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Constipation

Constipation is defined as either a decrease in the frequency of bowel movements or the painful passage of bowel movements. Children 1 to 4 years of age should have a bowel movement 1 – 2 times a day but many children go at least every other day. When children are constipated for a long time, they may begin to soil their underwear. This fecal soiling is involuntary, and the child has no control over it

How common is constipation?

Constipation is very common in children of all ages, especially during potty-training and in school-aged children. Of all visits to the pediatrician, 3% are in some way related to constipation. At least 25% of visits to a pediatric gastroenterologist are due to problems with constipation.

Why  does constipation happen?

Constipation is often defined as being organic or functional. Organic means there is an identifiable cause such as colon disease or a neurological problem. 95 % patients have constipation which is functional meaning there is no identifiable cause.

In some infants, straining and difficulties in expelling a bowel movement (often a soft one) are due to their immature nervous system and uncoordinated defecation. Also, it should be remembered that some healthy breast-fed infants can skip several days without having a movement.

In children, constipation can begin when there are changes in the diet or routine, during toilet training, or after an illness. Occasionally, children may have phobia to unfamiliar toilet facilities.

Once the child has been constipated for more than a few days, the retained stool can fill up the large intestine (the colon) and cause it to stretch. An over-stretched colon cannot work properly, and more stool is retained. Defecation becomes very painful and many children will attempt to withhold stool because of the pain.

Concerns are:

  • If the child has hard or small stools that are difficult or painful to pass
  • If the child consistently skips days without having normal bowel movements
  • If the child has large stools that clog the toilet
  • Other symptoms that can accompany constipation are stomach pain, poor appetite, crankiness, and bleeding from a fissure (tear in the anus from passing hard stool).

In most cases there is no need for testing prior to treatment for constipation

How is constipation treated?

Treatment  is on individual basis.

Some children may only require changes in diet such as an increase in fiber, fresh fruits, or in the amount of water they drink each day. Other patients may require medications such as stool softeners or laxatives. Stool softeners are not habit forming and may be taken for a long time without worrisome side effects.

It is often helpful to start a bowel training routine where the child sits on the toilet for 5 – 10 minutes after every meal. It is important to do this consistently in order to encourage good behavior habits. Praise your child for trying. If the child is not toilet trained yet, it is best to wait until constipation is under control.

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