Constipation is a common problem for children. Children who are constipated will often hold in their poop and try not to go to the bathroom. Children will tighten their bottoms, cry, scream, hide in corners, cross their legs, shake, get red in the face or dance around to try to hold in their poop. Parents / family / caregivers think children are trying to pass poop when actually children are trying to hold in the poop.

When your child is having trouble with constipation, they may have:

• A decrease in how often they poop, may skip days between pooping
• Hard, dry poop
• Trouble pushing poop out of their rectum
• Pain with pooping
• Abdominal bloating, cramping or pain
• Small liquid stools or smears of stool in their underwear

Causes of Constipation

Most times, there are no exact reasons why children have trouble with constipation. Your child’s healthcare team might call this “functional constipation.” Some things that might add to your child’s trouble with constipation are:

Diet: Some children eat too many foods that are high in fat and low in fiber (“fast foods,” “junk foods,” soda). Also, some children do not drink enough water.

Lack of exercise: Exercise helps move food through the intestines. Children who watch too much TV or play too many video games may not be getting enough exercise.

“Busy” children: Some children are too busy playing and forget to go to the bathroom. They ignore their bodies’ signals that it is time to go sit and poop.

Behaviors: Sometimes children may feel too much pressure to potty train and will resist potty training. Also, children might hold back the urge to poop because they refuse to use public or even school bathrooms.

Reasons Constipation is a Concern

While it is hard to see your child in pain from constipation, there are other concerns if your child has trouble with constipation for a long time. These concerns include:

• Hard stools and passing large poops can cause a tear in the anus. This tear is called a fissure. Fissures can bleed and be painful.
• Straining to poop can cause blood vessels inside the child’s anus to become swollen or inflamed (hemorrhoids) and can cause burning pain and bleeding.
• When a child holds in their poop, over time the poop builds up inside the rectum. This causes the poop to become larger and harder to pass. This can also stretch out the rectum. Runny poop can leak out around this build up of hard, large poop and cause the child to soil their underwear. This soiling is called “encopresis” (in-co-pre-sis). Children may not feel this leakage of poop and are often not able to even smell that they have soiled in their underwear. Children may try to hide their underwear when this happens.

How Do You Know It's Constipation

During an office visit, a doctor (or advanced practice nurse) will ask you questions about your child’s medical history and complete an exam. The provider might ask questions like:

• How old was the child when they had their first poop as a newborn baby?
• How often does your child poop?
• Does your child complain of pain with pooping?
• Have you been trying to toilet train your child lately?
• What is your child’s diet like?
• Has your child had any increased stress lately?
• Does your child soil their pants? If so, how often?

Your child may need to have a rectal exam. The doctor or nurse can help explain this special exam to your child before the exam is done.

Sometimes, your child may need special tests to help find a cause for the constipation. These tests might include:

Abdominal X-ray: This is a special X-ray picture to evaluate the amount of stool in the large intestine.

Contrast enema: This is a test that uses X-rays and a special kind of enema solution to take pictures of the colon or large bowel, which is the lower part of the intestines. The test shows the doctor if there is anything wrong inside the colon and how well it is working.

Anorectal manometry: This is a test that measures the strength of the muscles in the anus, nerve reflexes, the sense that the rectum is opening, and coordination of muscles when pooping.

Rectal biopsy: A tissue sample is taken from the lining of the rectum to look at under a microscope for any problems.

Treatment for Constipation

Your healthcare team will talk with you about your child’s specific care plan to treat constipation. This care plan is based on:

• Cause of the constipation, if one is found
• Dietary needs
• Your child’s age, overall health and any special care needs
• How long your child has had trouble with constipation
• Your child’s ability to tolerate medications, tests or therapies
• How long the treatment might take
• Your feedback on what works best for your child

The outlook for treating children with constipation will depend on if there is a complex problem causing the constipation. Children with diseases of the intestine may have long-term issues with constipation. Up to 90% of children will have no long-term or recurring problems.