Is my child constipated?

What is constipation?

• Difficulty or seeming to push very hard when passing a poo.
• Pain on pooing.
• A small amount of blood in the nappy or on the paper due to a cut in the skin of the anus.
• Passing fewer poos than normal (it is not a strict number, but doing fewer than 3 proper poos per week is not normal).
• Small pellet like poos (like rabbit droppings) or very large hard poos.

Types of constipation

There are 2 main types.

Functional or Idiopathic: This is very common. Idiopathic means where no cause can be found. It can either be short lived, for up to 2 or 3 days and then settles with no need for any treatment. Or, in 1 in 3 children, the problem lasts a lot longer.

Secondary: This is quite uncommon. The constipation is caused by another condition such as an underactive thyroid, cystic fibrosis, cerebral palsy, anal tears or cows milk intolerance. Or it can be caused by medication such as anti-epilepsy medication, some antihistamines that cause drowsiness, strong pain killers that contain codeine or morphine and certain medications for overactive bladders can also cause constipation. Check with your GP if you are unsure.

Causes of functional or idiopathic constipation

Whilst often no single cause can be found there are often various factors that combine to make constipation likely:

• insufficient fibre in the diet
• dehydration either due to an acute illness or to poor fluid intake
• lack of physical exercise or immobility
• stool holding

Why do children try to hold their poos in?

• a previous poo might have been painful to pass
• they may have a cut in the skin around their anus from a previous very large poo. It is very painful child instinctively tries to stop the poo coming out any further.
• they may dislike the toilets at school and so try and hold their poo until they get home

But the build up means the next poo is big and harder to pass and the child is even more reluctant to poo.

Impaction

This is where hard poo gets stuck (impacted) in the rectum (the last part of the colon). More poo builds up behind this large poo and can cause pain as the colon tries to push it forward but the blockage holds fast. Some of this new poo can become runny and may bypass the hard stool and leak out.

The lower part of the hard stool also becomes runny and may leak out.

The child soils their underwear almost constantly and parents may mistake this for diarrhoea.

The child will often be irritable, have tummy ache and feel nauseous.

Unfortunately even when this hard poo is passed, the rectum fills up with more hard poo from the logjam (no pun interned) behind.

Common symptoms

• Tummy ache and feeling sick.
• Feeling generally off colour.
• Behaviour problems (especially where children seem quite unhappy or irritable.
• Poor appetite.
• Restlessness.