Childhood Constipation

Constipation means that a person has three or fewer bowel movements in a week.

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Constipation means that a person has three or fewer bowel movements in a week. The stool can be hard and dry. Sometimes it is painful to pass. At one time or another, almost everyone gets constipated. In most cases, it lasts a short time and is not serious7.

 

Constipation affects approximately one in 10 children worldwide8. It occurs most commonly in toddlers9, often presenting at the time of transition to solids, toilet training, or starting school10

Constipation means that a person has three or fewer bowel movements in a week. The stool can be hard and dry. Sometimes it is painful to pass. At one time or another, almost everyone gets constipated. In most cases, it lasts a short time and is not serious7.

 

Constipation affects approximately one in 10 children worldwide8. It occurs most commonly in toddlers9, often presenting at the time of transition to solids, toilet training, or starting school10

Overview

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Though constipation is quite common in children, it is usually temporary11. Some people experience chronic constipation that can interfere with their ability to go about their daily tasks23. Chronic constipation however can lead to complications or be the result of an underlying condition23.

 

Constipation can be distressing for families; parents may feel isolated and have concerns about possible underlying medical causes12. Long-standing constipation can cause soiling (repeated passing of stool, usually involuntarily into clothing). It can be frustrating for parents and embarrassing for the child.13

 

Chronic constipation may also cause people to strain excessively to have a bowel movement and lead to complications or signal an underlying condition11.

 

If you or any member of your family have fewer than three bowel movements a week combined with difficulty with your bowel movements or other discomfort, it may be worthwhile to talk to a doctor14.

Causes and risk factors

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Many factors can contribute to constipation in children, including15:

  • Your child may ignore the urge to have a bowel movement because he or she is afraid of the toilet or doesn’t want to take a break from play. Some children withhold when they’re away from home because they’re uncomfortable using public toilets.
  • Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience.
  • Toilet training issues. If you begin toilet training too soon, your child may rebel and hold in stool. If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that’s tough to change.
  • Changes in diet. Not enough fibre-rich fruits and vegetables or fluid in your child’s diet may cause constipation. One of the more common times for children to become constipated is when they’re switching from an all-liquid diet to one that includes solid foods.
  • Changes in routine. Any changes in your child’s routine — such as travel, hot weather, or stress — can affect bowel function. Children are also more likely to experience constipation when they first start school outside of the home.
  • Various medicines can contribute to constipation.
  • Cow’s milk allergy. An allergy to cow’s milk or consuming too many dairy products (cheese and cow’s milk) sometimes leads to constipation.
  • Family history. Children who have family members who have experienced constipation are more likely to develop constipation. This may be due to shared genetic or environmental factors.
  • Medical conditions. Rarely, constipation in children indicates an anatomic malformation, a metabolic or digestive system problem, or another underlying condition.

Signs and symptoms

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Signs and symptoms of constipation in children may include15:

  • Less than three bowel movements a week
  • Bowel movements that are hard, dry, and difficult to pass
  • Pain while having a bowel movement
  • Stomach pain
  • Traces of liquid or pasty stool in your child’s underwear — a sign that stool is backed up in the rectum
  • Blood on the surface of hard stool.

 

In normal cases, stools should have a soft consistency and a long cylinder shape. The stool should be easy to pass, without any pain16. The Bristol Stool Chart (Figure 1) was created to help standardise the evaluation of stools16.   Types 1 and 2 indicate constipation, types 3 and 4 are healthy stool, while types 5–7 suggest diarrhoea and urgency16.

Type 1 stools are usually small hard lumps that evacuate individually and are usually difficult to pass. Type 2 stools are usually compacted into one single mass, but with a lumpy appearance.

Call your child’s healthcare provider if you have any questions or concerns about your child’s bowel habits or patterns.

Diagnosis - when to see a doctor

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Constipation in children usually is temporary. However, chronic constipation may lead to complications or signal an underlying condition11. Make an appointment with your doctor if your child or any member of your family experiences unexplained and persistent changes in your bowel habits or if constipation is accompanied by fever, not eating and blood in the stool.

Impact on quality of life

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Constipation is distressing for children and their parents. Studies18 show that parents rate Quality of Life (QoL) lower than their children, particularly in the domains of emotional and social functioning. The goals of treating constipation in childhood are to produce soft, painless stools and to prevent the re-accumulation of faeces19. These outcomes are achieved through a combination of education, behavioural modification, daily maintenance stool softeners and dietary modification20.

Treatment

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Laxatives are a type of medicine that can treat constipation. It is important that you drink plenty of fluids when taking any laxative. This means drinking at least two litres per day (8-10 cups)21.

There are several types of laxatives22:

Bulk-forming laxatives

Bulk-forming laxatives work by increasing the “bulk” or weight of the stool, which in turn stimulates your bowel.

