There is not one definition of constipation that applies to all children. Children with constipation may experience reduced frequency of stools, hard stools, pain with bowel movements, difficulty passing stools, or straining.
Symptoms of constipation in children include
- Fewer bowel movements than usual
- Postures that indicate withholding, such as standing on tiptoes, clenching buttock muscles, and other dance-like behaviors. Parents often mistake these behaviors as attempts to "push" or strain.
- Abdominal pain or cramping
- Painful stools
- Stools that are difficult to pass or require straining
- Hard, dry, or large stools
- Stool in the child's underwear (soiling)
Most children with constipation do not have an underlying medical problem causing their symptoms. Functional constipation describes constipation with no organic or medical cause. It accounts for more than 95 percent of constipation-related symptoms in infants and children.
Underlying medical problems or organic causes for pediatric constipation are rare. Those underlying problems can include
- Low intake of fluids or food
- Abnormal position or size of the anus
- Spinal cord disorder
- Absent nerve cells in the colon (Hirschsprungs disease)
- Celiac disease
- Muscle disease
- Low thyroid function
More commonly, functional constipation develops and leads to stool withholding due to fear of painful stool passage, fear of using a public bathroom, or ignoring the urge to have a bowel movement while playing. When the stool is passed after it has been "held in," the stools are often large, hard, and painful to pass. These experiences reinforce a determination to hold in stools and the cycle is repeated.
Many children and toddlers will pass small amounts of stool or smears of stool from the rectum despite their best efforts to hold it inside. Over time, the rectum becomes distended or stretched due to being overfilled and not emptying. The muscles become weaker and the nerves that signal that the rectum is full do not work properly, so the child may not feel the need to have a bowel movement.
As a result, days pass between bowel movements. The rectum stays filled and stretched, producing a back-up into the colon. This can lead to worsened constipation or soiling accidents.
In some children, the stool moves slowly through the colon or large intestine. Some children are born this way. Others start with stool withholding and then develop longer lasting problems with constipation.
Soiling (encopresis or fecal incontinence)
Some children with chronic constipation pass stool in their underwear. These soiling accidents can occur several times per day, and sometimes represent the only passage of stool.
Soiling represents the overflow of stool from the full rectum. The sphincter or holding muscle relaxes on its own and allows stool to leak from the full, distended rectum. Children cannot control this process when the rectum is overfilled. They are unaware these accidents are about to occur. Often, soiling is upsetting and frustrating for children and their families. Children with this problem may be embarrassed and teased by other children. They are often are disappointed in themselves.
When is constipation most likely to occur?
The times in a child's life when they are more prone to developing constipation include:
- Introduction of solids foods (baby foods and infant cereals) into the diet
- Toilet training
- School entry
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