Causes Of Constipation In Children, Its Treatment & Prevention

Constipation in children occurs when they have hard stools or problems while passing a bowel motion. The common childhood problem accounts for about three to five percent of pediatric primary care visits and 10-25% gastroenterology consultations for children. Functional constipation is when the disorder continues for at least a month without any other underlying cause. It may cause discomfort, psychological problems, and reduced quality of life in children (1).

This post talks about the types of constipation in children, its symptoms, diagnosis, and management.

What Are The Types Of Constipation In Children?

Constipation is usually seen in children when they change to solid food, get potty-trained, or enter school. Constipation in children may be divided into two main types (2).

• Organic (5% of the cases)
• Functional (comprises the rest 95%)

Organic

causes of constipation are due to specific structural, neurological, metabolic, or intestinal disorders. These may include:

• Hirschsprung disease (disorder due to absence of nerves in lower part of the intestine)
• Malformation of the anorectal area
• Cystic fibrosis (genetic disease that causes damage to the lungs, digestive system, and multiple other organs)
• Metabolic disorders such as thyroid problems and electrolyte disturbances.
• Lower spinal cord abnormalities

Functional constipation is difficulty passing stools due to factors other than organic causes. In children, it is described using the Rome IV criteria. Functional constipation is defined by the presence of at least two of the following features for a minimum of one month with insufficient criteria for diagnosis of irritable bowel syndrome (3).

• Two or fewer bowel movements per week
• Excessive stool retention
• Painful or hard bowel movements
• Large fecal mass present in the rectum
• History of large-diameter bulky stools
• Greater than one incidence of fecal incontinence (leakage of liquid stool from the rectum) after completing toilet training

Constipation may also be classified as:

• Acute constipation: It is a temporary problem that occurs once in a while. It is usually harmless and gets resolved with time.
• Chronic constipation: It is constipation for a longer duration due to problems with digestion of food and elimination of waste. It may cause complications if left untreated.
• Idiopathic constipation: The term idiopathic is used when the cause is unknown.

What Are The Causes Of Constipation In Children?

Functional constipation in children can have multiple causes. If stool stays too long in the colon, much of the water gets absorbed by the colon, making the stool dry, hard, and difficult to pass (4).

Children may delay or avoid passing stools for the following reasons or scenarios.

• Stressed about potty training
• Embarrassed using a public bathroom
• Reluctant to stop playing
• Fearful of having a painful bowel movement or experiencing an unpleasant sensation during the passage of stools

Certain problems with food habits or nutrition may also cause constipation.

• Inadequate hydration from not drinking enough water or fluids
• Low-fiber diet or junk food intake

Some medications or dietary supplements may also cause constipation.

• Antacids containing aluminum and calcium
• Anticholinergics (blocks action of neurotransmitter acetylcholine) and antispasmodics (relaxes muscle spasms)
• Anticonvulsants (drugs against seizures)
• Dietary iron supplements
• Narcotic painkillers or opioids
• Certain antidepressants

What Are The Symptoms Of Constipation In Children?

The signs of constipation in children may include (4):

• Fewer than two episodes of bowel movement per week
• Passing hard, dry, or lumpy stools
• Motion is difficult to pass or painful defecation
• Child complains that not all stool has passed
• Changing positions to avoid or delay bowel movement, such as clenching the abdomen or buttocks or walking awkwardly
• Bloated or swollen abdomen
• Daytime or nighttime wetting
• Leaked liquid stool that stain underwear and looks like diarrhea
• Pain abdomen and tenderness on touching
• Bleeding per anum passing hard stools

When To See A Doctor?

It is advisable to consult a pediatrician if the child does not respond to home treatment and symptoms persist beyond two weeks. Seek immediate medical help if the following symptoms accompany constipation.

• Rectal bleeding
• Blood in the stool
• Bloating and constant abdominal pain
• Vomiting
• Weight loss

How Is Constipation Diagnosed In Children?

Your child’s healthcare provider may usually diagnose constipation by knowing the frequency of the passage of stools. The doctor may also ask parents about the texture of the stool since hard, lumpy stool also indicates constipation.

If the child has no other symptoms, the doctor may suggest treatment. If the child is in pain, has constipation for several weeks, or has other symptoms, the healthcare provider may suggest the following diagnostic tests to determine any underlying problem (5) (6).

• Blood, urine (to rule out UTI), and stool test
• Abdominal X-ray
• Use abdomen if lower GI pathology suspected
• Barium enema (X-ray after the introduction of barium sulfate contrast agent through enema)
• Manometry (check pressure, muscle strength, and reflexes in the anorectal region and colon) if hirschsprung’s disease is suspected
• Colonoscopy (inspection of the intestine with the insertion of a camera-containing tube through the anus) if any bleeding per anum

What Are The Complications Of Constipation In Children?

Chronic constipation may impact your child’s well-being and overall quality of life. The complications may include the following (1).

• Anal fissures (tearing of inner anal lining) may appear from straining and passing hard and bulky stools.
• Prolonged constipation may cause fecal impaction (blocked stools) and large bowel obstruction in severe cases.
• Involuntary overflow of stools (encopresis or fecal soiling) may result in chronic untreated cases.
• Bedwetting and urinary tract infections may occur in some children with constipation.
• Psychosocial effects, such as mood changes, depression, anxiety, or aggression, may occur in some children.
• Prolonged bleeding may lead to iron deficiency.

How To Treat Constipation In Children?

Mild constipation in children may be treated with home remedies. If the constipation is not due to any underlying health problems, the initial treatment should focus on enabling smooth bowel movements.

The treatment of constipation in children may consist of the following modalities and interventions (7) (8).

1. Good toilet routine

Encourage toilet routine in children with rewards and praises whenever they use the toilet independently or intimate you when they wish to use the toilet. Ensure the child is not in any discomfort when using the toilet. Check if the toilet seat is of the right shape, size, and height for the child to sit comfortably without worrying about falling.

2. Healthy diet

Dietary changes, such as increased dietary fibers and plenty of fluids, could improve constipation in many children. The following dietary changes may help most children with constipation.

• Include fiber-rich fruits preferably with their peels intact, such as plums, prunes, raisins, apricots, and peaches, papaya.
• Serve high-fiber vegetables such as beet, broccoli, Brussels sprouts, cabbage, carrots, green beans, green peas, and spinach.
• Avoid fast foods or refined cereals, such as corn flakes and rice bubbles, since they are low in fiber.
• The reduction of cow milk intake (if excess) may help some children.
• Increased fluid intake

3. Medications

If home remedies do not relieve your child’s constipation, you may ask the doctor to prescribe medications. Avoid using over-the-counter constipation medicines for children. The doctor may prescribe any of the following medicines, depending on several factors, such as the severity of constipation, the child’s age, and the presence of any underlying problem.

• Laxatives: These are OTC medications used to facilitate bowel movement. There are several types of laxatives. The common ones are bulk-forming (Psyllium husk), osmotic (polyethylene glycol), stimulant (bisacodyl), and stool softener (docusate).
• Suppository and enema: Suppositories are small capsules that can be inserted into the rectum for relief from constipation. An enema involves introducing fluid into the rectum with relevant fluid injectors. The use of suppository and enema could require some skill, and the child cannot use these themselves. Parents may take the doctor’s guidance and instructions on the right use of prescribed suppositories and enemas.

How To Prevent Constipation in Children?

Some dietary and lifestyle changes may help in preventing constipation in your child (9).

• Keep children well-hydrated by giving them plenty of fluids.
• Give them a variety of fiber-rich foods. Focus on providing fresh, homemade preparations than processed, ready-to-eat alternatives, which may usually be low in fiber.
• Make sure your child has adequate physical activity through sports and exercise.
• Ensure proper potty training and help your child maintain a routine of regularly sitting on the potty or toilet.
• Attend to your child’s worries about bowel movement and see that they do not feel stressed or ashamed while using the toilet at home or school.
• Maintain good urinary hygiene to avoid UTI

References

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