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August 14, 2020

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Weekend doctor: Constipation in children

By Ailing Chen, MD, Pediatrics
Caughman Health Center
“Have you pooped today? Did you have any problem with pooping?” It seems I have this kind of conversation with my son at home every day.

As a doctor, I usually need to ask similar pooping questions for every well visit and even most acute visits at the office.

As we all know, a normal bowel pattern is a very important sign of our good health. However, constipation is a very common health problem in children of all ages.

What is constipation in children?

Constipation is generally defined as infrequent defecation, painful defecation or both. Most of the time, kids will complain that stool is too large, too hard, infrequent and/or painful to pass, and sometimes they even have blood on wiping tissues. Some children may present leaking feces in underwear or may present more frequent urination and bedwetting.

Children suffering from constipation typically have no underlying medical condition, which is defined as functional constipation. In most cases, childhood constipation could start with painful defecations. When pain is associated with the passage of bowel movements, the child begins to withhold stools to avoid discomfort. As feces content stays in the colon longer, the feces get bigger and drier. The next defecation, of course, would become even harder and more painful for the child. If this withholding behavior and stool retention continue in a cycle, constipation will get worse and worse.

What can you do as a parent? First, establish regular bowel habits. After your child is toilet trained, try to encourage your child to attend the toilet one to two times a day, for five to ten minutes. The best time is after breakfast and after supper to take advantage of the gastrocolic reflex. Most school-age children will not attend the toilet while at school and tend to withhold stool during school hours.

The next step is to increase the child’s intake of water. Children forget to drink water all the time, especially when they are too busy. Parents need to make sure their child drinks water instead of soda. Drinking too much milk can also make constipation worse for most children.

 The fiber in vegetables and fruits will increase fecal water content. A balanced diet with vegetables and fruit daily is strongly recommended for children of all ages. For extremely picky eaters, try to make sure that they are at least eating more fruits, especially apples or pears. 

Trying to decrease pain associated with the passage of bowel movement is extremely important. Using stool laxative medication may be necessary for your child’s constipation treatment. Children with chronic constipation may require a few months of laxative therapy to help maintain soft stool and eliminate the pain associated with bowel movement. 

Please talk to your child’s pediatrician or primary care provider to get a detail evaluation and discuss the right medication and treatment for your child.