Constipation in Kids

Constipation in kids is a medical condition where a child experiences difficulty passing stools or having infrequent bowel movements. It is a common problem among children. The characteristic symptoms of constipation are hard, dry stools or having bowel movements less than three times a week. It may cause pain, bloating, and abdominal discomfort in the child.

In India, a study conducted by the Indian Academy of Pediatrics found that about 10-20% of Indian children have constipation, which is comparable to rates in other countries. However, this data may vary according to the age group, gender, and other demographic factors of the children.

Constipation in children is often underreported and undertreated. Therefore, parents should be aware of signs of constipation in their children, such as difficulty passing stools, abdominal pain, and bloating. So they can seek medical attention to prevent potential complications. 

•   Functional Constipation: This type of constipation is the most common, accounting for around 85-90% of cases. It occurs when a child has difficulty passing stools or has infrequent bowel movements without an underlying medical condition. The root causes of functional constipation include dietary factors, dehydration, and toileting habits. A child may develop functional constipation if they consume a fiber-deficit diet or do not drink enough water or other fluids, causing their stools to become dry and difficult to pass. Other contributing factors include lack of physical activity, holding feces for a long time, and anxiety or stress.

•   Organic Constipation: This type of constipation occurs due to an underlying medical condition, such as Hirschsprung's disease, hypothyroidism, or cystic fibrosis. Hirschsprung's disease is a rare condition that affects the muscles in the colon, making it difficult to pass stool. In hypothyroidism, the thyroid gland does not produce enough thyroid hormone, which can slow down bowel movements. Cystic fibrosis is a genetic disorder that affects the digestive system, causing thick mucus to build up and block the intestines, leading to constipation. Organic constipation is a rare condition, accounting for only 5-10% of cases of childhood constipation.

•   Slow-Transit Constipation: This type of constipation occurs when the muscles in the colon are weak or do not work accurately, causing relatively slow movement of the stool through the colon. Numerous factors, such as nerve damage, hormonal imbalances, or abnormalities in the colon muscles, may cause a slow-transit colon. Slow-transit constipation is rare, affecting less than 5% of children with constipation.

•   Psychogenic Constipation: Emotional or behavioral issues, such as anxiety, stress, or fear of using the bathroom, are the prime cause of psychogenic constipation. A child may withhold feces due to anxiety or fear of experiencing pain during bowel movements, leading to chronic constipation.

•   Encopresis: When a child has bowel movements in inappropriate places, such as underwear or clothing, known as encopresis. It is often related to chronic constipation and can occur due to stool withholding or a lack of awareness of the need to use the toilet. Over time, the impacted stool can leak out around the blockage, leading to soiling the clothes and other related problems.

Psychogenic constipation and encopresis account for less than 5% of cases of childhood constipation. 

The symptoms of constipation can vary from child to child and depend on the severity of the condition and the child's age. The following are common signs and symptoms of childhood constipation:

•   Infrequent bowel movements: Having fewer bowel movements than required for a child's age and usual pattern is known as a lesser bowel movement. It can vary according to age, as infants pass more frequent bowel movements than older children. Generally, infants may have several bowel movements a day, while older children may have one or two bowel movements per day or every other day. However, if a child experiences fewer bowel movements than usual or has not had a bowel movement in several days, this may be a sign of constipation.

•   Difficulty passing stool: Children with constipation may experience straining or pushing during bowel movements. This may lead to other complications like hemorrhoids or anal fissures.

•   Hard, dry stools: The stools of children with constipation are often solid and dry and may be difficult to pass. Children may also experience small, pellet-like stools or big feces.

•   Abdominal pain or discomfort: Children with constipation may experience mild to severe abdominal pain or discomfort.

•   Loss of appetite: Children with constipation may experience a loss of hunger or may be reluctant to eat due to abdominal discomfort. The abdominal pain or the stool pressure on the stomach and intestines may cause a feeling of fullness.

•   Irritability or changes in mood: Children with constipation may experience pain, gas, or bloating, which leads to mood changes and irritability. They may also become frustrated or embarrassed about their inability to have a bowel movement, which can lead to changes in behavior. 

Numerous factors can cause constipation in children. The following are the most common causes of constipation in children:

•   Diet: A diet plays a crucial role in constipation. For example, food low in fiber and high in processed foods, dairy products, and sugar can cause fewer bowel movements. Fiber is essential for healthy bowel movements, as it helps to add bulk to the stool and promotes regularity. When a child does not consume enough fiber in the diet, the feces may become hard and dry, making it difficult to pass. On the other hand, drinking less water can also lead to constipation, as water is needed to soften the stool and make it easier to pass.

•   Changes in routine: Any alteration in daily schedule can disrupt a child's usual bowel habits and lead to constipation. It includes changes in diet, decreased physical activity, traveling, starting school, potty training, and changes in the child's environment. Children may also be hesitant to use unfamiliar bathrooms or take time to use the bathroom, which results in constipation.

•   Medications: Certain medications, such as painkillers, antacids, and iron supplements, can slow down the digestive system, which may contribute to constipation. 

