Constipation in Children: What to Do?

Constipation is a common health issue affecting 0.7% to 29.6% of children across the globe.There are many different factors which affect the nature of bowel movements ranging from eating habits, exercise, overall health status, etc.

Many of you who might have experienced constipation as an adult, know the uncomfortable feeling associated with it. Just imagine how difficult it will be for a young child who cannot clearly explain what is happening.

Studies have shown that roughly 1 out of 20 paediatrician visits is because of constipation.

In this article, we aim to understand what constipation is and how to manage it in children.

What Is Constipation?

Constipation is a condition in which an individual has infrequent or uncomfortable bowel movements. For example, an individual with constipation generally passes stools less than 3 times a week.

In a healthy person, stool elimination will be done 1 to 2 times a day or at least every alternate day.

Constipation could happen due to several factors, such as insufficient fibre intake, changes in routine or diet, lack of proper hydration, etc.

Chronic constipation in children

Children occasionally experience bouts of constipation in their growing years. However, chronic constipation is slightly different and more challenging because it can lead to loss of bowel control and long-term discomfort.

Idiopathic constipation in children

In most cases, constipation will have a known cause. However, it is "idiopathic constipation" if it happens without a cause. The term "idiopathic constipation" means constipation without a known cause. This could usually be very severe and sometimes requires a high dose of medications, laxatives, enemas, or even surgery. This problem can be managed but cannot be cured.

What Are the Symptoms of Constipation in Children?

There are several symptoms which are common in babies and older kids. As infants cannot communicate, you must carefully observe their bowel movements.

Symptoms in babies:

Hard or lumpy stools
Crying during bowel movements
Difficulty passing stools
The stomach could feel slightly hard to touch
Less frequent bowel movement

Symptoms in toddlers and older children:

Bloating
Nausea or vomiting
Not having a bowel movement each day
Straining to have bowel movements
Bowel movements may be painful
Bowel movements are stiff and small
May soil their underwear

In severe cases of idiopathic constipation, the anus may tear when the child passes a large hard piece of stool.

What Are the Causes of Constipation in Children?

Once the stools reach the large intestine, water is reabsorbed for various bodily functions. However, the stools get hard and dry if the colon absorbs too much water.

Specific muscle movements (peristalsis) in the colon push it towards the rectum, from where it is eliminated. If the peristaltic motion is slow, it takes longer for the stool to move. So finally, when the stool reaches the rectum, most of the water is absorbed, making it dry and hard.

Children may find it painful to pass the stools in such a case and often ignore going to the bathroom. Unfortunately, this can worsen the problem; and over time, the rectum can get stretched, resulting in the child not feeling the urge to go. As a result, the stools continue to build up in the colon, resulting in leakage or overflow.

Some common causes of constipation include:

Not consuming food rich in fibre like vegetables and fruits
Not drinking enough liquids
Lack of exercise
Medications
Irritable bowel syndrome
Problem with intestinal function
Poor toilet training
Ignoring the urge for bowel movement

Some studies indicate that children with Attention Deficit Hyperactivity Disorder (ADHD) or other developmental issues are at a higher risk of developing constipation.

How Is Constipation in Children Diagnosed?

Here are the ways in which constipation in children is diagnosed.

Gather medical history	The paediatrician will ask questions, such as: Past illnesses of the child. Types of foods the child likes to eat. How often the child has bowel movements. How stressful is your child. Amount of water the child drinks daily, etc.
Perform physical examination	The paediatrician will place a gloved hand in the anal region of the child to look for abnormalities.
Abdominal X-ray	Abdominal X-ray is conducted to check and confirm any abnormalities or blockages in the abdominal region of the child.
Colorectal transit study	In a colorectal transit study, the child will swallow pills filled with markers which can be seen on the X-ray. This helps to determine how food moves through the colon. However, the child must be on a high-fibre diet for the next few days to ensure that all the swallowed pills are eliminated.
Rectal biopsy	Tissue samples from the rectum are taken and examined for abnormalities in rectal biopsy.
Colonoscopy	In this test, a long flexible, lighted tube with a camera on the tip is inserted into the colon to check for bleeding, sore tissues, abnormalities, or other growths. It also helps the paediatrician to take tissue samples or remove some polyps or obstructions.
Blood test	Blood tests are performed to check the presence of any infections or hormonal imbalances.
Barium enema	This is an imaging technique in which the child is given a metallic fluid known as barium. The barium coats the internal organs so that they light up on the x-ray. For example, barium will be put in a tube for imaging the colon and inserted into the rectal region. X-ray is performed after some time to check for obstructions, narrowed areas or other abnormalities.
Anorectal manometry	A catheter is inserted into the rectum to measure muscle coordination while passing the stools.

