Constipation

Constipation is a common childhood problem characterised by bowel motions that are hard, dry and difficult to pass.

Indications include:

• Abdominal pain and cramps
• Loss of appetite
• Nausea and vomiting
• Pain when passing a motion
• More frequent urination due to pressure on the bladder
• Soiling of underwear with liquid faeces (encopresis)

Constipation in adults is usually caused by diet.

Constipation in children is more likely to be behavioural.

Busy little people delay going to the toilet because they may be involved in an activity or anxious to avoid the pain previously experienced in trying to pass a motion.

Other reasons to avoid toilets away from home may be because they are dirty, lack privacy or toilet paper or the child is bullied or teased in the toilets.

Particularly strong-willed children may be rebelling against toilet training. Constipation can also be aggravated by lack of fibre, fluid or adequate exercise.

Underwear soiling is a problem that arises in children commonly as a result of chronic constipation. It is known medically as encopresis or faecal incontinence. Soiling is most common in children aged 3-7 years, and affects more boys than girls.

Nearly all children who soil are constipated. Sometimes when a child becomes constipated they end up passing very large movements which cause considerable pain.

Sometimes they can even cause small tears around the anus (anal fissures), and this can further frighten a child from wanting to go to the toilet. Over time, their large intestine fills with faeces and stretches, becoming considerably larger than normal. This condition is known as ‘megacolon’. The formed stool becomes impacted.

The more stretched the large intestine becomes, the less sensitive it is to the nervous stimulation that tells your child that they need to go to the toilet. So the condition becomes self-perpetuating. 

As a result, liquid faeces from the small intestine may leak around the harder faeces in the large intestine and onto the underwear. At first it might just seem as if the child is not wiping their bottom properly. 

If left untreated, the bowel may expand to the extent that the whole movement just exits into the underwear. Because the stool is leaking around the impaction and isn’t being totally digested it can be very smelly and dark in colour. 

How to Help

Slowly increase amounts of fruit, vegetables and wholegrain cereals in the diet. Prune juice is also excellent, as it helps the intestine retain water therefore helping to keep stools soft. Make sure they drink enough water and try to get the child into the habit of going to the toilet as soon as they have the urge to defaecate.

When should you go to the doctor?

Sometimes additional help is required to empty the bowel. If the condition becomes chronic it is likely that laxatives may be required or the doctor may suggest an enema or suppository. Children with encopresis must receive medical assistance to help to initially resolve the problem.

Source: Child and Youth Health: Parenting and Child Health     

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.

This article was first published in Australian Family Magazine, May 2002. Updated July 2009.