Introduction
Constipation is when poo becomes too hard and difficult to pass through the rectum when your child goes to the toilet. Constipation can be very painful and upsetting for children, especially when it goes on for a long time.
Constipation is a common problem in children and can be caused by not having enough fibre or water in the diet or holding onto poo for too long.
Medical issues rarely cause constipation, but it can be a side effect of some medications.
Signs and symptoms
Constipation can cause your child to:
- have stomach cramps that can come and go
- feel pain or sharpness when trying to go to the toilet
- feel less hungry than usual
- have irritable behaviour
- push and strain more than normal when going to the toilet
- develop anal fissures, which are small splits of the skin around the anus, when pushing out a poo.
Children who have ongoing discomfort with constipation can develop “holding on” behaviours to avoid pain.
They might do things like:
- squatting
- crossing their legs tightly
- refusing to sit on the toilet
- hiding when they need to do a poo.
Holding on can make constipation worse. This is because the poo sits in the bowel for longer and gets harder as all the water is absorbed into the body.
Diagnosis
Your child’s doctor can diagnose constipation based on your child’s signs and symptoms and a physical examination.
Treatment
Treatment of constipation involves passing the hard poo that is stuck in the bowel, then making sure the bowel is healthy to avoid constipation from happening again.
If your child is constipated for too long, their bowel might stretch out and not work properly. If this happens, your child will probably become constipated again as their bowel cannot move the poo through well enough.
To treat constipation, you can:
- increase fibre in your child’s diet with fruit like apples, pears, prunes and legumes like lentils and kidney beans
- increase your child’s water intake to help bulk out the fibre and make their poo soft and easy to pass
- help your child to do some movement or exercise each day to get their bowel moving.
Severe cases of constipation may need to be treated by removing poo using enemas, stool softeners or laxatives.
See your local doctor if your child has more severe constipation, including impacted faeces. They can give you information on safe medications to help with constipation.
Management
What is normal in babies and older children
Babies under 12 months old have a wide variety in the colour, texture, and regularity of their poo.
Constipation in babies under 12 months is very common and is usually caused by a change in diet or getting used to new foods.
Speak to your doctor if you are concerned about constipation in a baby under 12 months old.
Older children can also have a wide variety in how often they poo. Some children can poo three or four times a day, and others may go twice a week without any problems. Pay attention to what is normal for your child.
To get an idea of whether your child has a healthy poo, have a look at the shape and texture and compare it to the Bristol Stool Chart:
Soiling and encopresis
Encopresis is also called soiling. It is a condition where children have runny poo that they can’t control due to unknown severe constipation. This happens when there is a build-up of loose, liquid poo that leaks around the hard, older poo that is stuck in the bowel.
Signs of encopresis include:
- leakage of liquid poo, which can be mistaken for diarrhoea
- smears or “skid marks” of poo on underwear or clothing
- lack of appetite and nausea
- longer than regular periods between doing a poo
- fear and anxiety around doing a poo
- unusually large, painful poos.
Speak to your doctor if your child shows signs of encopresis or soiling. Treatment involves medication, diet, and behaviour changes and can often take a long time.
Healthy bowel habits
Healthy habits for good bowel health include:
Water
School-age children should drink around 4-6 cups of fluid daily, more if thirsty, unwell, active or in hot weather.
Children should be encouraged to drink water at an even pace throughout the day and avoid drinking large amounts right before bedtime.
Water is the best type of fluid, but your child can also keep their fluids up through things like:
- milk
- yoghurt
- watery fruits and vegetables.
It’s important to limit things like sugar, caffeine, and fizzy drinks, as these can irritate the bladder.
Fibre
Dietary fibre includes parts of foods that the body cannot break down and digest. Fibre and water make poo bulky, soft, and easy to pass out of the body.
You can find fibre in:
- multi or wholegrain breads
- fruit
- vegetables
- legumes
- nuts
- seeds.
Prunes and pears are very high in fibre and are often used to treat constipation in children. Your child can try them as puree or juice if they are struggling to do a poo.
It is important to ensure you increase your child’s water intake when you increase their fibre intake. Too much fibre without enough water can make constipation worse.
Exercise
Gentle movement and exercise are good for the body and help get the bowel muscles moving. Walking, stretching, and swimming are all great ways to keep your child’s body and bowel active.
Healthy toilet habits
Healthy toilet habits are behaviours you can encourage to help your child avoid constipation.
They include:
- reminding your child to go to the toilet when they feel the urge to go
- avoiding "holding on" to a poo
- avoiding doing a wee "just in case"
- using a footstool to prop the knees up higher than the hips while sitting on the toilet to relax the muscles around the bowel and help poo to pass more easily
- giving your child lots of positive praise and encouragement during toilet training and when they are struggling with constipation.
Resources and more information