What Are the Treatment Options for Constipation in Children?

After carefully analysing your child's symptoms, the paediatrician may recommend the treatment depending on the symptoms.

Enema at the hospital
If the child is severely constipated for more than a week or two, he/she will be administered an enema at the hospital, which will clear off the bowels. This is only done in severe cases.
Laxatives
If the child's constipation is caused due to blockages, the paediatrician will prescribe laxatives to help remove the blockages. Some of the commonly used laxatives include mineral oil, polyethene glycol etc. Make sure that you give laxatives with the paediatrician's instructions.
Over-the-counter stool softeners or fibre supplements
These are used if your child lacks sufficient fibre intake. However, for these products to work, the child should consume at least 1 litre of water a day. Additionally, glycerine suppositories may be recommended which help soften the stools of children who have difficulty swallowing pills.
Home remedies for constipation in children
If the constipation is not on the severe side, there are several home remedies which could help provide relief to the child:
- Hydrate more by giving your child sufficient water.
- Avoid rice cereal.
- Give them probiotics like yogurt.
- Massaging the abdomen.
- Give more fruits like apples and prunes.

What Are the Complications of Constipation in Children?

Although constipation is quite common in small children, it is not severe in most cases. However, in certain rare cases, it could get serious and cause complications like:

Stool withholding
Anal fissures
Rectum coming out of the anus (rectal prolapse).
Rectal leakage-caused due to long-term stool withholding.

How to Prevent Constipation in Children?

The following are some tips to prevent your child from getting constipated.

Give plenty of fluids to your child	Constipation happens when your child's stools become dry and hard. The best way to counteract this is by drinking more water. It naturally helps to soften the stools and make it easier to pass. If you feel your child is constipated, make sure they have sufficient liquid intake through the day. Offer your breastfed baby plenty of breast milk. Offer formula-fed babies additional drinks of water in between the feeds. Offer your child additional amounts of water in between meals.
Give a high-fibrous diet to your child	For children and adults alike, a fibre-rich diet is of great importance as fibre helps the body form soft bulky stools, which are easy to eliminate. Ensure your child eats a diet rich in high-fibre content, such as fruits, vegetables, and whole grains. The recommended intake is 14 grams for every 1,000 calories. Carrots, green peas, beans, broccoli, sweet potato, green vegetables Oatmeal Green peas Fruits like apples, oranges, pears, bananas, mangoes, and avocados Salad leaves High fibre cereals Whole grains
Feed your child a variety of foods	Feed your child a variety of food and avoid eating the same type of meals repeatedly to ensure that the intake of fibre is sufficient. Additionally, a larger variety of food helps the digestive system to stay active.
Encourage physical activity	If your child leads a sedentary lifestyle, it could be a cause for constipation. Motivate your child to engage in physical activities as it may stimulate the intestine and help in bowel movements.
Create a toilet routine	It is essential to create a toilet routine for the children as it helps them recognise bodily signals like when to eliminate the stools. In addition, it will also help to align the body clock to have a fixed schedule for going to the toilet.
Encourage a comfortable sitting position on the toilet	Children may sometimes ignore nature's calls if they feel uncomfortable sitting on the toilet. Help your child to choose a good position or consider products like toddler toilet seats that are designed to make the child feel comfortable.
Give mental support	Some children take longer to complete toilet training, which is normal. However, make sure that you support your child's efforts no matter what. You could also give your child small presents after toilet time to establish a positive feedback loop in the brain. Sometimes, your child might be reluctant to go to the toilet in unfamiliar places, such as school. Talk to your child to establish mental support and explain the importance of going to the toilet.
Check for any medication-related issues	Sometimes constipation can be caused as a result of side effects of medication. In such a case, check with your paediatrician to express your concerns.

When to Worry or Take Your Child to a Hospital?

Constipation in children is not abnormal, and in most cases, goes away with simple home remedies. However, if you notice that your child has been constipated for more than a week, you should seek immediate medical intervention.

Consult a paediatrician without losing time if you observe some of these symptoms:

Anal fissures or tears that occur in your child's anus and cause pain, itching or bleeding.
Swelling of the veins present inside or outside the anus.
Extremely thick and hard stools inside the rectum or intestine that are hard to push.
Incontinence.
Blood in stool.
Severe abdominal pain.
Weight loss.
Vomiting.

Make an Appointment at Pantai Hospitals

In children, it is occasionally normal to have constipation which is usually not a cause for concern. However, if your child appears to be in pain or has not passed stools for more than a few days, it is best to consult your paediatrician.

Get in touch with us to book an appointment today for a consultation, or visit our Paediatric Care Department at your nearest Pantai Hospital.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.

This article has been medically reviewed by Consultant Paediatrician, Dr Kong Sik Lian.