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Constipation is common in children of all ages and happens occasionally. Some children, however, may have prolonged constipation which cannot be resolved with usual therapeutic measures. For these children, more comprehensive diagnostic testing, prescription medications and therapy may be required.

An estimated 25% of visits to a pediatric gastroenterologist are due to problems with constipation.

What is constipation?

Constipation is defined as either a decreased frequency of bowel movements or having painful bowel movements due to hardened stools. Children above one year of age typically have a bowel movement one to four times a day and at least three times a week.

Symptoms vary for each child, but in general they are:

  • Stools that clog the toilet
  • Abdominal bloating, cramps, or pain
  • Decreased appetite or a feeling of being “full”
  • Clenching teeth, crossing legs, squeezing buttocks together, or turning red in the face as your child tries to “hold in” a bowel movement to avoid discomfort
  • Fecal soiling (encopresis), including small liquid or soft stool, that soil your child's underwear.

When children are constipated for a long time, they may begin to pass stool in their underwear. This is called fecal soiling. It occurs when children develop a stretched rectum gradually due to chronic constipation. Over time, the stretched rectum is filled with a stool plug that is hard for a child to push out. Liquid stool then seeps down around this stool plug, staining the underwear.

It’s important for parents to know that this soiling is an involuntary action – the child has no control over it and is typically unaware that they are going to have an accident.

There are some cases when fecal soiling may be voluntary. This form may represent significant psychological problems.

What causes constipation?

Constipation is often defined as organic or functional. Most constipation is functional, meaning that there is no specific identifiable cause. It is commonly triggered by:

  • changes in a child’s daily routine, such as being away from home
  • changes in diet (e.g., the start of taking whole milk or solid food)
  • changes in activity
  • toilet training
  • Starting school (avoidance of a public toilet)

Some medical conditions also can cause constipation, including congenital abnormalities of the intestinal tract, neurological or behavioral issues, or endocrine and metabolic disorders.

When should you take your child to see the doctor?

If constipation persists for a couple of weeks, or if there is blood in the stool, unexplained weight loss, or severe or persistent abdominal pain or cramps, poor appetite, and vomiting, it’s time to see a doctor.

How do we treat constipation?

Treatment of constipation varies depending upon what causes the condition. Some children may only require changes in diet, while others may need medications. Others may require physical and behavioral therapy as well. Very rarely, surgery is recommended.

Our gastroenterology team at SSM Health Cardinal Glennon Children’s Hospital can help identify the cause of your child’s constipation and provide access to highly specialized care.

If motility disorders are suspected, SSM Health Cardinal Glennon Children’s Hospital has the region’s only comprehensive Pediatric Neuro-Gastroenterology and Motility Center that specializes in the diagnosis and treatment of severe bowel dysfunction.

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