About the Chronic Constipation Program
What is chronic constipation?
Constipation occurs when stools move too slowly through the colon and fluid is absorbed by the body. This makes stool hard. Constipation is one of the more common bowel movement disorders in children and can range from mild to severe.
Symptoms of severe constipation may include:
- Large bowel movements
- Frequent abdominal pain
- Clogging the toilet with stool
- Encopresis (stool leakage)
A child is considered to have chronic constipation if they have experienced severe symptoms for three months.
Who We Treat
The Chronic Constipation Program treats toilet-trained children and teenagers who are developmentally capable of engaging in behavioral intervention (e.g., able to participate in conversation, able to understand cause-and-effect). Patients:
- Have experienced severe constipation (with or without encopresis) for over two years
- Have been treated by a gastroenterology (GI) specialist at least three times without improvement
- Have difficulty taking daily medications
- Have difficulty related to structured “sit times”
- Require frequent medication changes
- Would benefit from frequent visits to reinforce progress toward treatment goals
For patients with occasional constipation, or who have failed toilet-training, CHOP’s GI psychologists can help caregivers develop strategies for managing GI challenges and associated symptoms.
What We Do
The Chronic Constipation Program provides short-term, intensive medical and behavioral therapy to children with chronic constipation. During your initial visit, you and your child will meet with multiple team members at the same time, including an attending physician, a nurse practitioner and a psychologist. The team will review your child’s medical history and any medical or behavioral interventions you have already tried. Your child will receive a medical exam, and you will leave the visit with a detailed medical and behavioral treatment plan.
Managing Chronic Constipation
The Chronic Constipation Program takes a multidisciplinary approach to managing chronic constipation, addressing both your child’s physical and behavioral needs. While interventions will vary, medical recommendations for managing constipation may include:
- Medicines to keep stools soft and slippery, making them easy for your child to pass
- Eating a high-fiber diet
- Increasing water in the diet to soften the stools
- Toilet sitting after meals to promote regular stooling
- In some cases, laxatives or enemas
- Biofeedback therapy
Behavioral Management
Children with chronic constipation often require behavioral treatment to address problems that have developed as a result of severe constipation. Painful bowel movements can cause children to experience fear and anxiety related to toileting. To avoid more pain, children may refuse to sit on the toilet or to take medicine as prescribed. Sometimes, children who are afraid of painful bowel movements may appear to be straining, when in fact they are trying to “hold it” in order to avoid more pain. While these emotions and behaviors are normal reactions to pain, they can make constipation management more challenging.
At the Chronic Constipation Program, GI psychologists help patients and caregivers use behavioral strategies to address toileting anxiety, refusal behaviors and stool withholding, in order to promote treatment success.
Follow-up
Your child will be seen by the Chronic Constipation team every two weeks for intensive medical and behavioral therapy. As your child makes progress, program visits will become less frequent until your child is able to transition back to their regular GI provider or primary care physician.