Introduction
Constipation is when poo becomes hard and difficult to pass out of the bowel.
The bowel is the lower part of your child’s digestive system and is responsible for making, storing, and passing waste, or poo.
Constipation can be very painful and upsetting for children, especially when it goes on for a long time. It can be common, and caused by many different things including:
- not eating enough fibre
- not drinking enough water
- holding on to poo for too long without going to the toilet
- some medications
- rarely, another health issue.
Constipation can cause serious issues if it is left for too long without treatment.
Signs and symptoms
Constipation can cause your child to:
- lose control of their bladder and urine
- 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 may start to “hold on” to avoid the pain that is associated with going to the toilet.
They might do things to stop a poo from coming out, 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 will be able to diagnose constipation based on:
- signs and symptoms
- a physical check
- their medical history.
Treatment
Constipation is treated by:
- helping the hard poo to pass out of the body
- making sure the bowel is healthy to prevent it from happening again.
Constipation that is severe or left untreated for too long can stretch out the bowel. When the bowel is stretched, it may not be able to move poo out of the body properly. This can cause constipation to happen regularly.
Treatment at home
To treat mild to moderate constipation at home:
- 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 kind of movement or exercise each day to get their bowel moving
- see your local doctor if it does not improve or gets worse.
Treatment with your local doctor
Children with severe constipation may need medical treatment to remove poo from their bowel.
This may include:
- enemas – to flush out the poo
- stool softeners – to make the poo softer
- laxatives – medications that soften poo and force the bowel to move.
See your local doctor if your child has a more severe case of constipation, including impacted faeces. They will be able to give you information on safe medications to help with constipation.
Management
What is normal poo
Babies under 12 months old can have differences in their poo. Including:
- colour
- texture
- frequency
- smell.
Constipation in babies under 12 months is very common and is usually caused by a change in diet or getting used to new foods.
Older children can also poo at different frequencies. Some children can poo two to three times a day, while others may go twice a week without any problems.
Pay attention to what is regular for your child and speak to your local doctor if you have any concerns.
The Bristol Stool Chart can help you identify sudden changes to poo.
Soiling and encopresis
Encopresis is also called soiling. It is a condition where children have runny poo that they can’t control. This is usually due to severe constipation that has not been diagnosed.
Severe constipation causes a build-up of loose, liquid poo around the hard, older poo that is stuck in the bowel. The liquid poo can escape through cracks and passages in the constipation, causing soiling.
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 normal periods between doing a poo
- fear and anxiety around doing a poo
- unusually large, painful poos.
Speak to your doctor if your child is showing signs of encopresis or soiling. Treatment can take a long time and involves:
- medication
- diet changes
- behaviour changes.
Fluids and bowel health
School-age children should drink around 4-6 cups of fluid a day, more if they are:
- thirsty
- unwell
- active
- in hot weather.
Encourage your child 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 that can irritate the bladder, like:
- sugar
- caffeine
- fizzy drinks.
Fibre and bowel health
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.
Prune and pear puree and juice are high in fibre and are often used to help children with constipation. Remember to increase water intake, or constipation could get worse.
Exercise and bowel health
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 can help your child avoid constipation.
They include:
- encouraging 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"
- use 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
