Constipation in Children

• No bowel movements for several days
• Bowel movements that are hard, dry and difficult to pass
• Abdominal pain
• Nausea
• Traces of liquid or clay-like stool in the child's underwear — a sign that stool is backed up in the rectum
• Bright red blood on the surface of hard stool
• Poor appetite
• Cranky behavior

If your child fears that having a bowel movement will hurt, he or she may try to avoid it. You may notice your child crossing his or her legs, clenching his or her buttocks, twisting his or her body on the floor, or making faces.

Causes

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract, causing it to become hard and dry.

Many factors can contribute to constipation in children, including:

• Withholding. Your child may ignore the urge to have a bowel movement because he or she is afraid of the toilet or doesn't want to take a break from play. Some children withhold when they're away from home because they're uncomfortable using public toilets. Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience.
• Early toilet training. If you begin toilet training too soon, your child may rebel and hold in his or her stools. If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that's tough to break.
• Changes in diet. Not enough fiber-rich fruits and vegetables or fluid in your child's diet may cause constipation. For some children, too much milk and not enough water can lead to constipation as well.
• Changes in routine. Any changes in your child's routine — such as travel, hot weather or stress — can affect the way his or her bowels function.
• Medication or illness. Certain antacids, antidepressants and various other drugs can contribute to constipation. Changes in your child's appetite or diet due to illness may have the same effect.
• Cow's milk allergy. An allergy to cow's milk or drinking too much cow's milk sometimes leads to constipation.
• Family history. Shared genetic or environmental factors may make a child more likely to experience constipation.
• Medical conditions. Rarely, constipation in children indicates an anatomic malformation, a metabolic or gastrointestinal problem, or another underlying condition.

Risk factors

Constipation in children is more likely for kids who:

• Are sedentary
• Don't eat enough fiber
• Don't drink enough fluids
• Take certain medications, including some antacids and antidepressants
• Have attention deficit/hyperactivity disorder
• Have a medical condition affecting the anus or rectum

In addition, constipation is slightly more common in boys than in girls.

Complications

Although constipation in children can be uncomfortable, it usually isn't serious. If constipation becomes chronic, however, complications may include:

• Painful cracks in the skin around the anus (anal fissures)
• Stool withholding
• Resistance to having bowel movements, which causes impacted stool to collect in the colon and rectum and leak in underwear (encopresis)

Diagnosis

Your child's doctor will ask questions about your child's medical history and do a physical exam, which will likely include placing a gloved finger into your child's anus to check for abnormalities or the presence of impacted stool. Stool found in the rectum may be tested for hidden blood. The doctor may order an abdominal X-ray as well.

More extensive testing is usually reserved for only the most severe cases of constipation. If necessary, these tests may include:

• Anorectal manometry or motility test. In this test, a thin tube called a catheter is placed in the rectum to measure the coordination of the muscles your child uses to pass stool.
• Barium enema X-ray. In this test, the lining of the bowel is coated with a contrast dye (barium) so that the rectum, colon and sometimes part of the small intestine can be clearly seen on an X-ray.
• Rectal biopsy. In this test, a small sample of tissue is taken from the lining of the rectum to determine if normal nerve cells are present.
• Transit study or marker study. In this test, your child will swallow a capsule containing markers that show up on X-rays taken over several days. Your child's doctor will analyze the way the markers move through your child's body.
• Colonoscopy. This procedure allows your child's doctor to examine the entire colon with a flexible, camera-equipped tube.
• Colonic manometry. In this test, done during a colonoscopy, a catheter is placed in the colon to determine if there are normal contractions in all parts of the colon.

Treatments and drugs

Depending on the circumstances, your child's doctor may recommend over-the-counter fiber supplements or stool softeners.

If an accumulation of fecal material creates a blockage, your child's doctor may suggest a laxative or enema to help remove the blockage. Never give your child a laxative or enema without the doctor's OK.

Surgery is rarely needed for constipation in children. Exceptions may include constipation caused by a lack of contractions in the colon, Hirschsprung's disease or spinal cord abnormalities.

Lifestyle remedies

Often, simple changes in diet and routine help relieve constipation in children:

• A high-fiber diet. A diet rich in fiber will help your child's body form soft, bulky stool. Offer your child high-fiber foods, such as beans, whole grains, fruits and vegetables. Limit foods that have little or no fiber, such as cheese, meat and processed foods.
• Adequate fluids. Water and other fluids will help soften your child's stool. Be wary of offering your child too much milk, however. For some children, excess milk contributes to constipation.
• Adequate time for bowel movements. Encourage your child to sit on the toilet for five to 10 minutes within 30 minutes of each meal. Follow the routine every day, even during holidays and vacations.

Alternative medicine

In addition to changes in diet and routine, various alternative approaches may help relieve constipation in children:

• Relaxation strategies. Slow, deep breaths may help your child release his or her pelvic floor muscles and overcome anxiety related to bowel movements.
• Mental imagery. Thinking about a favorite place or imagining an easy, comfortable bowel movement may reduce anxiety about having a bowel movement.
• Massage. Gently massaging your child's abdomen may relax the muscles that support the bladder and intestines, helping to promote bowel activity.
• Acupuncture. This traditional Chinese medicine involves the insertion and manipulation of fine needles into various parts of the body. The therapy may help promote more frequent bowel movements.

Prevention

To help prevent constipation in children:

• Offer your child high-fiber foods. Fill your child's diet with high-fiber foods, including fruits, vegetables, beans and whole-grain cereals and breads.
• Encourage your child to drink plenty of fluids. Water is often the best bet.
• Promote physical activity. Regular physical activity helps stimulate normal bowel function.
• Create a toilet routine. Regularly set aside time after meals for your child to use the toilet. If necessary, provide a footstool so that your child is comfortable sitting on the toilet and has enough leverage to release a stool.
• Remind your child to heed nature's call. Some children get so wrapped up in the activity at hand that they ignore the urge to have a bowel movement. Postponing the event can lead to problems in the long run, however.
• Review medications. If your child is taking a medication that causes constipation, ask his or doctor about other options.

References:

http://www.emedicinehealth.com/constipation_in_adults/article_em.htm

http://www.medicinenet.com/constipation/article.htm

https://en.wikipedia.org/wiki/Constipation

https://www.hse.ie/eng/health/az/C/Constipation/

http://www.health.com/health/gallery/0,,20452199,00.html