Pediatric Constipation

Prevention and Risk Assessment

• What is constipation?

  Constipation is when your stools are painful or they do not happen often enough. It is the most common GI (gastrointestinal) problem.

  You may have constipation if:

  • You have bowel movements less than three times a week
  • Your stool is hard, dry and in small pieces

  Normal bowel movements vary depending on the person. They may happen as often as three times a day. Or they may happen just three times a week.

• What causes constipation in children?

  Your stool gets hard and dry when your colon (large intestine) absorbs too much water.

  In most cases, as food moves through your colon, the colon absorbs water while it makes stool. Muscle movements (contractions) push the stool toward your rectum. When the stool gets to the rectum, most of the water has been soaked up. The stool is now solid.

  If you have constipation, your colon's muscle movements are too slow. This makes the stool move through your colon too slowly. The colon absorbs too much water. The stool gets very hard and dry.

  Some of the most common diet and lifestyle causes of constipation are:

  • Not getting enough exercise
  • Not drinking enough liquids
  • Not eating enough fiber
  • Not moving your bowels when you feel the urge to
  • Changes in your lifestyle, such as travel, pregnancy, and old age

  Other causes of constipation include:

  • Medicines
  • A problem with how your stomach and bowels work (such as irritable bowel syndrome)
  • Your intestine does not work well
  • Taking too many medicines that help to loosen your bowels (laxatives)
  • Metabolic problems such as thyroid disease
  • Intestinal blockage

• Why is constipation in children a concern?

  Hard stools can irritate or tear the lining of the anus (fissure), making it painful to have a bowel movement. The child may avoid having a bowel movement, which can cause further constipation.

• What are the symptoms of constipation in children?

  Each person’s symptoms may vary. Symptoms of constipation may include:

  • Difficult and painful bowel movements
  • Less than 3 bowel movements a week
  • Feeling bloated
  • Not having much energy
  • Belly (abdominal) pain
  • Ineffective straining to move your bowels

  The symptoms of constipation can look like other health problems. Always talk with your healthcare provider to be sure.

• Can constipation be prevented?

  Many of the same lifestyle changes that help treat constipation may also help to stop it from happening:

  • Have plenty of fiber, water, and liquids each day.
  • Get regular exercise.
  • Allow plenty of time for bowel movements. When you feel the urge to have a bowel movement, be sure to do it.
  • Try to have a bowel movement at the same time each day.
  • If another health problem makes you more likely to have constipation, take your healthcare provider’s advice for treating that problem.

Diagnosis

• How is constipation in children diagnosed?

  Most people have constipation at one time or another. To see if you have constipation, your healthcare provider will do several tests. These tests will depend on how long you have had symptoms and how serious your case is.

  First your healthcare provider will look at:

  • Your age
  • If you have any blood in your stool
  • Any changes in your bowel habits
  • Weight loss

  Your healthcare provider will likely:

  • Ask about your past health. You will be asked to give details about your constipation,, such as how long you have had symptoms and how often you have bowel movements.
  • Give you a physical exam. Your healthcare provider will do a full physical exam.
  • Give you a digital rectal exam. This exam helps tell if the area is soft, blocked, or bloody. It can also check how much and what kind of stool you have. Your healthcare provider will also see if your rectum is bigger than normal.

  Your healthcare provider may also do other tests such as:

  • Abdominal X-ray. This X-ray test can show the fullness of the bowels.
  • Blood work. Blood is taken for testing.
  • Lower GI series (also called barium enema). This is an X-ray exam of your rectum, the large intestine, and the lower part of your small intestine. You will be given a fluid called barium. It coats the organs, so that they can be seen on an X-ray. An X-ray of your belly will show if you have any narrowed areas (strictures), blockages, or other problems.
  • Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores (ulcers), or bleeding.
  • Sigmoidoscopy. This test lets your healthcare provider check the inside of part of your large intestine. It helps to tell what is causing constipation.
  • Colorectal transit study. This test shows how long it takes for food to move through your colon. You will be asked to swallow pills (capsules) filled with small markers that can be seen on an X-ray. The X-rays will show how the capsules moved through your colon.
  • Anus and rectum (anorectal) function tests. These tests can tell if you are constipated because your anus or rectum is not working well.

• When should you contact a healthcare provider?

  Most people have constipation at one time or another. But call your healthcare provider if:

  • Constipation lasts longer than 3 weeks.
  • Constipation pain is stopping you from doing your daily activities.
  • You have symptoms of any of the complications of constipation.

Treatments

• What are treatments for constipation in children?

  Your healthcare provider will come up with a care plan for you based on:

  • Your age, overall health, and past health
  • How serious your case is
  • How well you handle certain medicines, treatments, or therapies
  • If your condition is expected to get worse
  • Your opinion and what you want to do

  In most cases, diet and lifestyle changes can help reduce constipation symptoms. They can also stop it from happening. These changes may include:

  • Drinking more water and juice.
  • Getting regular exercise.
  • Giving yourself time to have a bowel movement each day.
  • Eating more fiber.
  • Taking laxatives.
  • Stopping or changing medicine.
  • Doing biofeedback (part of a special physical therapy program)

• Foods with fiber

  Bread

  •  Moderate fiber: Whole-wheat bread, granola bread, wheat bran muffins, grain bars, waffles, popcorn

  Cereal

  • Moderate fiber: 100% whole-grain cereals, oatmeal, granola, and oat bran
  • High fiber: 100% bran cereal

  Vegetables

  • Moderate fiber: Beets, broccoli, Brussels sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado

  Fruits

  • Moderate fiber: Apples with peel, dates, papayas, mangoes, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins
  • High fiber: Cooked prunes, dried figs

  Meat Substitutes

  • Moderate fiber: Peanut butter, nuts
  • High fiber: Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix

• What is the long-term outlook for a child with constipation?

  The outlook depends on what type of condition caused the constipation. Those children with diseases of the intestine, such as Hirschsprung's disease, may have chronic problems. However, most of the time, constipation is a temporary situation.