Definition & Facts

What is constipation in children?

Constipation in children is a condition in which a child may have

• fewer than two bowel movements a week
• bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass

In most cases, constipation in children lasts a short time and is not dangerous.

How common is constipation in children?

Almost 5 percent of visits to pediatricians are for constipation. About 25 percent of the children who visit gastroenterologists are constipated.¹

What are the complications of constipation in children?

Constipation can lead to health problems such as fecal impaction, anal fissures, or rectal prolapse.

Fecal impaction

Fecal impaction happens when hard stool packs a child’s intestine and rectum so tightly that the normal pushing action of the colon is not enough to push the stool out.

Anal fissures

Anal fissures are small tears in the anus that may cause itching, pain, or bleeding.

Rectal prolapse

Rectal prolapse happens when a child’s rectum slips so that it sticks out from his or her anus. Rectal prolapse in children is not common in developed countries.² Rectal prolapse can happen if a child strains during bowel movements, among other reasons. Rectal prolapse may cause mucus to leak from the child’s anus.

References

Symptoms & Causes

What are the symptoms of constipation in children?

If a child is constipated, he or she may have the following symptoms:

Posturing or changing positions

Posturing or changing positions can show that a child is trying to hold in stool or is constipated. When a child postures or changes position, he or she may

• stand on tiptoes and then rock back on his or her heels
• clench his or her buttocks muscles
• do unusual, dancelike movements

Parents or caretakers often mistake these postures as ways to try and have a bowel movement.

Abdominal pain and bloating

A child may feel pain or bloating in his or her abdomen.

Stool in a child’s underwear

If a child delays having a bowel movement, he or she may develop a large amount of stool in the rectum—something health care professionals call a fecal impaction. Some of this stool may leak and soil a child’s underwear. Parents or caretakers often mistake this soiling as a sign of diarrhea.

Urinary incontinence

Stool in a child’s colon can press against his or her bladder. This pressure may cause daytime or nighttime wetting called urinary incontinence.

When should a child with constipation see a doctor?

A child should see a doctor if his or her symptoms of constipation last for more than 2 weeks. You should take a child to see a doctor right away if he or she has one or more of the following symptoms:

• fever
• vomiting
• blood in his or her stool
• a swollen abdomen
• weight loss

What causes constipation in children?

Constipation happens when stool stays too long in a child’s colon. Causes of constipation in children may include the following:

Ignoring the urge to have a bowel movement

Children most often get constipated from holding in stool. When a child holds in stool, the colon absorbs too much fluid and his or her stool becomes hard, dry, and difficult to pass.

Children may hold in stool because they

• are feeling stressed about potty training
• are embarrassed to use a public bathroom
• do not want to interrupt playtime
• are worried about having a painful or an unpleasant bowel movement

Diets low in fiber

Another common cause of constipation in children is a diet with too little fiber. Fiber helps stool stay soft so that it moves smoothly through a child’s colon. Liquids such as water and juice help fiber work better.

Medicines

Some medicines that doctors prescribe to treat other health problems can cause constipation in children. Medicines that can cause constipation in children include

• antacids—used to neutralize stomach acid—that contain aluminum and calcium
• anticholinergics—used to treat muscle spasms in the intestines
• narcotics—used to treat severe pain
• some medicines used to treat depression

Certain health problems

Certain health problems can make stool move more slowly through a child’s colon, rectum, or anus, causing constipation:

• Hirschsprung disease—a birth defect in which the large intestine lacks some nerve cells. The signals that tell your muscles to push stool along are missing, so stool stays in the large intestine and causes blockage.
• obstructions that block part of the lower gastrointestinal (GI) tract
• tumors or narrowing of the GI tract

Functional GI disorders

Functional GI disorders happen when something changes the way a child’s GI tract works, yet doesn’t cause damage. Functional constipation happens when the muscles in a child’s colon or anus move stool more slowly, and it often happens during one of three times:

• when infants transition from breast milk to formula or when they start eating solid foods
• when parents or caretakers are potty training toddlers, and toddlers are learning how to control bowel movements
• when children start school and avoid using the bathroom at school for bowel movements

Irritable bowel syndrome (IBS) is also a functional GI disorder. Children with IBS can be constipated.

Diagnosis

How do doctors diagnose constipation in children?

To find out why a child is constipated, the child’s doctor will take a medical history and perform a physical exam, and may order tests.

Medical history

The medical history will include questions about the child’s constipation, such as

• what are the child’s bowel movement patterns, including how often the child has bowel movements
• when the first bowel movement after birth happened
• what are the child’s eating habits, including when and what the child most often eats and drinks
• what are the child’s social situations like, including
  • his or her day care attendance
  • his or her potty training
• whether the child has any health problems
• whether the child is taking medicine that can cause constipation
• what is the family’s history of constipation

Doctors primarily use a child’s medical history to diagnose functional constipation. The child’s history and symptoms may be different depending on his or her age.

