What is constipation?

Constipation occurs when stool moves too slowly through the colon and fluid is absorbed by the body. This can make stool hard and difficult to pass. As one of the more common bowel movement disorders in children, constipation can range from mild to severe.

In some cases, constipation in kids is obvious, as in situations where the child is passing hard, dry, pellet-like stools with straining, or only has a bowel movement every few days.

Other constipation symptoms in children include:

• Large bowel movements
• Frequent abdominal pain
• Clogging the toilet with stool
• Soiling the underwear
• Leakage of watery stools

If your child has any of these symptoms, they may have constipation or excess stool in the colon and rectum.

Causes of constipation

Causes of constipation in children most commonly include:

• Willful avoidance of using the toilet either because children get too involved in play to take a toilet break, or they may be concerned about lack of cleanliness or privacy in bathrooms away from home.
• Prior painful experience passing large or hard stool.
• Dietary changes or lack of fiber and water.
• Family history of constipation and/or emotional stress

Constipation not caused by an identifiable medical problem is called idiopathic constipation.

Treatment for constipation in kids

At Children's Hospital of Philadelphia, children with constipation may be evaluated and treated by doctors and nurses from the Division of Gastroenterology (GI), Hepatology and Nutrition, the Division of Urology and other related specialty programs. Depending on the cause and severity of your child’s constipation, other pediatric subspecialists may be involved in their care, including dietitians or pediatric colorectal surgeons (for a small number of patients). Your child’s Primary Care provider is typically the first point of contact for treatment.

Urologic treatment of constipation

There is a close relationship between the muscles and nerves that control bladder functions and those that control bowel movements. Additionally, both the bladder and end part of the colon sit in the pelvis near each other. Constipation can change the way your child senses their bladder and the way the bladder functions. For this reason, your child's care may include treatment by a pediatric urology team.

Bladder and bowel dysfunction (BBD) is a common condition that refers to people with both bladder and bowel symptoms. In some cases, an underlying neurologic condition may be the cause of BBD; however, no neurologic cause is identified in most cases.

Children with constipation may tighten the pelvic floor muscles and hold back when they urinate, and not completely empty their bladders. Stool in the lower colon and rectum can put pressure on the bladder, causing a sudden urge to pee (urinary urgency) as well as bladder overactivity from increased and earlier bladder contractions.

Many children with recurrent urinary tract infections (UTIs) often have underlying constipation. Children with daytime wetting often have problems with their bowels in the form of constipation or fecal soiling (encopresis).

Maintaining soft, regular bowel movements is an important part of managing urinary urgency or other related bladder problems.

Recommendations for managing constipation may include:

• Medicine to soften stool
• Eating a high-fiber diet
• Increasing water intake
• Toilet-sitting after meals

In some cases, a laxative or enema may be necessary to provide quick relief from constipation pain or discomfort.

A potential newer treatment option for severe cases of constipation and encopresis is neuromodulation, which may involve tools such as skin patches, needle electrodes, or in some cases, implantable devices. While the exact mechanism by which neuromodulation works is still unknown, it has been shown to effectively restore bladder function. This form of treatment is available for patients with complex bowel and bladder disorders through our multidisciplinary Neuromodulation Bowel and Urologic Alliance Program.

Your provider will discuss the best treatment options for your child.