Constipation is treated by the division of Gastroenterology and Nutrition's Pediatric Multidisciplinary Chronic Constipation Clinic

What is Constipation?

Children with constipation usually have bowel movements that are large, hard, dry and painful to pass. These stools may occur every day or may be infrequent. This condition is very common and is one of the main reasons patients come to our clinic.

Symptoms

• Several days without a bowel movement followed by a very large, hard stool
• Small round pellet-like balls of stool
• Bleeding from the rectum (often from tears called "fissures")
• Leakage of liquid, diarrhea-like stool into clothing, called "encopresis"
• Refusal to go to the toilet or hiding to have their stool in a private place
• Crossing legs, making faces, clenching buttocks, or writhing on the floor
• Trying to push out stool but cannot (in most cases they are actually holding the stools back)
• Irritability/crankiness
• Stomach aches and cramps
• Nausea, vomiting and bloating
• Poor appetite, and even weight loss
• Headaches
• Bed-wetting or day-time accidents, referred to as enuresis
• Urinary tract infections

It can be normal to have a stool infrequently. Simply having infrequent stools that are soft and painless may not be a medical problem.

Causes

Constipation often begins when a child holds back a bowel movement. Perhaps the child has had hard, painful stools. Some children naturally have dry, hard stools. A diet change, viral illness, hot weather or travel can lead to hard stools/ A bad diaper rash can cause painful passage of stool. Older children may start holding bowel movements when they go to school or summer campy and must use a toilet that is less private than the one they have at home. At any age, fear of discomfort or embarrassment can make a child try not to have a bowel movement. If this continues, the result is constipation. The intitial cause may have occurred many years before the child is seen by a doctor for treatment of constipation.

Stool that is held back eventually fills up the colon and stretches it out of its normal shape. Stool retained in the colon dries out as the colon absorbs water from it. The longer the stool is held in the colon, the larger and harder it becomes, making bowel movements even more painful. This starts a vicious cycle. In the normal colon, muscles try to push stool out. Nerves tell the child that a stool needs to come out. However, the stretched-out flabby colon muscles cannot push. Hard stool gets stuck. Sometimes only liquid can pass around the rock-like stool. Stretched nerves become less sensitive. The child may no longer realize that he needs to have a bowel movement, and he may be afraid to try to go.

Treatment

Constipation treatment consists of two parts: clean-out and maintenance. First, it is important to clean the retained stool out of the colon. Secondly, maintenance therapy prevents stool build-up, allows the colon to return to its normal shape and muscle tone, and encourages regular bowel movements. Maintenance therapy may consist of increased fiber in the diet, regular toilet habits and medications. It is important to continue the therapy for as long as the healthcare provider recommends.