What is constipation?

Constipation is when there is difficulty in emptying the bowels, usually associates with hardened faeces.

How common is this in children and what contributes to it?

• It is a common problem in children but is usually temporary.
• Factors promoting constipation are:
  • Inadequate fluid intake.
  • Inadequate fiber in diet.
  • Lack of exercise.
  • Resisting the urge to have a bowel movement.
  • Underlying illnesses eg Hirschprung disease or hypothyrodism.
  • Medications eg narcotic analgesic.

How do I know if my child has constipation?

Signs and symptoms include:

• No bowel movement for days or passing stools that are hard and dry.
• Cramping abdominal pain.
• Painful defaecation process as manifested by clenching buttocks, rocking up and down on toes, and turning red in the face.
• Faecal soiling (known as encopresis) of child’s underwear.

What problems can it cause?

• Small tears in anal area (known as anal fissures) which can bleed and cause pain.
• Refusal to have a bowel movement.
• Social embarassment from faecal soiling.
• Complications arising from underlying illnesses eg intestinal obstruction in Hirschprung disease.

How is constipation in a child managed?

Evaluation

• Important to evaluate situation to exclude and treat underlying illnesses.

Diet

• Increase fluid and fiber (found in fruits, vegetables and whole-grain cereals) in diet for older children.
• In young babies who are not yet on solids, ensuring adequate milk intake is important. A change of formula in formula fed babies may be considered after consultation with the doctor.

Toilet retraining

• To reestablish a regular bathroom routine.

Exercise

• Getting more exercise may also be helpful.

Medication

• If condition is serious, oral laxative to soften the stool or an enema to remove it may be prescribed by the doctor as initial therapy.

How is toilet retraining done?

• Child should sit on the toilet on a daily basis for at least 15 minutes.
• During this time he can read a book.
• Consistency, patience and persistence are necessary to succeed.

How can this constipation be prevented?

• High fiber and adequate fluids in diet.
• Exercise.
• Bowel habit training.

What are the warning signs to be aware of?
Consult your doctor if:

• Episodes last more than 8 weeks.
• Child is restricted in normal activities.
• Anal fissures occur.
• Small amount of intestinal lining protrudes through the anus (including haemorrhoids).
• Inability to expel stool from anus.
• Presence of encopresis.