•   Medical conditions: Sometimes, underlying medical conditions, such as hypothyroidism, diabetes, and neurological disorders, may affect the nerves and muscles in the digestive tract, leading to constipation in children. 

•   Withholding stool: Some children may hold back their feces due to fear or embarrassment or because they are too busy to use the bathroom. It can cause stool accumulation in the colon, making it more difficult to pass.

•   Anatomical abnormalities: Certain anatomical abnormalities, such as anorectal malformations, can contribute to constipation in children. 

•   Family history: Children with a family history of constipation may have a higher risk of developing the condition. Genetic factors or dietary and lifestyle habits within the family plays a major contributing factor.

•   Emotional factors: Children who are anxious or stressed may be more likely to withhold stool, further contributing to constipation. 

There are several steps you can take to help prevent constipation in your child:

•   Encourage a healthy diet: A healthy diet with plenty of fiber-rich foods, such as fruits, vegetables, whole grains, and beans, can help prevent constipation in children. Fiber adds bulk to the stool, making it easier to pass, and promotes regular bowel movements. Encourage your child to eat colorful fruits, vegetables, whole-grain bread, cereals, and beans. Avoid junk food or restrict junk food/processed food to once a week.

•   Promote regular physical activity: Daily activity help keep the digestive system functioning and prevent constipation. You can indulge yourself with your child to engage them in regular physical activity, such as playing, riding bikes, swimming, or participating in sports. Aim for at least 30 minutes of physical activity each day.

•   Establish regular toilet habits: Encourage your child to use the bathroom regularly. Teach them to use the bathroom when they feel the urge to have a bowel movement. Establishing a regular bathroom routine can also be helpful, such as having your child sit on the toilet each day at the same time.

•   Avoid withholding stool: Teach your child to use the bathroom when needed and avoid holding feces or using the bathroom on a strict schedule. If your child is shy to use the bathroom, you may need to provide reassurance and support to help them feel comfortable.

•   Talk to your healthcare provider: If your child is experiencing constipation and other symptoms, talk to your doctor about ways to manage it. They may recommend dietary changes, medication, or other treatments to help prevent and manage constipation. Sometimes, your doctor may recommend stool softeners or laxatives for a bowel movement. 

Several tests can verify the underlying cause of constipation and help formulate a proper treatment plan. The specific tests to diagnose the condition depend on their age, symptoms, and medical history, including:

•   Physical exam: During a physical exam, your doctor will examine your child's abdomen, rectum, and anus for any signs of physical abnormalities or blockages. They may also perform a digital rectal exam to assess the tone of the rectal muscles and check for any masses or blockages.

•   X-ray: Abdominal X-ray can evaluate the amount of stool in the colon and rectum. Before the X-ray, your doctor will ask your child to drink a liquid that contains a contrast agent, which shows up on the X-ray and highlights any stool in the colon. Abdominal X-rays can also help to identify the constipation severity and guide to formulation treatment accordingly.

•   Anorectal manometry: This diagnostic test measures the function of the muscles in the anus and rectum. During the anorectal manometry, the healthcare provider inserts a small tube into the rectum, and pressure sensors measure muscle activity. It can help determine if the muscles are contracting and relaxing, which is crucial for bowel movements.

•   Colonoscopy or sigmoidoscopy: Your doctor may recommend colonoscopy or sigmoidoscopy if your child is experiencing severe constipation or other symptoms or risk factors that indicate an underlying condition. This procedure allows the healthcare provider to evaluate the colon and rectum for abnormalities or blockages.

•   Blood tests: Your doctor may suggest blood tests to evaluate your child's overall health and rule out any underlying conditions that cause constipation. For example, blood tests can help diagnose conditions such as thyroid problems, diabetes, and electrolyte imbalances, which can contribute to constipation. 

The treatment and management of constipation in children may depend on the underlying cause and severity of the symptoms. The following are some treatment approaches for constipation:

•   Dietary Changes: Increasing fluid intake and consuming fiber-rich foods may help. Fiber-rich foods like fruits, vegetables, whole grains, and legumes may increase stool bulk. Limiting high-fat products, processed snacks, and sugary drinks are also helpful and drink plenty of water.

•   Lifestyle Modifications: Regular physical activity can help stimulate bowel movements. It includes playing outside, walking, running, swimming, or developing creational habits. Encouraging your child to sit on the toilet at regular times can also help establish a bowel routine.

•   Stool Softeners and Laxatives: Stool softeners and laxatives can help soften the stool and make it easier to pass. Various laxatives are available, including osmotic laxatives, stimulant laxatives, and lubricants. Lubricants help the feces pass smoothly by coating it with a slippery substance. Your healthcare provider can recommend the appropriate type and dosage for your child.

•   Enemas and Manual Disimpaction: When a child is experiencing severe constipation or not benefitting from the other treatments, doctors may suggest enemas or manual disimpaction. Enemas involve inserting a solution into the rectum to soften the stool and stimulate bowel movements. Manual disimpaction involves physically breaking up and removing the impacted stool from the rectum under professional guidance. 

