Constipation in children

What is it about ?

The constipated child has difficulty having a bowel movement, that is, they defecate less than three times a week or they have to push hard and / or their stools are hard and painful.

Constipation can have different possible causes.

• Often the baby’s constipation is due to the change in diet.
• In older children, it is mainly caused by a diet low in fiber, poor bowel movements and a lack of physical activity.

Here we only discuss functional constipation, i.e. constipation that is not due to illness.

How to recognize it?

Constipation is characterized by infrequent, hard, or straining stool production. The child may also complain of an upset stomach or have difficulty holding urine. He may also suddenly have loose stools, which mix with hard stools during bowel movements.

There are different types of functional constipation:

• The occasional constipation is associated neither with a problem in the anus, nor with an emotional problem. Most often, there is no fecal soiling in the underwear, unlike constipation due to an emotional problem (see below).
• a disorder of voluntary coordination of defecation is usually the consequence of pain felt during defecation, for example in case of anal fissure. Subsequently, the child (usually at a young age) deliberately holds his stool. A diet rich in fiber and increased exercise can quickly remedy this form of constipation. The crack usually heals quickly. You can optionally apply a little petroleum jelly or hydrocortisone cream.
• As part of a trouble with involuntary coordination of bowel movements, the anal muscle paradoxically closes during the production of loose stools. The child is not aware of it. This form of constipation is often difficult to distinguish from voluntary cessation.
• In case of constipation due to an emotional problem, constipation is a physical reaction to emotional stress without physical problems (no cracks, no problem with the anal muscle, …). This form is often, but not always, manifested by the presence of fecal soiling in the underwear.

How is the diagnosis made?

The doctor will ask questions about the defecation pattern and any associated symptoms. He will distinguish between functional constipation and constipation due to disease, for which specific tests and treatment are needed. The doctor will also try to identify the type of functional constipation. During the physical examination, the doctor will palpate and auscultate the child’s stomach, then examine and possibly palpate the entrance to the anus for the presence of hard stools.

What can you do ?

Adopt a diet rich in fiber (wholemeal bread, fruits and vegetables (raw)). There are lists to help you do this. Fiber stimulates intestinal transit; they draw fluid into the intestine, which softens the stool.

Good defecation requires good hydration. Make sure the child is drinking enough.

Physical exercise is an absolute necessity for the proper functioning of the intestine.

Also make sure that going to the toilet is pleasant. It is very important, certainly in children. Children often wait too long to use the bathroom and usually don’t take the time to sit on the throne.

What can your doctor do?

If diet and lifestyle adjustments are not enough to relieve constipation, the doctor will take it step by step. He will begin by explaining to you where functional constipation comes from. Then he can prescribe a mini-enema for a few days, the time to treat the constipation. At the same time, a laxative treatment can be started to soften the stool and facilitate defecation. As a result, the child will no longer be afraid to have a bowel movement. This management usually resolves constipation in about four weeks, provided the child maintains an appropriate diet and a good level of physical activity.

There are different types of laxatives. The doctor will prescribe, depending on the situation, either lactulose or macrogol. It is still important that the child always drinks enough water.

If the constipation reappears quickly, the doctor will refer the child to a specialist.

Want to know more?

• Fruits, vegetables and whole grains – mongeneraliste.be – SSMG – Scientific Society of General Medicine
• Fibers: multiple benefits – mongeneraliste.be – SSMG – Scientific Society of General Medicine

• Physical activity – Eat Move – Health question

• Lactulose – CBIP – Belgian Center for Pharmacotherapeutic Information
• Macrogol – CBIP – Belgian Center for Pharmacotherapeutic Information

Source

Foreign clinical practice guide ‘Constipation in children’ (2005), updated on 13.07.2016 and adapted to the Belgian context on 12.05.2019 – ebpracticenet