Constipation in children is often caused by infrequent stools or hard, dry stools.
There are several factors that can cause constipation in children. Common causes include early control of sphincters and dietary modifications. However, most cases of constipation in children are temporary.
It is recommended to encourage the child to make simple changes in diet – eat fruits and vegetables rich in fiber and drink more fluids – until the constipation has completely disappeared.
If the doctor agrees, sometimes constipation in children can also be treated with laxatives.
- Less than three evacuations a week.
- Stool hard, dry and difficult to evacuate.
- Pain with defecation.
- Abdominal pain.
- The traces of liquid or clay-like stool in underwear.
- Blood on the surface of hard stools.
- Fear of evacuation due to pain or irritation.
Constipation occurs most often when the waste or stool moves slowly through the digestive tract, causing the stool to become hard and dry.
There are several causes that can contribute to childhood constipation:
Retention. The child may overlook the need to have a bowel movement because of fear of going to the bathroom or not wanting to take a break from the game.
Some children retain the need to evacuate when they are away from home, because they are uncomfortable when using public restrooms. Painful stools caused by large, hard stools can also lead to retention.
Early spiders . If potty training is started too early, the child may rebel and keep stool down.
Sphincter control can turn into a battle of wills, and a conscious decision to ignore the urge to defecate can quickly become an involuntary habit difficult to change.
The changes in the diet . Not eating enough fruits and vegetables rich in fiber or liquids can cause constipation.
One of the most common times for children to suffer from constipation is when changing from a liquid diet to a solid diet.
The changes in the routine . Any change in the child’s routine – such as travel, heat or stress – can affect bowel function.
Children are also more likely to experience constipation when they start school outside the home.
Drugs . Certain antidepressants and other medications can contribute to constipation.
Lactose intolerance . An allergy to milk or consuming too many dairy products (cheese) sometimes leads to constipation.
Family history . Children who have relatives who have experienced constipation are more likely to develop the same condition.
This may be due to shared genetic or environmental factors.
Medical conditions . Rarely, constipation in children indicates an anatomical malformation, a metabolic problem or in the digestive system, or another underlying condition.
Exams and Diagnosis
Conduct a physical examination . During the physical examination, a gloved finger may be placed in the child’s anus to detect abnormalities or the presence of retained stools.
A stool test may be done on the stool found in the rectum. The most extensive tests are usually reserved for the most severe cases of constipation. For example:
Abdominal x-ray . It is a standard x-ray test, which allows the doctor to see if there is any obstruction in the child’s abdomen.
The ano-rectal manometry or mobility test . In this test, a thin tube called a catheter is placed in the rectum to measure the coordination of the muscles you use to remove stool.
X-ray barium enema . In this test, the lining of the intestine is coated with a contrast dye (barium) so that the rectum, colon, and sometimes part of the small intestine can be clearly seen on an x-ray plate.
Rectal biopsy . In this test, a small sample of tissue is taken from the lining of the rectum to see if the nerve cells are normal.
Study of transit or study marker . In this test, the child swallows a capsule that contains markers that appear on x-rays. The doctor discusses how the markers move through the digestive tract.
Blood tests . Occasionally, blood tests are performed, such as a thyroid panel.
Fiber supplements or stool softeners
If the child does not receive a large amount of fiber in their diet, an over-the-counter fiber supplement, such as Metamucil or Citrucel, can be added to it.
However, the child needs to drink at least 32 ounces (approximately 1 liter) of water per day for the products to work properly.
Glycerin suppositories can be used to soften stools in children who can not swallow pills.
A laxative or an enema
If an accumulation of fecal material creates an obstruction, the doctor may recommend a laxative or an enema to help eliminate the obstacle, for example: polyethylene glycol (Glycolax, Miralax) and mineral oil.
Never give a child a laxative or an enema without instructions from the doctor about the proper dose.
Occasionally, a child may be severely constipated, to the point that he must be hospitalized for a short time in order to have a stronger enema that cleans the bowels. This is known as disimpaction .
The treatment of constipation in children requires patience, dedication and time. The first consultations are very important to clarify and demystify the cause of the problem.
The treatment should not be started without a complete evacuation.
Modifying the child’s behavior, to achieve a regular evacuation is often the most difficult to achieve.