CONSTIPATION

What is constipation?

Constipation is when your child has hard, infrequent poo - it's a common problem in childhood.

Making sure your child has plenty of water to drink, and enough fibre in their diet, can help prevent constipation, but not treating it once established.

constipation is when your child has hard, infrequent poo
it is a common problem in childhood
constipation often starts after 1 hard poo has caused pain and so your child has tried to avoid pain the next time by 'holding on' to the poo, resulting in a vicious cycle
increasing the fluid your child drinks and the amount of fibre in their diet can help prevent constipation
laxatives are often necessary - they work by making the poo softer and easier to poo out
sitting on the toilet regularly is important
children often need laxatives for months and sometimes years to manage the problem

What is normal poo?

There is a wide range of normal pooing for breastfed babies. They may poo as often as after every feed or as infrequently as once in 10 days. Breastfed babies' poo is mustard yellow, soft and can look like it has seeds in it.
Most bottle-fed babies and older children will have a poo every day or every second day. Some have more than one poo a day. The poo should be like a soft sausage.

What is constipation?

If your child of any age has firm, hard or painful poo, they are likely to be constipated. If children are not breastfeeding and are pooing less than every 3 days, they are likely to be constipated.

What are the signs and symptoms of constipation?

Your child may be constipated if they have some of the following:

large and hard poo
hard 'pebble-like' poo
no poo for 3 or more days
pain or crying when having a poo
bright blood around the poo due to tears in the skin around the anus (anal fissures)
tummy pain
urinary tract infections, wetting pants (urine incontinence), bedwetting - constipation can increase the risk of these
liquid poo that may leak out at times in between harder poo
soiling accidents (encopresis)

What causes constipation?

Constipation in children is common.

There are many possible reasons for your child's constipation. Often, it is several things:

weaning from breastmilk to formula
starting solids
not having enough fibre (vegetables, fruits, whole grains) - ready-made food and takeaways are low in fibre
not doing much physical activity
not eating and drinking as much as normal, for example when your child is unwell
a natural tendency to having slower gut movement

Toileting habits are important. Your child can become constipated if they:

ignore the urge to do a poo
don't let all the poo come out when going to the toilet
don't sit on the toilet regularly

How can constipation cause a vicious cycle?

Constipation often starts after 1 hard poo has caused pain. The natural response to a painful experience is to try and avoid or escape it in the future. So, the next time your child feels the urge to poo, they 'hold on' in an attempt to avoid passing another painful poo. This results in the poo becoming firmer, larger and even more painful to poo out and your child becomes even more reluctant to poo in the future.
This leads to a vicious cycle.
The key to stopping this cycle is making the poo soft again.

What if constipation continues for a long time?

If constipation continues for a long time and all the poo doesn't come out, the bowel can become overloaded and stretched. The overloaded and stretched bowel means the feeling of needing to do a poo is lost and can cause soiling accidents.

Could childhood constipation be due to an abnormal bowel?

Constipation is hardly ever due to an abnormal bowel. Most bowel problems show up in early life and are diagnosed within the first few months. Occasionally, constipation in children can be due to coeliac disease.

If your child passed meconium (the green/black poo newborn babies pass) within 24 hours of birth, it is unlikely your child has a bowel problem causing constipation.

Your doctor may suggest your child sees a specialist nurse or doctor if:

your child's constipation is proving difficult to treat after standard treatments or,
your doctor thinks there may be another condition causing your child's constipation

Constipation Treatment

The aim is for your child to do 1 soft formed poo every day. You can try some simple measures first for your child's constipation. If those don't work, your child will need help from laxatives.

Key points to remember about constipation treatment

Use adequate dose of Laxatives
encourage your child to sit on the toilet whenever they feel urge and for 5 minutes once-twice a day following meals.
increase your child's fluid, fibre and exercise

What toileting habits should I encourage for my child?

Encourage your child to sit on the toilet for 5 minutes twice a day about 10 minutes after a meal (breakfast and dinner). Even if they don't do a poo, still encourage this.

make sure your child is comfortable on the toilet
get a stool for them to rest their feet on to make sure your child's knees are higher than their hips
use a child's toilet seat for preschoolers - if your child is not relaxed because they're worried about falling into the toilet, this makes it difficult to have a relaxed successful poo
encourage your child to lean forward and rest their elbows on their knees
teach them to push their tummy out when trying to poo
make the toilet interesting and child-friendly with books and toys
incentive or 'star' charts can help encourage your child to sit on the toilet even if they don't always do a poo

When should I take my child to the doctor for constipation?

You should take your child to your doctor if:

simple measures and good toileting habits haven't worked
your child has had constipation for a long time
your child has tummy pain
your child is pooing their pants (soiling)

If your child has any of the above, it usually means their constipation is more severe and they need medicine for constipation.

What are laxatives?

Laxatives are medicines that help the body to get rid of poo. They are an essential part of the treatment of long-lasting constipation and soiling. Most are available to buy at a pharmacy but it may be better to go to your doctor first. Your doctor can give you advice about the best laxative for your child and how much to give them. Your doctor can also give you a prescription which usually means you won't have to pay for the laxative.

There are 3 ways laxatives for childhood constipation work:

Poo softeners- soften the hard poo and make it easier to do
Stimulants- Help the bowel push the poo out (Bisacodyl, Dulcolax)
Bowel Wash out -Wash the bowel out completely (Picosalax)

How long are laxatives for constipation necessary?

For as long as it takes. Children often need laxatives for months to years rather than weeks.

Remember that the purpose of laxatives is to allow your child to develop a normal habit of pooing regularly.

Ideally, your child should aim for 1 soft formed poo that is not painful to do, every day. Laxatives are necessary until the body can manage this without help. You may need to adjust the dose over time, but it is important to continue the laxative treatment.

Often children get sick of taking medicine, or dislike the taste. Try to make the medicine taste better by putting it with milk or juice, or ask your doctor or nurse about an alternative laxative. Incentive or 'star charts' can be a good way of encouraging your child to take medicine regularly.

Enemas and suppositories for constipation

These are medicines given into the bottom to help to empty the lower bowel. This can be an unpleasant experience for children, causing pain and embarrassment. They are generally avoided in children and should only be used under medical direction.

Bowel washout for constipation

If your child has had constipation for a long time, your doctor may recommend emptying the bowel of poo. This is often necessary to allow the bowel to return to a normal size. It is called disimpaction - a washout of the bowel contents. A bowel washout is always just one part of your child's overall treatment - the first part. It is never a standalone treatment. In fact, if your child needs a washout, they will usually need a long course of laxatives. Eventually, they can be weaned off the laxatives and on to a high fibre diet.
A bowel washout usually involves giving a powerful laxative solution (such as sodium picosulphate or Molaxolw). Your child will need to drink the solution until the bowel is emptied. Because of the volumes necessary for some of these treatments, your child may need to go to hospital to have the laxative solution through a nasogastric tube.