Constipation – When Your Child Struggles to Poop
“Are you pooping okay?” is something I ask multiple times a day. Depending on the age of the child, this question is met with either laughter, embarrassment, or confusion as to why I am talking about poop during a well-child checkup. In fact, this is an important part of child health, as constipation is very common among American children.
Symptoms of constipation
Bowel patterns vary from child to child, but most children have a bowel movement (or BM) once to twice daily. Some children go 1-2 days between BM, which is fine as long as the stool (poop) is still soft and easy to get out. Children with constipation usually demonstrate the following characteristics:
- Hard, firm stools (pellets or rock-like)
- Painful and/or large stools
- Several days between BM
- Abdominal pain and cramping
- Stooling accidents or leakage of stool in the underwear (called encopresis)
- Blood in the stool
Causes
One of the most common reasons for constipation is diet related. Children are notorious for being picky when it comes to fruits, vegetables, and fiber sources. Many children are also dehydrated, not drinking enough water during the day. The combination of lack of fiber and fluids can affect bowel patterns and promote development of harder stools.
Changes in a child’s environment such as illness, traveling and stress, can all affect overall gut health and functioning. In addition, potty-training can lead to constipation as many children struggle to feel comfortable with stooling on a toilet at first. Children may hold back stools due to fear, or because they don’t want to stop playing or don’t want to use a toilet away from home. This holding back of stool causes it to become drier and more difficult to pass.
Unfortunately, constipation can become a vicious cycle in children. Large, hard stools are painful to expel, which leads to withholding, or avoidance of stooling in order to avoid pain. This in turn leads to larger, harder stools.
Treatments
Constipation treatment depends on age and severity. It can become worse if not treated, so be sure to address the issue immediately upon recognizing it.
For infants, constipation is less common but often happens when switching from breastmilk to formula or when starting solid foods. Talk with your Pediatrician about how to treat constipation in your infant if it occurs.
For children and teens, constipation is usually treated with a combination of dietary changes and medications prescribed by your Pediatrician. Do not give laxatives or enemas unless you are instructed to by the Pediatrician. Common dietary changes include increasing fiber and water intake, as well as certain fruits (prunes, pears, peaches).
It can be helpful to set an established time for toileting with your young child. Often this is most successful about 30 minutes after a meal. Make sure children have something firm to rest their feet on, as this helps to provide stability to push stool out.
Complications
Abdominal pain – when stool remains in the large intestine (colon) and becomes hard and large, the intestine has to work harder to get it out. This is done by stronger muscle contractions and leads to cramping. This can be incredibly painful, especially the longer it goes on. Kids are often seen in the emergency room for abdominal pain that turns out to be constipation!
Fissures/tears – a fissure is also known as a tear in the lining of the anus. This occurs due to stretching as large stools are expelled. Children may have bright red blood on toilet paper or on the stool. These will heal as the stool becomes softer and easier to pass.
Urinary accidents and UTI – the end of the colon is very close to the bladder. Enlargement of the colon can cause it to take up more space and prevent the bladder from fully emptying when a child urinates. This extra urine collection that remains in the bladder often leads to urinary accidents. It is also at a higher risk of developing a urinary tract infection, or UTI.
Stretching of the rectum – when children are constipated for a long time, it causes the colon and rectum to stretch out. When this happens, liquid stool “leaks” around the large stools that have formed. This type of stool is difficult to control. Once a constipation regimen in is place and children are pooping easily, it can take a long time for the colon and rectum to return to normal size.
Final thoughts
Constipation is a common occurrence in children that is best treated before it escalates. Though no one wants to talk about poop on a regular basis (unless you are a Pediatrician!) it is important to notice the signs and talk to your child if you suspect he or she is struggling with stooling. Trust me, you do not want to end up in the emergency room with a child you are sure has appendicitis, only to find out that the problem is too much poop.
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