Constipation is common in children and adolescents. It happens when stool stays in the colon (large intestine) too long, leading to symptoms such as hard stools, difficulty passing a bowel movement, and painful BM’s. Constipation can look different depending on the child’s age.
Having a bowel movement every day does not always mean that a child is not constipated. Some children may have regular bowel movements but still have hard, painful, or difficult-to-pass stools.
Signs of constipation include:
- Having BMs less often than usual
- Spending a lot of time on the toilet
- Large or hard BMs,
- Pain or straining during a BM
- Bloating or abdominal pain.
- Small amounts of bright red blood on the outside of the stool or on toilet paper, often from a small tear caused by passing a hard stool
How Common is Constipation?
Constipation is one of the most common digestive problems in children. Studies estimate that up to 32% of kids will fit the clinical definition of constipation at some point, and 25% of all pediatric GI visits are to treat constipation.
Most constipation is what we term “functional” meaning it is related to how the digestive system is working without showing any signs of inflammation, another disease, blockages, or injury.
What Causes Constipation?
The colon is a muscular tube that stores stool, absorbs water, and helps move stool out of the body.
Stool enters the colon as a liquid. As it moves through the colon, the colon absorbs water, making the stool more solid. When stool reaches the rectum, the rectum stretches and sends a signal to the brain that it is time to have a bowel movement.
Sometimes, a child has a bowel movement that is hard or painful. The child may then try to avoid having another bowel movement by holding in their stool.
Common causes of constipation include:
- Switching from breast milk to formula
- Holding in stool
- Starting solid foods
- Toilet training
- Starting school
- Changes in daily routines
- Travel
- Stress or other major changes
Linked diseases
Many conditions also can increase the risk of constipation, or directly cause it. These conditions include:
- Slow transit (when contents travel slower than normal throughout the digestive tract)
- Hypothyroidism (an underactive thyroid)
- neurological diseases
- celiac disease
- inflammatory bowel disease
- Growths or other conditions that take up space in the abdomen making it more difficult to pass stool.
Typically these presentations are marked by other concerning symptoms (poor growth, abnormal weight gain, blood in soft stool, rash, poor response to laxatives). Your healthcare provider may test them immediately, or consider empiric therapy given just how common functional constipation is. In the absence of “red flag” symptoms like weight loss, significant blood with soft stool, or other constellations of concerning symptoms, evaluation is often not needed.
Constipation is also more common in children with autism spectrum disorder often due to sensory processes.
Constipation Cycle
Once a child begins holding in their stool, constipation can become a cycle.
When stool stays in the colon for too long, the colon continues to absorb water from it. The stool becomes larger, harder, and more difficult to pass.
The “Cookie in the Oven” Analogy
Think about what happens when you leave a cookie in the oven for too long. The longer it stays in the oven, the more water it loses. Eventually, the cookie becomes hard, dry, and difficult to chew.
The same thing happens with our colon, and over time, the rectum and colon can become stretched and less sensitive to the feeling of stool. A child may not feel the normal urge to have a bowel movement, which can make constipation harder to recognize and treat.
Once a child has experienced a painful bowel movement, they may exhibit withholding behaviors such as
- Stiffening their body
- Crossing or squeezing their legs together
- Turning red or sweating
- Hiding or avoiding the toilet
- Holding onto furniture
- Grunting or straining
This cycle can also lead to stool accidents or leakage when stool builds up in the colon.
What Treatment Options are Available?
Treatment often focuses on emptying the colon and helping children develop healthy bowel habits. There are many different laxative options available. In most cases, how long the treatment is continued is more important then which laxative is used.
Non- Medication Options:
- Eat fruits, vegetables, and drink plenty of water.
- Limit potty time to 10 minutes, but schedule at least 2 visits a day.
- Proper positioning is key, you want your knees above your hips. Options to help this include stools, squatty potty, or using a child-sized potty.
Learn more about Lifestyle Changes and Nutrition and Diet
Medications:
Several types of laxatives can be used to treat constipation in children. Your child’s healthcare provider can recommend the type and amount that is appropriate for your child.
Treatment may need to continue for some time, especially when constipation has been present for a long period. Stopping treatment too soon can allow the cycle of constipation and stool withholding to start again.
The goal is not only to treat the current constipation but also to help your child develop comfortable, regular bowel habits.
Learn more about laxatives
When to Contact Your Healthcare Provider
Talk with your child’s healthcare provider if constipation:
- Is painful or keeps coming back
- Causes frequent stool accidents
- Interferes with school or daily activities
- Does not improve with recommended treatment
- Is associated with poor growth or weight loss
- Includes significant blood in the stool
- Is accompanied by repeated vomiting, severe abdominal pain, or significant abdominal swelling
🎬 Watch Now
Physician Introduction on Constipation and Irritable Bowel Syndrome – Pediatric
In this presentation, Dr. Samuel Nurko defines constipation and IBS-C, how they are diagnosed, and how constipation and IBS-C can be treated in children today.
Adapted from IFFGD publication Laxatives: A Parent’s Guide to the Successful Management of Constipation in Children #828 by Joseph Levy, M.D., and Diana Volpert, M.D., Division of Pediatric Gastroenterology, Children’s Hospital of NY-Presbyterian, New York, NY, Colombia University Medical Center; updated by Thomas Wallach M.D., Chief, Pediatric Gastroenterology, SUNY Downstate Health Sciences University; edited by Jose M Garza M.D., Medical director, Neurogastroenterology and Motility, Children’s Healthcare of Atlanta. Partner at Gi Care for Kids, Atlanta, GA.