Constipation is a common temporary gastrointestinal problem that occurs when the colon absorbs too much water or the colon muscle is slow or sluggish and the stool becomes hard and dry. Common symptoms of constipation include: fewer than 3 bowel movements per week, stool is difficult to pass, hard, dry and large, abdominal pain, stool soiling in underwear and/or a decreased appetite.

Not having a bowel movement every day doesn’t mean you are constipated. Most people who have constipation don’t go to the doctor. Some use over the counter laxatives to relieve their constipation. However, using laxatives too much can cause your body to depend on them and become habit-forming. Chronic constipation, however, may lead to complications or be a sign of a serious underlying disorder.

Causes

There may be several causes for constipation in a child. Some of these include:

• too little fiber in the diet
• not drinking enough fluids
• not enough exercise
• some medications
• eating too many processed foods
• not taking time away from playing to try to have a bowel movement
• Changing from breast milk or formula to whole milk or from baby food to solid food.
• Anxiousness or tiredness

In cases of chronic constipation it can begin from one large stool causing a crack in the anus, making bowel movements painful so the child resists the urge. This starts a vicious cycle where your child holds their stool to avoid pain, but the longer it is held the stool gets larger and harder. This makes bowel movements even more painful. 

In children who have constipation frequently, behavior changes are recommended to help the child develop normal bowel habits. Children may become constipated if they are afraid or don’t want to go to the bathroom. This often happens at school because children would rather use their toilet at home. If this behavior happens often enough it can become difficult for your child to tell when they need to use the bathroom. 

Treatment/Prevention

Some of the same things that can be done to treat constipation can be done regularly in order to prevent a child from becoming constipated again. It is important to be consistent and patient with treatment, it may take many months for the intestine to regain strength and feeling. Constipation is a problem that takes time to develop, it is unrealistic to expect it to be solved over night. 

• • More fiber in the diet. The US Dietary Guidelines  recommend children eat their age + 5 grams of fiber each day (e.g. a 10 year old needs 10+5=15 grams fiber). Examples of foods that contain fiber are:

• • • Whole grain breads, whole grain pasta, bran cereals and brown rice
    • Fresh vegetables and fruits and fruit juices
    • Nuts and seeds
    • Pinto beans, kidney beans, black-eyed peas
    • Limit bananas, cheese, chocolate, and fried foods.

• • Plenty of fluids. It is very important for children to drink plenty of fluids to help soften the stool—at least 8 cups a day. Fluids include drinks, soups, juice fruits, etc.

• • Regular exercise. Physical activity helps stimulate the intestines so the child can go to the bathroom.

• • Take time to go to the bathroom. Children should learn when to go to the bathroom and have enough undisturbed time when they need to go.

• Behavioral modification. A regular bowel habit is key to avoiding constipation. Children who are toilet trained (or in the process of learning) should sit on the toilet for 5-10 minutes following meals. Meals are often followed by contractions in the colon so the body can get rid of stool, and sitting on the toilet can take advantage of this movement.
• Pelvic floor therapy. The muscles in your pelvic floor (the area around and inside your hips) help control movements in your bowels and your bladder. Constipation or trouble controlling the bladder may be caused by the pelvic floor becoming weak or being too tight. Pelvic floor therapy is a type of physical therapy that aims to bring the pelvic floor muscles back to their normal function. 
• Medications. Your doctor may recommend a home clean out in order to remove the stool that has collected in the intestine. Once the stool has been removed it is important to make sure your child can use the bathroom easily so that stool does not collect again. In order to make using the bathroom easy for your child your doctor may recommend stool softeners such as miralax and linzess. Laxatives such as Amitiza may be prescribed to allow for easier bowel movements and so your child feels the urge to go. Your doctor will give the dosage and for how long you should use any prescribed medications.
• Anorectal Manometry In order to tell if your child’s anal nerves are working properly your Doctor may decide to perform an Anorectal Manometry. This is a painless test that lasts 5-10 minutes where a lubricated tube and a ballon are inserted into the anus. The ballon will inflate with air and deflate several times throughout the test. Your child may feel the need to poop but this will only last a few seconds. Older children may be asked to squeeze the muscles in their butt. Afterwords your child can return to normal activites.

Please visit the Nutrition section of the website for further information, or contact one of our dieticians for nutritional help. Call (865) 546-3998.

When to contact the Doctor

If you try the above suggestions and your child does not improve within 3 days, contact your doctor before giving the child any medication or an enema. Also, contact your doctor if your child is having increased abdominal pain, blood in the stools, or fever.

Further Information

Behavior problems are common in children who have constipation. Consider meeting with one of our psychologists for support in dealing with the various stressors and emotional issues related to your child’s constipation issues.