Constipation is a very common medical problem encountered in children — and the good news is, it’s often temporary. A child with constipation has infrequent bowel movements and/or hard, dry stools.
While constipation can be prevented and treated, if left unaddressed, the problem can lead to anal fissures, stool accidents — secondary to impaction of stool in lower large intestine — and rarely, rectal prolapse, where rectum comes out of the anal canal.
The Signs and Symptoms You Need to Know
These may indicate that your child could have constipation:
— Less than three bowel movements in a week or hard stools that are difficult to pass.
— Pain associated with bowel movement or lower abdominal pain prior to, or along with, hard stools.
— Passing large diameter stools that clog up toilets.
— Large stools with streaks of bright blood, which can suggest anal fissure.
— Having stool accidents in underwear — this often appears as soft or pasty, or occasionally, as loose, clay-colored stools. These symptoms are suggestive of being impacted by stool in the lower colon.
— Avoidance of bowel movement due to fear that it may hurt — this may lead to withholding behavior. Children in this setting may cross their legs, clench their bottom, grimace or make faces trying to withhold.
[See: What to Eat, Drink and Do to Relieve Constipation.]
Reasons Your Child May Become Constipated
Constipation occurs when contents transit slower and normal through the digestive tract, especially through the large bowel. This causes more water to be absorbed back into the body, making stools harder. Once stools become large, it hurts when the child passes them, leading to withholding behavior and further worsening of constipation. There are three periods in a child’s life that are prone for constipation:
— Toilet training: This time period can be can be stressful to some children, especially if they’re forced or started too soon. This can lead to involuntary withholding behavior.
— Starting school in children: Children often avoid using toilets in school, leading to constipation.
— Starting weaning foods: This leads to change in stool consistencies in some infants, as well as harder stools, pain associated with bowel movements and withholding.
Dietary habits, especially foods with less fiber, make children prone to constipation. Less than optimal fluid as well as excess dairy consumption also make your child prone for constipation. Changes in routine, especially travel, as well as stress and hot weather may also increase your child’s risk. Children with positive family history of constipation are more likely to experience it, suggesting environmental and possibly genetic factors. Medications like anti-depressants, ADHD medications and others may also contribute to constipation, and it’s also more likely in children who are sedentary. Anatomic disorders like ano-rectal malformations and neural disorders like Hirschsprung’s disease are rare causes of constipation.
[See: How Often Should I Poop, and Other Toilet Topics.]
How to Control Constipation
Encouraging a higher fiber diet with balanced amounts of fruits and vegetables and adequate water intake is the first step toward prevention of constipation. Your child may need to be offered a variety of foods to increase fiber intake. It’s also important to ensure that your child maintains a certain level of physical activity. Toilet routine is crucial, and we recommend that parents remind children to sit on toilet for few minutes after a meal, especially if they have the tendency for constipation. If your child is taking medications, review them with your pediatrician to see if your child could become constipated with any of them.
When Should You Seek Help?
More often than not, constipation can be managed by increasing fiber and changing your child’s diet. However, if the constipation lasts more than two weeks, if the child has blood in his or her stool, if there are concerns for anal fissure, if there’s consistent observation of stool accidents in underwear or if there are concerns for rectal prolapse, it is prudent to seek medical opinion for evaluation and management.
When seeking medical care, the doctor will take a detailed medical history including dietary habits and bowel habits and perform a medical examination. This may include a rectal examination to look for abnormalities and for stool in the rectum. Further evaluation may include blood tests — especially tests for the thyroid — an X-ray of the abdomen and a motility test (to measure pressure changes in the rectum and anal canal). Other tests, such as a barium enema (to evaluate anatomy) or a rectal biopsy (to look for presence of neural cells) may be requested by your child’s doctor.
[See: Foods That Cause Bloating.]
Management of constipation requires prolonged courses of intervention, persistence and patience. Short courses of management or premature termination of treatment often results in a relapse of symptoms and worsening of constipation. Your child’s doctor may prescribe a trial of an over-the-counter soluble fiber source if the symptoms are not severe. If your child has stool impaction or accidents, treatment with a laxative like polyethylene glycol or lactulose may be prescribed by the doctor. In younger children, glycerin suppository may help alleviate stool impaction. Sometimes, children may require an enema to help with stool impaction, followed by treatment with laxatives as advised by your doctor. Occasionally, a child may require admission to the hospital for a medically supervised clean out, using larger doses of laxatives for severe stool impaction. During the treatment course, it very important that parents are patient with the child and do not induce guilt. Lastly, it’s necessary to talk with your child’s doctor regarding concerns with medication and treatment courses before stopping treatment.
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Toilet Troubles: What to Do if Your Child Struggles With Constipation originally appeared on usnews.com
