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Author: Robert Scott-Jupp
Role: Consultant
Date written: July 2011
Last revised: November 2014
Review date: April 2018
Version: 1.1
Code: PI0827
Constipation in Children (1 of 3)
What is Constipation?
Constipation is a very common problem in children at all ages.
Constipation means either infrequent stools (less than one every two
days), or passing hard or painful poo (stools). Passing stools infrequently
may be normal for some children and if it is not causing them any distress
or other problems it does not need treatment.
In most children, there is no specific cause and this is referred to
by doctors as ‘idiopathic constipation’, or sometimes ‘functional
constipation’. Very uncommonly, there may be a specific medical
condition associated with it. If the child is otherwise well this is unlikely.
Diagnosis
The diagnosis is usually made from the history given by the parents of
infrequent, hard, or painful stools, and sometimes soiling. This can be
confirmed by the doctor examining the child’s abdomen. It is sometimes
possible to feel lumps of stool inside the large intestine. Sometimes, but
not often, it is necessary to do an internal examination by feeling inside
the anus. The child will be asked beforehand if it is OK to do this, and the
parent will be able to stay with them throughout the examination.
Causes
In most children the cause is unknown. It is often just an exaggeration
of a natural tendency to have infrequent bowel motions. It often runs in
families. Although a healthy diet is encouraged, a poor diet alone is not
normally the main cause.
There are some rare conditions that may cause constipation, but these
will always cause other symptoms as well. Constipation can be a sideeffect of some medications.
If the child’s bowels were opened normally as a young baby then you can
be reasonably certain that there is no underlying blockage or any other
physical problem, even in severe cases.
Tests
Tests are not normally required to diagnose constipation, unless an
underlying cause is suspected.
Stool withholding and pain on passing stool
The common pattern is that the child may normally only produce one
Day Assessment Unit
01722 336262 ext 4201
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk
Constipation in Children (2 of 3)
large stool every two or three days, and then for some reason it becomes painful. Sometimes
when the child is a little constipated and the bowels are opened there is a tiny split in the skin
around the anus (back passage) which produces a little bleeding and can be very painful. The
child then becomes frightened to pass a stool and holds on. This rapidly leads to a vicious circle
of holding back the stool which in turn becomes harder, larger, and more difficult to pass, and
thus more painful.
Soiling
In children who are out of nappies, sometimes the constipation builds up and they are unable to
hold on any more and the stool seeps out into their pants. Often this is the more liquid part of
the stool which gives the impression of diarrhoea but is not true diarrhoea. If the child has been
constipated for some time, they often lose the feeling in their lower bowel and are unable to tell
when they need the toilet. They therefore lose control and this makes the soiling worse. The
stretching effect on the bowel means it is more difficult for them to control the muscles which
normally open and close the anus.
Treatment
It is nearly always possible to treat constipation if enough of the right treatment is given for long
enough. Medicines can usually be given by mouth, and it is only rarely necessary to resort to
suppositories or enemas. Treatment needs to involve both sorting out the constipation and retraining the child to go to the toilet normally.
There are two types of medicines normally used: stool softeners (e.g. Lactulose, Movicol) which
make the stool wetter and hence softer, and laxatives such as Senna which stimulate the bowel
directly and make it work better. If the child at the beginning has a large build up of stool inside
their bowel (known as impaction) they may need large doses of medicines to start with, to empty
the bowel fully. Later, medicines need to be continued at a lower dose to keep the stool soft,
to encourage regular bowel motions, and prevent further impaction. Medicines may need to be
continued for a long period of time, months or even years, and this is quite safe. Doses can be
adjusted according to how hard or frequent the child’s stool is, and this can be done without
having to see the doctor each time.
Diet
It is important to encourage a healthy diet that has enough fibre, and includes plenty of fruit and
vegetables. The easiest way to give fibre to children is in the form of breakfast cereals, which
can be given at any time of the day. However, for most children with constipation, improving
the diet alone is not enough to resolve the problem, although it is important to encourage good
eating habits for the long term.
Drinking plenty of fluids (water or dilute fruit juice) will also help.
Toilet training
It is important to encourage a healthy attitude to opening the bowels. Some children who have
had constipation develop a fear of sitting on the toilet or potty.
Day Assessment Unit
01722 336262 ext 4201
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk
Constipation in Children (3 of 3)
We recommend the following:
• make sure the toilet seat is comfortable with a child seat and a foot stool to put their feet
on.
• make it a welcoming place with books, pictures, toys etc.
• it is important to reward the child every time they pass a stool on the toilet, even if it is a
small amount.
• do not appear to punish or criticise them for soiling their pants as they often cannot help
this.
You might find it helpful to start a ‘Star Chart’ system so your child gets a star on their chart
every time they successfully pass a stool in the toilet.
Long term implications
Some children who improve may become constipated again in the future, sometimes in response
to upsets or to life events such as starting school. As long as this is recognised early then it
should be possible to restart the medicines as before and prevent the vicious cycle starting
again.
More information
NHS direct – www.nhsdirect.nhs.uk
Childhood Constipation – www.childhoodconstipation.com
Education and Resources for improving Childhood continence – www.eric.org.uk
NICE – www.nice.org.uk
Day Assessment Unit
01722 336262 ext 4201
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk