Digestive Topics : Constipation
Constipation is defined as either a decrease in the frequency of bowel movements, or the painful passage of bowel movements. Download the GIKids Constipation Fact Sheet to learn more about diagnosing and treating constipation.
What is constipation?
Constipation is defined as either a decrease in the frequency of bowel movements or the painful passage of bowel movements. Children 1 to 4 years of age should have a bowel movement 1 – 2 times a day but many children go at least every other day. When children are constipated for a long time, they may begin to soil their underwear. This fecal soiling is involuntary, and the child has no control over it.
How common is constipation?
Constipation is very common in children of all ages, especially during potty-training and in school-aged children. Of all visits to the pediatrician, 3% are in some way related to constipation. At least 25% of visits to a pediatric gastroenterologist are due to problems with constipation. Millions of prescriptions are written every year for laxatives and stool softeners.
Why does constipation happen?
Constipation is often defined as being organic or functional. Organic means there is an identifiable cause such as colon disease or a neurological problem. Fortunately, most constipation is functional meaning there is no identifiable cause. The constipation is still a problem, but there is usually no worrisome cause behind it.
In some infants, straining and difficulties in expelling a bowel movement (often a soft one) are due to their immature nervous system and uncoordinated defecation. Also, it should be remembered that some healthy breast-fed infants can skip several days without having a movement.
In children, constipation can begin when there are changes in the diet or routine, during toilet training, or after an illness. Occasionally, children may hold stools when they are reluctant to use unfamiliar toilet facilities. School or summer camps, with facilities that are not clean or private enough, are common triggers for withholding in this age group.
Once the child has been constipated for more than a few days, the retained stool can fill up the large intestine (the colon) and cause it to stretch. An over-stretched colon cannot work properly, and more stool is retained. Defecation becomes very painful and many children will attempt to withhold stool because of the pain. Withholding behaviors include tensing up, crossing the legs or tightening up leg/buttock muscles when the urge to have a bowel movement is felt. Many times these withholding behaviors are misinterpreted as attempts to push the stool out. Stool withholding will make constipation worse and treatment more challenging.
How does a health care provider know this is a problem for your child?
- If the child has hard or small stools that are difficult or painful to pass
- If the child consistently skips days without having normal bowel movements
- If the child has large stools that clog the toilet
- Other symptoms that can accompany constipation are stomach pain, poor appetite, crankiness, and bleeding from a fissure (tear in the anus from passing hard stool).
In most cases there is no need for testing prior to treatment for constipation. However, sometimes, depending on the severity of the problem your doctor may order X-rays or other tests to clarify the situation.
How is constipation treated?
Treatment of constipation varies according to the source of the problem and the child’s age and personality. Some children may only require changes in diet such as an increase in fiber, fresh fruits, or in the amount of water they drink each day. Other patients may require medications such as stool softeners or laxatives. Stool softeners are not habit forming and may be taken for a long time without worrisome side effects.
A few children may require an initial “clean-out” to help empty the colon of the large amount of stool. This typically entails the use of laxatives by mouth or even suppositories or enemas for a short period of time.
It is often helpful to start a bowel training routine where the child sits on the toilet for 5 – 10 minutes after every meal or before or after the evening bath. It is important to do this consistently in order to encourage good behavior habits. Praise your child for trying. If the child is not toilet trained yet, it is best to wait until constipation is under control.
Information on the Use of Miralax (PEG 3350)
At this time, there is no evidence to support serious side effects of Miralax (PEG 3350). Most commonly reported side effects include diarrhea, bloating and nausea. No psychiatric/neurological issues are reported in the scientific literature. Similar to many commonly used medications, the use of Miralax (PEG3350) is approved by FDA for adults only, due to lack of clinical trials in children. In the many years’ experience of most pediatric gastroenterologists, Miralax appears to be devoid of serious side effects. Its metabolism and long term use in children is being studied. The results from those studies are not likely to be available in the near future. Like all medications, the decision to use Miralax (PEG 3350) should be based on weighing benefits and possible unproven risks. If there is concern for the use of Miralax/PEG 3350 (for your child), please address it directly with their care provider.
Learn More about constipation: Listen to the segment on constipation for Healthy Children Radio — an educational resource offered to parents and caregivers by the American Academy of Pediatrics (AAP).
IMPORTANT REMINDER: This information from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.