Osmotic laxatives 

Osmotic laxatives draw water from the rest of the body into your bowel to soften the stool and make it easier to pass. An osmotic laxative can make you dehydrated so it is important to drink plenty of fluids.

  • lactulose
  • macrogol
  • polyethylene glycol

Stimulant laxatives

These stimulate the muscles that line your gut, helping them to move the stool along to your back passage.

  • bisacodyl
  • senna

Stool-softener laxatives

This type of laxative works by letting water into the stool to soften it and make it easier to pass.

Suppositories

Glycerine or bisacodyl suppositories also aid in moving the stool out of the body by providing lubrication and stimulation, respectively.




  1. Safely Using Laxatives for Constipation. Available on: https://www.webmd.com/digestive-disorders/laxatives-for-constipation-using-them-safely. [Updated 11 May 2022; Cited 24 August 2022].
  2. Full Prescribing Information. BROOKLAX Bisacodyl Laxative Pills. English. 2017-03.
  3. Full Prescribing Information. BROOKLAX Senna Laxative Chocolate. English. 2014-03.
  4. Full Prescribing Information. LENOLAX. Paediatric. 1 ml. English. 2015-06.
  5. Full Prescribing Information. LACSON. 3,3 g per 5 ml. English. 2021-06.
  6. Full Prescribing Information. Glycerine. Paediatric. 1,12 g. English. 2018-07.
  7. Constipation. Summary. Available on: https://medlineplus.gov/constipation.html. [Updated 28 July 2016; Cited 22 August 2022].
  8. Bradshaw O, Foy R, Seal AK and Darling JC. Childhood Constipation. BMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2021-065046(Published 02 December 2021)
  9. Walter AW, Hovenkamp A, Devanarayana NM, Solanga R, Rajindrajith S and Benninga MA. Functional constipation in infancy and early childhood: epidemiology, risk factors, and healthcare consultation. BMC Pediatrics (2019) 19:285 Page 6 of 10.
  10. Waterham M, Kaufman J, Gibb S. Childhood constipation. Aust Fam Physician 2017; 46:908-12. pmid:29464227.
  11. Mayo Clinic. Constipation – Overview. Available on: https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253. [Updated 13 August 2021; Cited 22 August 2022].
  12. Thompson AP, MacDonald SE, Wine E and Scott SD. Understanding parents’ experiences when caring for a child with functional constipation: interpretive description study. JMIR Pediatr Parent2021;4: e24851.
  13. Mayo Clinic. Diseases & Conditions. Encopresis. Symptoms & Causes. Available online at: https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494. [Updated 25 September 2021; Cited 3 October 2022].
  14. Cleveland Clinic. Constipation; Symptoms, Causes, Treatment & Prevention. Available online at: https://my.clevelandclinic.org/health/diseases/4059-constipation. [Updated 11 July 2019; Cited 3 October 2022].
  15. Mayo Clinic. Constipation in Children. Available online at: https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242. [Updated 18 September 2021; Cited 22 August 2022].
  16. Medical News Today. What are the different types of poop? Bristol Stool Chart. Available on https://www.medicalnewstoday.com/articles/320938. [Update 21 June 2022; Cited 24 August 2020].
  17. Sood MR. Up to Date. Patient education: Constipation in infants and children (Beyond the Basics). Available online at: https://www.uptodate.com/contents/constipation-in-infants-and-children-beyond-the-basics/print. [Updated 12 November 2021; Cited 2 September 2022.
  18. Belsey J., Greenfield S., Candy D. and Geraint M. (2010), Systematic review: impact of constipation on quality of life in adults and children. Alimentary Pharmacology & Therapeutics, 31: 938-949. https://doi.org/10.1111/j.1365-2036.2010.04273.x
  19. Xinias I, Mavroudi A. Constipation in Childhood. An update on evaluation and management. Hippokratia. 2015 Jan-Mar;19(1):11-9
  20. Rowan-Legg A. Managing functional constipation in children. Paediatr Child Health. 2011 Dec;16(10):661-70. Available online at: https://pubmed.ncbi.nlm.nih.gov/23204909/. Accessed on 3 October 2022.
  21. Sambrook J. Patient Info. Digestive Health. Constipation. Laxatives. Available on: https://patient.info/digestive-health/constipation/laxatives. [Updated 4 April 2018; Cited 13 September 2022].
  22. Laxatives. Considerations. Available at: https://www.nhs.uk/conditions/laxatives/. [Updated 10 June 2019; Cited 22 August 2022].
  23. Mayo Clinic. Diseases & Conditions. Constipation. Symptoms & Causes. Available online at: https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253 [Updated 31 August 2021; Cited 17 October 2022

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