Constipation is a state when the bowel movements are less frequent than usual or the stools are hard, dry and painful or difficult to pass. This is a common condition encountered in paediatric age, particularly at 1-4years and is usually without severe consequences.
Around 3% of visits to paediatrician and 25% of patients to paediatric gastroenterologists are someway related to constipation.
This phenomenon can impair the child’s quality of life, cause emotional stress to both the child and its parents. Constipation can rarely be the manifestation of an underlying disease as well.
Causes of constipation in children
In the absence of any structural disease, constipation is most commonly a result of withholding stools by the child. This might occur either because the child is:
Stressed about potty training
Scared to pass a motion that might be painful or distressful
Embarrassed about it in public
Finding a toilet different from home uncomfortable
Unwilling to interrupt play
Withholding the motions usually results in the stools being harder and dry and even more difficult to pass that causes a phenomenon called faecal impaction. The distended gut cannot contract, effectively worsening constipation. The stools that build up behind the impaction can occasionally leak (encopresis), which parents might mistake as diarrhea.
In infants, occasionally an immature system can be the reason for constipation even in presence of soft stools, where the rectum does not relax adequately. In breastfed infants motions can be delayed for days and this is considered normal.
Constipation in children can also be a result of inadequate fibre intake in the diet or drugs like opiates, antacids, antidepressant, etc.
Rarely, it can be a manifestation of diseases like diabetes, Hirschprung disease or congenital anomalies.
Symptoms and diagnosis of constipation in children
When the child is withholding stool, they attain postures like standing on tiptoes and then rocking back on their heels, clenching their buttocks, and other unusual dance like movements. These often appear to parents as an effort to pass the motion instead of holding it back.
Other manifestations are painful, less frequent passage of stools, abdominal cramps, stools that are dry, hard and small or leaking of it in the underwear, decreased appetite and irritability.
When to take a child to a doctor?
Parents should take their child to a doctor when:
Constipation persists for more than two weeks
There are associated symptoms like bleeding, abdominal distension, fever, vomiting, weight loss
Anal fissures that are painful cracks around the anus which may bleed
Rectal prolapse which is the lower part of intestine coming down the anus
The examining physician might perform a rectal examination in certain cases where there is suspicion of malformations or faecal impaction. Tests are rarely necessary but can be advised if underlying diseases are suspected.
Treatment of constipation in children
Treatment depends on the cause, the child’s age, personality and the severity of the problem.
Initial management requires adoption of healthy bowel habits like encouraging the child to use the toilet after meals or when there are withholding.
Dietary change like consumption of roughage and increased fluid intake helps in softening stools.
Laxatives and stool softners are often required but they should be used only on advice of a physician. An initial bowel clearance is sometimes required which can be done with oral laxatives or suppositories and enemas.
Persistence or recurrence of constipation or new complications necessitates detailed evaluation of underlying disease conditions.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)