Constipation, meaning the passage of hard painful stools, is a common problem in infants and children. It can cause children and their parents much distress and is a frequent reason for attendance at the emergency department.
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Constipation may continue for months to years, but is rarely caused by serious bowel disease.
Breast fed babies very rarely become constipated but may only pass a soft stool every week, which is normal.
Constipation is usually due to a slow gut, when stools take a long time to pass through the large bowel called the colon. As a result the stools are hard, large and often painful.
If the constipation is not adequately treated then problems occur because hard stools cause pain, and eventually the child will hold on and try to stop passing stools to avoid pain. The child may refuse to toilet resulting in a worsening cycle .
Constipation then worsens and it can become a chronic problem. The child may lose the sensation of needing to pass a stool and often has skid marks in the undies.
Mild episodes of constipation can be treated with increased fluid intake and dietary fibre. Sometimes children respond to a cow’s milk-free diet.
More severe cases of constipation need to be recognised, assessed and treated more intensively.
The treatment is to identify the problem and use big enough doses of stool softeners – for weeks to months – to allow the child to have painless stooling, and regain confidence to use the toilet again regularly.
Never force the child to sit on the toilet in these circumstances.
For children over one year of age the best softeners are Movicol or Osmolax which can be purchased from the chemist without a script. These softeners are safe, do not cause a lazy bowel and may need to be used for a long time.
Suppositories and enemas should only be used very occasionally under medical advice.
The child’s growth and nutritional status should be assessed, and an abdominal examination made to exclude any serious problems.
No routine investigations or tests are recommended and abdominal x-rays are generally not helpful.
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- This is one of a series of fortnightly articles written for children and families dealing with common paediatric and child health problems.
