Constipation in Children

Constipation is a very common problem in childhood. It does not usually have any particular underlying cause. This leaflet describes what can be done to help.

What is constipation?

Children are constipated if they pass hard painful stools (poo) or if they have infrequent stools (less than 3 times per week) or a combination of both. It may lead to soiling of underwear which can be very distressing.

Why does constipation happen?

Constipation often does not have any cause but can start off following an episode of being unwell with an infection, a reduction in the amount of fluid drunk or a change in diet. Usually constipation lasts a few days and clears up without any treatment or just with an increase in fluids and fibre. Unfortunately in many children the constipation doesn't go away quickly. The most common reason why constipation carries on is that children get discomfort or pain so instead of relaxing the muscles around their anus (bottom) they involuntarily tighten them. The stools (poo) builds up, and the next time the child gets the urge to go it's harder and more painful, so they tense up again. As this goes on, more stools build up in the lower bowels. The longer the stools stay in the bowels, the harder and drier or stickier they get. This cycle can continue and the bowel then gets stretched. After a while the stretched bowel stops sending the signals to the brain to say that the bowel needs to empty. Children can then sometimes soils themselves without realising it is about to happen. Soiling can also happens because old stool can become more liquid and can bypass a poo blockage and leak out. This can be called overflow diarrhoea. To fully recover from long-standing constipation can take a long time. The lower bowel needs to be fully emptied and then to stay empty to allow it to return to a normal size.

What can be done?

 Ensure good fluid intake, particularly as water. Aim for 6-8 drinks per day.

 Try increasing fibre in the form of fruit, vegetables, high fibre bread, wholemeal cereals and baked beans in the diet. We know however that increased fibre does not help all children with constipation.

 Encourage lots of activity and exercise.

 Try to get children into a regular toilet habit. Encourage children to sit on the toilet for 5 minutes approximately 20 minutes after a meal. After breakfast or before school or nursery, is often best. Try to allow plenty of time so they don't feel rushed.

 When using the toilet the child should be able to have their feet flat on a footstep to that the knees are higher than the hips. Encourage then to lean forward slightly.

 Praise your child for sitting on the toilet or for passing a stool in the potty or toilet, but do not punish accidents.

Medicines to treat constipation

Most children with long-standing constipation will need medicines to relieve the constipation. The most commonly used medicines are macrogols (eg Movicol® ) or lactulose. These medicines work to soften the stools within the bowels and then encourage the muscles to push them along. These medicines should be taken regularly, and it is important that your child drinks plenty of water to avoid dehydration. The dose needed will vary from child to child and you may need to alter it depending on how well it is working. The medication will probably need to be continued for several weeks and often for many months. This is very safe and will not make the bowel ‘lazy’. Your doctor, health visitor or school nurse can discuss with you how to alter the dose gradually as the symptoms change.

‘Disimpaction’

If it is felt that there is a significant build-up of stool in the bowel (impaction) this will need to be cleared. High doses of medication may be required to treat this impaction. This is usually done by increasing the dose until the bowel is completely cleared out. This is sometimes called a ‘disimpaction regime’. During this stage of treatment the child may have more symptoms of abdominal pain, soiling of underwear and/or diarrhoea – this is expected and will resolve as the blockage is slowly dissolved and the bowels are cleared out.

Long-standing constipation or soiling

It is easy to become frustrated with soiled pants or a child who refuses to pass a stool. Try to keep calm. If your child can see that you are stressed or upset, they will pick up on this feeling, and the toileting issue can become even more of a fraught battle. Constipation and soiling will take a while to treat. Persistence with toileting regimes and medication is vital. Each child will progress at their own pace.