Understanding Constipation in Children

Stool elimination in a healthy individual is 1 to 2 times a day or at least every alternate day.

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

Water is reabsorbed for various bodily functions once the stools reach the large intestine; however, the stools get hard and dry if the colon absorbs too much water. 

Specific muscle movements (peristalsis) in the colon push the stools towards the rectum before they are 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.

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

Symptoms of Constipation in Children

As infants cannot communicate, you must carefully observe their bowel movements.

Symptoms in babies include 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 include abdominal bloating; nausea or vomiting; not having a bowel movement each day; straining to have bowel movements; bowel movements may be painful, stiff, and small; the child may soil his/her underwear.

Causes of Constipation in Children

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 insufficient consumption of fibre-rich food like vegetables and fruits; inadequate liquid consumption; lack of exercise; certain medications; irritable bowel syndrome; problem with intestinal function; poor toilet training; and 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.

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, rectal prolapse, and rectal leakage-caused due to long-term stool withholding.

Diagnosis of Constipation in Children

Constipation is a common health issue affecting 0.7% to 29.6% of children across the globe. Studies have shown that roughly 1 out of 20 paediatrician visits is because of constipation. If you notice that your child has been constipated for more than a week, you should seek immediate medical intervention.

Constipation in children is diagnosed with the following ways:

1. The paediatrician will gather medical history such as past illnesses, types of food the child likes to eat; bowel movement frequency; how stressful is the child; amount of water the child drinks daily.
2. The paediatrician will perform a physical examination by placing a gloved hand in the anal region of the child to look for abnormalities.
3. Abdominal X-ray to check and confirm any abnormalities or blockages in the abdominal region of the child.
4. Blood tests to check the presence of any infections or hormonal imbalances.
5. Other tests include:
1. Colonoscopy: 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, take tissue samples or remove some polyps or obstructions.
2. Rectal biopsy: Tissue samples from the rectum are taken and examined for abnormalities.
3. Barium enema: 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. 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.
4. 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.
5. Anorectal manometry: A catheter is inserted into the rectum to measure muscle coordination while passing the stools.

Treatment Options for Constipation in Children

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

1. 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.
2. 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.
3. Over-the-counter stool softeners or fibre supplements 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.
4. If the constipation is not on the severe side, you could provide relief to the child by encouraging your child to drink enough water, give them probiotics like yogurt and more fruits like apples and prunes, massage the abdomen, and avoid rice cereal.

Prevention of Constipation in Children

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

1. Diet changes: If you feel your child is constipated, make sure they have sufficient liquid intake through the day. Ensure your child eats a diet rich in high-fibre content, such as fruits, vegetables, and whole grains. 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.
2. Lifestyle changes: 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.
3. Toilet routine: 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. Help your child to choose a good position or consider products like toddler toilet seats that are designed to make the child feel comfortable. 
4. 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.

Make an Appointment at Gleneagles Hospitals

If you suspect your child has constipation issues, get in touch with us to book an appointment today for a consultation, or visit our Paediatric Care Department at your nearest Gleneagles Hospital.