Physical exam

During a physical exam, a doctor will listen for bowel sounds and feel the child’s abdomen for

• swelling
• tenderness
• masses, or lumps

The physical exam may include a rectal exam. After putting on a glove, a doctor will slide a lubricated finger into a child’s anus to check for tenderness, blockage, or blood.

Diagnostic tests

Since functional constipation is so common in children, doctors do not normally use diagnostic tests for children with constipation unless they do not respond to treatment or the doctor suspects a specific cause.

What tests do doctors use to diagnose constipation in children?

A doctor may use one or more of the following tests to diagnose constipation:

Blood test

A blood test might show an abnormality, such as anemia, indicating that a disease might be the cause of a child’s constipation.

X-ray

A doctor may order an x-ray of the child’s abdomen to look for problems causing the constipation. The child will lie on a table or stand during the x-ray. A health care professional positions the x-ray machine over the child’s abdomen. The child will hold his or her breath while the health care professional takes the x-ray so that the picture will not be blurry. The health care professional may ask the child to change position for more x-rays.

Treatment

How do doctors treat constipation in children?

Parents or caretakers can most often treat a child at home. However, if a child does not respond to treatment, call the child’s doctor. Treatment for constipation in children may include changes in eating, diet, and nutrition; behavioral changes; and enemas and laxatives:

Changes in eating, diet, and nutrition

Changes in a child’s eating, diet, and nutrition can treat constipation. These changes include

• drinking liquids throughout the day. A health care professional can recommend how much and what kind of liquids a child should drink.
• eating more fruits and vegetables.
• eating more fiber.

Read what a child should eat to help prevent and relieve constipation and foods to avoid if a child is constipated.

Behavioral changes

Changing a child’s patterns and behaviors about having bowel movements can help treat constipation. You can help the child by

• encouraging older children to use the toilet shortly after meals to build a routine
• using a reward system when children use the bathroom regularly
• taking a break from potty training until the constipation stops

Enemas and laxatives

Some children need to have an enema or take medicines to treat constipation. Most often, a doctor will first recommend using an enema. Cleansing a child’s bowel with an enema flushes water or a laxative into his or her anus using a special squirt bottle, which helps the child pass stool.

A doctor may prescribe a laxative for a child to take by mouth until his or her bowel movements are normal. Laxatives clean out the bowel and help a child have a bowel movement. Once a child has better eating and bowel habits, the doctor will recommend stopping the laxative. If you stop giving a child the laxative too soon then the child could become constipated again. You should not give a child laxatives unless told to do so by a doctor.

How do doctors treat complications of constipation in children?

Doctors can treat or recommend how to treat complications of constipation in children. Fecal impaction, anal fissures, and rectal prolapse all have different treatments.

Fecal impaction

Talk with the child’s doctor for how to treat fecal impaction in a child under 2 years old.

For a child who is 2 years old or older, you can soften his or her fecal impaction with mineral oil that he or she takes by mouth or through an enema. A health care professional may then recommend that you bring the child in to the doctor’s office. The health care professional can break up and remove part of the hardened stool by inserting one or two gloved, lubricated fingers into the child’s anus.

Anal fissures

You can treat a child’s anal fissures by

• making changes in his or her diet to prevent constipation
• applying over-the-counter anesthetic cream to numb the area or relax his or her muscles
• using stool softeners
• having him or her take warm tub baths to soothe the area

Rectal prolapse

A child’s doctor may be able to treat rectal prolapse during an office visit by manually pushing the rectum back through the child’s anus. Helping a child prevent constipation is the best way to prevent rectal prolapse.

Eating, Diet, & Nutrition

How can a child's diet help prevent or relieve constipation?

A child should drink water and other fluids, such as fruit and vegetable juices and clear soups, to help the fiber in his or her diet work better. This change should make the child’s stools more normal and regular. A doctor can help you plan a diet with the appropriate amount of fiber to help treat a child with constipation. A list of high-fiber foods appears below. Use this table as a tool to help replace less healthy foods with foods that have fiber.

Children ages 1 to 18, depending on their age and sex, should get 14 to 31 grams of fiber a day.³ Fiber guidelines are not available for infants less than 1 year old, who normally eat little to no solid food yet. Talk with the infant’s doctor about possibly breastfeeding the infant or what kind of foods he or she should eat.

What should my child avoid eating if he or she is constipated?

If a child is constipated, try not to give him or her too many foods with little or no fiber, such as

• ?cheese
• chips
• fast food
• ice cream
• meat
• prepared foods, such as some frozen meals and snack foods, such as saltine or animal crackers, angel food cake, and vanilla wafers
• processed foods, such as hot dogs or some microwavable dinners, such as pizza, Salisbury steak, and pot pie?

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.??