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.

In some cases, constipation 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 signs of constipation include:

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

Any of these symptoms suggest the presence of constipation or excess stool in the colon and rectum.

Causes of constipation 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.
• A family history and/or emotional stress may also contribute to constipation.

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

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.

Recommendations for managing constipation may include:

• Medicines to keep the 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

For a small number of select patients, colorectal surgery may be an option. Another new treatment option that has been shown to improve constipation is sacral nerve stimulation, where a device is implanted that gently activates the pelvic nerves.

It is important to treat your child’s constipation to ultimately improve any related bladder symptoms your child may be experiencing.

Urologic treatment of constipation

There is a close relationship between the muscles and nerves that control bladder functions and those that control bowel movements. For this reason, your child's care may include treatment by a pediatric urologist.

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, resulting in urgency and more frequent 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 encopresis (fecal soiling).