Constipation in Children
Constipation is also often the cause for failed treatment of enuresis.
It is important to always treat the constipation. Some of the medication used to treat bedwetting can also cause constipation. Always let your doctors know if your child is constipated.
Constipation means that the food takes too much time on its passage from the mouth to the toilet and that, consequently, the bowel gets filled with too much stool.
This is a common problem, caused partly by genetic factors and partly by the way we live.
What’s wrong with the body when the child is constipated?
The rectum (the part of the bowel closest to the anus) is meant to be a “signal station” and not a storage room. When poo arrives in the rectum one is supposed to notice it and sense a desire to go to the toilet. But this mechanism doesn’t function properly in children who have been constipated for a while. They are forced to use all of the bowel – including the rectum – to store poo, and thereby lose the ability to notice that the rectum is filled (because then they would have to sense a constant urge to go to the toilet, and you don’t have time for that!). The link between the bowel and the bladder is important. If the rectum is filled it will compress the bladder an make it “irritable” and difficult to control. And a child with an irritable bladder often needs to contract the muscles of the lower pelvis in order to stay dry, and this leads to constipation.
What are the symptoms?
Constipation can give many symptoms or none, this differs a lot between different children. Some children have complaints from the bowel only, others mostly from the bladder. It is quite possible to be constipated even if you pass stool of normal consistency every day.
Bowel – Related Symptoms
- To pass stool, in small or large amounts, in the underclothes.
- To need to go to the toilet in a rush even though there was no need a few minutes ago.
- Intermittent stomach ache, often after meals.
- Hard and dry stools.
- Painful passing of stools.
- Infrequent bowel movements (every second day or less frequent).
Bladder – Related Symptoms
- Urine leakage in the underclothes or the bed.
- Sudden, unexpected attacks of urgent need to pee.
- The need to strain to pee.
- Repeated urinary tract infections.
For slightly constipated children some good advice regarding food, drink and toilet habits is often enough.
If the child is more constipated more thorough measures are needed: first the bowel should be emptied with the help of small enemas and then mild laxatives are needed to keep the bowel working while the family works with food, drink and toilet habits.
Food, Drink and Lifestyle Advice
The child should drink a lot of water but not too much milk, eat a lot of fibres (coarse bread, vegetables) and be active. Not too much computer games or TV! The bowel should be emptied at least once every day (after breakfast is a good time) and the toilet visits should not be rushed. And, importantly, the child should never postpone a toilet visit: as soon as the slightest need is felt the child should go immediately to the toilet
Children usually develop the ability to be toilet trained by about three years of age. ‘Soiling’ is when the bowels are emptied in places other than the toilet. Even after a child is toilet trained, there may be occasional accidents with soiling (poo) in your child’s underwear.
If a child is unable to be toilet trained or has regular poo accidents after the age of three to four years, then they should be medically assessed. If a child has been toilet trained and at a later stage starts to soil, this also needs medical assessment.
How many children get soiling?
About 1-3% of children can have this problem and some of them may have wetting as well. It is more common in boys.
Soiling may vary from a ‘skid mark’ to larger amounts that need to be removed from underwear before it can be washed.
Why do children soil?
In almost all cases soiling happens because the large bowel is not emptying properly, and the child is constipated. Constipation is very common and occurs at some time in up to 25% of children. If it is not recognised and treated, bowel actions may become harder and less frequent.
Over time, stretching of the bowel makes it less sensitive, so the child may not feel when poo needs to come out and therefore has an accident. It is quite possible that there is hard poo inside the bowel, but the soiling is soft runny poo leaking around the hard mass, and so you don’t realise that constipation is the underlying problem.
How does this cycle happen?
- Painful bowel actions may lead to the child avoiding pooing.
- The child may not want to use kinder / school toilets because of privacy or cleanliness issues.
- The child may not be able to access a toilet when they feel the urge to go.
- Some children just don’t feel the need to go when they are busy with something else.
Are there other reasons?
Yes, occasionally there is a physical cause of soiling, but these are usually diagnosed at birth or soon after.
There are some conditions where the bowel itself does not squeeze effectively and some food allergies may cause constipation or diarrhoea leading to soiling – but these reasons are less common.
Soiling is NOT caused by attention-seeking, naughtiness or laziness, and although it may cause emotional upset, soiling is not usually caused by it.
Children who have poo accidents may appear to be unaware they have happened, or not want to change. This is not a sign of naughtiness or not caring – they are usually very upset deep inside.
The social consequences of soiling are distressing for parents and children. It is important to realize that the problem can be treated, and early recognition and effective treatment will minimise the impact it has.