Constipated children have fewer bowel movements than usual or hard, dry, painful-to-pass stools. There’s no normal number of bowel movements for everyone. Constipation is usually temporary and not serious but can cause emotional problems and family stress. It’s very common in children, slightly more boys than girls.
Causes include low-fiber diets, not drinking enough fluids, not enough exercise, and certain medicines such as over-the-counter cold medicines and antacids. Diseases including diabetes, cystic fibrosis, or Hirschsprung’s disease can cause it. Some children don’t want to have bowel movements (withhold stool) because they’re stressed about potty training or worry about having painful or unpleasant bowel movements. They may not want to stop play or are embarrassed to use public bathrooms. Other causes are starting toilet training too soon, changes in children’s routines, milk allergy, and family history.
Symptoms include no bowel movements for several days, pains and cramps in the belly (abdomen), and hard, dry, or large stools. Certain postures may mean children are withholding stool. Babies may extend their legs and squeeze anal and buttock muscles. Toddlers rise up on toes, rock back and forth, and hold legs and buttocks stiffly. Stool in underwear may mean constipation, not diarrhea. Other symptoms include poor appetite and crankiness. Sometimes children can have watery stools that look like diarrhea, as watery stool leaks past a hard stool mass in their colon. More serious symptoms that should mean a doctor’s visit include fever, vomiting, bloody stool, and weight loss.
The health care provider uses the medical history, including lifestyle changes (stress, travel, fluid intake) and medicines. The health care provider will do a physical examination, especially of the abdomen. The health care provider may also do a rectal examination (putting a gloved finger in the anus) to check for more serious problems such as hemorrhoids. Stool may be tested for blood. Only severe cases need other tests.
Treatment depends on the child’s age. If present, fecal impaction—a large, hard mass of stool in the lower abdomen—must be removed. Other measures can be simple diet changes, taking laxatives, and having healthy bowel habits. Eating more high-fiber foods, such as whole grains, beans, fruits, and vegetables should help. Water and other fluids, but not milk, will soften stool. Over-the-counter fiber supplements or stool softeners may be tried. However, laxatives or enemas shouldn’t be given without a doctor’s ok. Allow enough time and a regular routine for bowel movements. Sometimes relaxation, mental imagery, and gentle belly massage can promote bowel movements. Regular physical activity helps normal bowel function.
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