•   Medications: The doctor may prescribe medicines to treat an underlying medical condition constipation. They can also prescribe laxatives or stool softeners to ease bowel movement. 

•   Behavioral Therapy: If your child is avoiding the bathroom visit due to fear or anxiety, behavioral therapy may help address these issues and establish a regular bowel routine. It involves encouragement to the child to sit on the toilet for a certain period each day, even if they don't feel the urge to go. 

What is constipation?

Constipation is a medical condition that occurs when a child is experiencing difficulty passing stools or infrequent bowel movements. The main symptom is hard and dry stools that are difficult and painful to pass. 

What causes constipation in children?

Several factors can contribute to constipation in children. It includes a fiber-deficit diet, less fluid intake, lack of physical activity, certain medications, medical conditions such as hypothyroidism and Hirschsprung's disease, and psychological factors such as anxiety and stress. 

What are the symptoms of constipation in children?

The symptoms of constipation in children can vary. But many children may experience infrequent bowel movements, hard and dry stools, abdominal pain or discomfort, bloating, nausea, vomiting, and anal fissures. 

How is constipation in children diagnosed?

The diagnosis of constipation in children includes a child's medical history, physical examination, and laboratory tests. The doctor may also order imaging tests such as an abdominal X-ray, ultrasound, or MRI to determine the severity of the condition and as a base for treatment planning. Additional investigation such as blood tests, anorectal manometry and/or colonescopy may be needed depending on the initial evaluation. 

How is constipation in children treated?

Treatment includes a combination of lifestyle modifications, dietary changes, and medication. Lifestyle modifications like regular exercise, toilet training, and behavioral therapy may improve this condition. Dietary changes may include increasing fiber and fluid intake and avoiding foods that can cause constipation. Medications like laxatives or stool softeners are of great help. 

How long does constipation in children last?

The duration of constipation in children can vary depending on the severity of the condition and the underlying causes. In some cases, constipation may resolve with lifestyle modifications and dietary changes, while sometimes, it may require medical intervention. 

How can constipation in children be prevented?

Some preventive measures like encouraging regular bowel habits, increasing fiber and fluid intake, encouraging physical activity, and avoiding foods that can cause constipation may help. Addressing any underlying medical or psychological conditions is crucial to improve constipation symptoms. 

When should I see a doctor for my child's constipation?

You should consult a doctor if your child's constipation lasts more than two weeks or if they experience severe abdominal pain, vomiting, fever, or blood in their stool.  

Can constipation cause bedwetting in children?

Yes. Sometimes, constipation may cause bedwetting in some children, as a stretched rectum can pressurize the bladder. It is known as functional encopresis and occurs due to chronic constipation. The stretching of the rectum can affect the nerves that control the bladder, leading to involuntary bedwetting. 

Can certain medications cause constipation in children?

Yes. Some medications, such as antihistamines, pain relievers, and certain antidepressants, can cause constipation in children as a side effect. These medications can slow down the digestive system and make it harder for stool to move through the intestines. 

Can constipation lead to other health problems in children?

Yes. Chronic constipation in children can lead to other health problems, such as anal fissures, hemorrhoids, urinary tract infections, and urinary incontinence. It can also lead to poor appetite, abdominal pain, and less weight gain. 

How much fiber should my child consume to prevent constipation?

According to health and nutrition experts, children between the ages of 1-3 years should consume at least 19 grams of fiber per day, while children between the ages of 4-8 should consume at least 25 grams of fiber per day. High-fiber foods include fruits, vegetables, dried fruits, nuts, whole grains, beans, and lentils. 

Can toilet training cause constipation in children?

Yes, toilet training can sometimes cause constipation in children, especially if they are not ready or under pressure to perform. If a child is holding in their stool for fear of using the toilet or experiencing pain, it can lead to chronic constipation. 

How long does it take for a laxative to work in children?

The duration it takes for a laxative to work in children can vary depending on the type of laxative, but it usually takes between 6-12 hours. Stimulant laxatives work faster than bulk-forming laxatives but can also cause cramping and diarrhea. 

Can constipation be a sign of a more serious underlying condition in children?

Yes. In rare cases, constipation in children can be a sign of a more serious underlying condition such as Hirschsprung's disease or cystic fibrosis. These conditions can affect the nerves and muscles in the digestive tract, leading to chronic constipation. 

Can a child have diarrhea and constipation at the same time?

Yes. Some children may experience alternating episodes of diarrhea and constipation as a symptom of irritable bowel syndrome. In this condition, children may experience abdominal pain, bloating, and changes in bowel habits. 

Are there any natural remedies for treating constipation in children?

Some natural remedies like prune juice, fiber-rich foods such as fruits and vegetables, and probiotics can help relieve constipation. It is crucial to consult with a pediatrician before trying any natural remedies, especially if your child is on medication. 

Can constipation affect a child's mood and behavior?

Chronic constipation in children can sometimes lead to mood swings and behavior changes, such as irritability, anxiety, and depression. It occurs due to stool accumulation in the intestines, affecting the balance of chemicals in the brain. Treating constipation can help improve mood and behavior in some children.