Constipation can be very distressing for kids, and for their parents, but how can you tell if your child’s bowel movements are “normal”? Constipation is defined as hard stools (poo), passed infrequently, but we recognise it can be more complex than that as there is a lot of variation in what is “normal” in children.
Your child’s perception of pain or difficulty when doing a poo, rather than the frequency of doing poos, is the key. If your child has fewer bowel actions than normal and complains of pain while passing a poo, they may be constipated. For some children, who usually go a few times a day, constipation would be only going every two days. For others, it may be much less frequent, along with the pain and difficulty of passing a bowel action. The same is true for infants.
Most children don’t have an underlying medical problem causing their constipation. Constipation is more common at certain times, such as when an infant starts solids, around the time of toilet training or when children start school and are in an unfamiliar environment. Sometimes a short illness may trigger constipation with hard stools, and this can lead to withholding (avoiding going to the toilet) to prevent pain. Diseases causing constipation are rare and occur in less than five per cent of cases.
What are the symptoms of constipation?
Constipation can cause:
- Bloating, tummy pain and distress.
- Not wanting to eat as much or loss of appetite.
- Irritable behavior.
- Hard lumps of poo which can be felt in your child’s belly, especially down the left side if you press gently.
- Soiling: if your child has been constipated for some time, their rectum might be so stretched and full that poo just comes out into their underpants during the day. When this happens, the child may have lost the ability to tell when they need to go or be able to feel when poo is being passed into their underpants. This is called “encopresis”.
- Holding on and/or fear of passing a poo in the toilet. Some children might only do a poo in a pull-up, or be scared to go at school or kinder. Others are just too busy and don’t like to spend time sitting on the toilet.
- Passing some blood if there is a tear around the anus from passing hard poos, called an anal fissure.
- Daytime and night-time wetting.
How can I treat my child’s constipation?
Treatment usually involves optimising your child’s diet, developing good bowel habits and occasionally using softeners. Treatment usually needs to be continued for a few months, not weeks, to be effective.
Most children with constipation already have a good diet, but sometimes increasing soluble fibre in their diet as a first step can help. Giving your child two to three serves of fruit or vegetables each day, especially prunes and apricots, changing to brown or wholegrain bread and offering less processed cereals are all great ways to increase your child’s fibre intake. Make sure they are drinking plenty of water, and be aware that consuming large volumes of cow’s milk can make constipation worse.
The next step is to encourage your child to sit regularly on the toilet. This can be done with the help of a star chart, which encourages your child to sit on the toilet two to three times a day after meals for three to five minutes each time. By sitting on the toilet or potty long enough to pass a poo, the child starts to properly empty their rectum. In this way, the sensation or feeling in the stretched bowel returns and they can once again feel when they need to go.
The position in which your child sits is also important: their feet need to be supported on a stool and make sure that their knees are bent and are higher than their hips. They need to lean forward and push out their tummy (like pushing out a fart), which relaxes their pelvic floor and makes it easier for the poo to come out. It can sometimes be very hard to get a child to sit on the toilet, especially if they are fearful and are holding on, and so it may be useful to speak to your GP or paediatrician. There are also physiotherapists who specialise in continence who can help. Sometimes a psychologist may be helpful if your child is really fearful about sitting on the toilet and the previous suggestions haven’t worked.
If your child is very distressed or their poo is very hard, you will most likely need to soften the poo. Softeners such as Osmolax, Movicol, Lactulose or Parachoc are good and some of these softeners also stimulate the bowel. The exact regimen that works best for your child should be discussed with your doctor. Don’t worry about your child becoming “dependent” on softeners – it is much better to treat the constipation properly to prevent ongoing problems.
Constipation in infants is best discussed with your doctor, as formula changes or adjustments to their solid diet, if they have started solids, may be needed. Children who have a developmental disability often struggle with constipation and there are different strategies that we may use with them. This will be discussed in another blog.
There are no ongoing health problems from occasional bouts of constipation. However, long lasting constipation (six to 12 months) with ongoing pain and soiling can lead to social and emotional problems, and so should be tackled as soon as possible.
Dealing with constipation can be difficult, so if you are worried about your child and have tried some simple measures, or you are concerned that there may be an underlying medical problem, seek help from your doctor, paediatrician or a continence specialist who works with children.
Has your child suffered from constipation? How did you know, and what did you do to help? Please share your experiences by making a comment on my Facebook post.
Other helpful resources:
- Kids Health Info factsheet: Constipation www.rch.org.au/kidsinfo/fact_sheets/Constipation/
Please note: Dr Margie is no longer monitoring this blog. If you are concerned about your child, please contact your GP for advice, or visit the above resources.