Constipation In Children 

Constipation is a very common problem in kids and turns out to be one of the most common reasons while children get recurrent stomach aches.  Constipation is when stool (i.e. poop) is firm/hard or painful.  Other common signs of constipation that may be present are when children:  

·        Have large stools that clog the toilet

·        Strain with bowel movements (although often not for the reason parents think!)

·        Have recurrent soiling of the underwear (small poop stains)

·        Have recurrent stomach aches, especially after eating

 Children can have occasional loose stools and still be constipated!

Fear Of Stooling

Children can become constipated at any age although it might be more common to happen in the following situations (when children associate pain or fear with stooling):  

·        following a stomach virus or bad diaper rash

·        at the time of potty training if a child is pressured to start too early or has fear of sitting on the toilet (it can be scary for a toddler!)

·        when starting school when not enough time is allowed for stooling or if the school bathroom seems to be a scary place

What Happens In Constipation

The vicious cycle of constipation is one that surprises many parents but it is important to understand it to understand how the problem happens, why it easily becomes chronic and why it takes treatment usually for months to get better when it has been chronic.  The problem becomes both a mental and a physical problem:

Mentally –

·        Adults know the basic fact that “If I poop today, it won’t hurt tomorrow”

·        Children, however, will reason “It hurts to poop, so I just won’t do it!” and a vicious cycle will follow (even some adults with constipation may fall into this thought process and “shortchange” themselves on necessary toilet time)

·        This is where the straining part comes in: parents may see their kids “straining” with bowel movements.  They are usually not straining to poop, THEY ARE STRAINING TO HOLD IT IN!!

Physically –

          After holding in stool for a long period of time, the rectum (the end of the intestines where the poop collects) gets stretched and swollen, it’s muscles thick and it collects large volumes of stool.  

This leads to:

·        Less sensitivity to the urge to poop which perpetuates the cycle of holding it in!

·        Periodic large stools that might clog the toilet

·        Intermittent loose stool or diarrhea – as some liquid stool leaks around the “dam” of poop that hangs out in the rectum

·        Staining of the underwear as the “iceberg” of poop in the rectum pokes out the bottom when the child tries to hold it in or leaks out without the child being able to control it.

Parents often get mad at their kids when they stain their underwear thinking they are doing it out of laziness or even maliciousness.  But as you can see from the information above, it is not the child’s fault, they can’t control it and they are embarrassed about it.  Also after this happens for awhile they get used to the smell and feeling so they aren’t even aware of it!

So because long standing constipation creates vicious cycles both physically and mentally, it can take months to help a child get over these habits when they occur chronically.  There are some dietary and behavior things that you can do at home, but if the problem persists, getting help from your doctor is crucial to break this cycle of constipation.

How to help constipation

Foods:

The best foods to help children with constipation at home are fruits and juices.  Kids like them and the types of sugar in them help your child to poop.  Normally we say we don’t recommend juice for kids because it is just a lot of sugar but for constipation it is the one time when it can help.  We say not to water it down because the sugar is what helps your child poop.

·        Fruits – Grapes, Pear, Apricot, Plum , Cherry, Peach

·        Juices – White Grape (the best!), Apple Juice (the sugar helps you to poop), Pear, Apricot, Plum , Peach

·        Popcorn is helpful (in kids who are old enough not to choke on it).  Fiber can help in general but really it is fruits and juices which help kids with constipation.

  Apples (the fruit) and bananas are constipating! (They are part of the “BRAT” diet we give when kids get diarrhea)

Toileting:

·        One of the most important and often overlooked parts of treating constipation is budgeting time every day to sit on the toilet! 

·        This is especially important because many kids who have been constipated for awhile will lose the natural urge to poop until they have recovered from the constipation!

·        The best time to sit on the toilet is after meals as your body has a natural reflex to have a bowel movement after eating (out with the old, in with the new!)

·        For kids who are constipated and only recently “toilet trained”, it might be best to go back to diapers until the constipation is better

So we would recommend sitting on the toilet for 10 minutes after breakfast and/or dinner whether or not your child feels the need to stool (this might mean getting up 10 minutes earlier for school!).  You can make this fun by letting them have a special video game, magazine or toy that they can only play with during these bathroom breaks.  By helping your child to poop regularly, without pressure and without pain, they can get over the mental block that leads to constipation.

Medications:

While proper diet and spending time on the toilet can be very helpful for constipation, many children also need medication under the care of a doctor to help them get over the vicious cycles we described above.  In nearly all cases these medicines are temporary but at the same time taking them regularly for a period of months is often necessary to break bad habits and hopefully stop the problem from returning.  We do not recommend using suppositories or enemas for kids without consulting your doctor.  If constipation is a problem for your child, discussing it with your child’s doctor for proper guidance and treatment is a good idea.