliminating a child's constipation may likewise:

  • Reduce the child's urinary tract infections, equally about ten% of children with constipation accept recurrent urinary tract infections. Learn more about urinary tract infections.
  • Reduce abdominal discomfort.
  • Reduce episodes of incontinence. Constipation takes up a large amount of space in the abdomen, which ofttimes leads to dysfunction of the bladder. This can cause incontinence, urgency of urination, frequency of urination or a sensation of having to urinate when there is petty or no urine to urinate. Learn more than about incontinence.
  • Reduce the amount of daytime urine accidents, equally 1-third of constipated children feel daytime incontinence (urine accidents).
  • Ameliorate the child's vesicoureteral reflux, as constipated children with reflux are more probable to have quantum infections. Larn more than about vesicoureteral reflux.
  • Decrease a child's stool accidents and stool leaking. Often stool accidents (known every bit encopresis) is actually a sign of constipation. Families should make an engagement with their child'due south doctor to become assistance determining if the child's diarrhea may actually be stool leakage due to constipation.

Chronic Constipation in Children

Chronic constipation occurs when symptoms concluding for a prolonged menstruation, typically longer than 3 weeks, despite efforts to care for the condition.

Treatment of Chronic Constipation

Treatment of children with chronic constipation is necessary to reduce their risk of developing other complications such as:

  • Hemorrhoids, which occur past straining to accept a bowel movement
  • Anal fissures (tears in the peel effectually the anus), which occur when hard stool stretches the sphincter muscle. This can effect in rectal bleeding. Learn more about hemorrhoids.
  • Rectal prolapse, in which a small-scale amount of intestinal lining pushes out from the anal opening.
  • Fecal impaction, which takes place when the hard stool packs the intestine and rectum so tightly that the normal pushing activeness of the colon is non enough to miscarry the stool.
  • Long-term constipation leading to diverticulitis as an adult.

Managing Chronic Constipation

The following steps are recommended for optimal management of chronic or severe constipation that needs medical attention:

Disimpaction. The best fashion to get-go off handling of a constipated child is to evacuate the onetime stool from the rectum and colon. This tin exist accomplished by giving rectal enemas followed by oral intake of high doses of osmotic (water retaining) and stimulant laxatives.

Maintenance regimen. Once no longer impacted with stool, the child needs to exist on a daily regimen of laxatives as recommended by the physician. Maintenance treatment should keep for at least two months, if not longer. All symptoms of constipation should be resolved for at least one month earlier the treatment is stopped. Treatment should be decreased gradually. During the stage of toilet training, laxatives should exist only stopped once toilet training is achieved.

Often, the pediatrician or gastroenterologist may recommend the child take polyethylene glycol 3350 (Miralax®). This is an osmotic laxative that is very well tolerated and effective in children. Information technology has limited known side effects that can include gas, nausea, airsickness, diarrhea and abdominal hurting. A child should accept Miralax® according to the instructions on the packaging or co-ordinate to the doctor's instructions.

Lifestyle Changes. Along with medications, children with astringent constipation must make dietary and lifestyle modifications:

  • Eat the right amount of fiber. The right corporeality of fiber is equivalent to your child'due south age plus 5 grams. For case, a child who is 5 years onetime should eat ten grams of cobweb each mean solar day (5+5=10), or a child who is ix years old should eat 14 grams of fiber each day (9+five=14).
  • Children need to sit on the toilet two to iii times each day for v to 10 minutes each time. The all-time time to sit on the toilet is v to 10 minutes afterward a meal, since nutrient entering the stomach stimulates motility of the colon.
  • While sitting on the toilet your kid can be given balloons or pinwheels to accident in gild to increment the pressure on the abdomen.
  • When the child sits on the toilet, his or her feet should exist touching the footing or a pace stool so that their legs are not dangling.
  • Most important, always be positive and never punish or scold a child who is toilet training or having difficulty with bowel movements.

Constipation symptoms that could point an underlying disease

There are sure crimson flags or alarm symptoms that could suggest an underlying condition is responsible for a child's constipation. Laboratory testing to screen for these conditions is only recommended in children with chronic or severe constipation in the presence of scarlet flags or when symptoms do non amend with treatment.

Cerise Flags

  • Constipation starting early on in infancy
  • Recurrent fevers
  • Airsickness bile
  • Astringent intestinal swelling
  • Poor feeding
  • Bloody diarrhea
  • Poor growth
  • Pus collection around anus
  • Feeling cold even when information technology is warm
  • Developmental delays
  • Problems with walking.

Some diseases that commonly cause constipation include celiac disease, hypothyroidism, inflammatory bowel disease, spinal cord issues, neuromuscular diseases, atomic number 82 poisoning, and anal malformations.

When should my child come across a doctor?

It is important to speak with your kid'southward main care doctor about their constipation when:

  • Episodes of constipation last longer than iii weeks and dietary changes or adding hydration has non helped.
  • The parents can't salve the child's pain.
  • The child is unable to participate in normal activities considering of constipation.
  • The child soils his dress.
  • The kid develops abdominal hurting or swelling that could be a sign of another medical problem.
  • At that place is blood in the stool.
  • Dietary changes do not amend constipation.
  • Any of the cerise flags mentioned above are present with constipation.

Find a nearby CHOC pediatrician and make an appointment.

When should my child see a pediatric gastroenterologist?

In most cases, your child's pediatrician can manage constipation. If, with treatment, the kid's constipation does not go away, talk to the child's doc about seeing a pediatric gastroenterologist. The pediatric gastroenterologist volition obtain advisable screening evaluations based on symptoms as well as specialized testing modalities, such as motility studies, and treatments tailored to your kid's case.

Chronic Constipation in Kids

Constipation is a common problem that can make kids – and their parents – miserable. "I think I accept changed more lives past treating constipation than any other status," says Dr. Mitchell Katz, a CHOC pediatric gastroenterologist. Constipation is a decrease in the frequency of bowel movements, compared to a child's usual pattern. How often a child makes a bowel movement varies. Chronic constipation is normally painful and causes the child great discomfort.

Small boy being comforted by his father