If you ask your pediatrician or family doctor how often they diagnose and treat constipation, they will likely respond “weekly,” “daily,” or maybe “several times per day.” Constipation can be a sensitive subject to discuss, but it is a very common issue among children. Many parents do not realize that their kids are constipated because stool patterns and symptoms vary. The goal of this article is to raise awareness and help parents identify the signs and symptoms of constipation. Additionally, I will give you some helpful tips on preventing constipation.
So, what is constipation? According to dictionary.com, it is “a condition of the bowels in which the feces are dry and hardened and evacuation is difficult and infrequent.” Although this definition is accurate and describes many constipated patients, it can lead to an under-appreciation of the condition. Infrequent is a relative term and although the quality of the feces may be dry and hard, it may also be loose or liquid. The loose or liquid stools occur when there is a large, hard piece of feces in the rectum and liquid waste leaks around it. This is called encopresis and sometimes occurs without the child’s knowledge, leading to stains in their underwear. Abdominal pain, especially when relieved by a bowel movement, is another common symptom. Many children come in with concerns for urinary tract infection due to urgency, frequency, or accidents. Constipation can cause these symptoms by compressing the bladder and decreasing its capacity to hold urine.
Some parents are surprised, or even skeptical, when I diagnose constipation in their child. I reassure them that it is an extremely common condition that I see on a daily to weekly basis. There are several factors that lead to the frequency of this ailment. A diet low in fiber and high in fat is a leading cause. Physical activity helps move digested food through the bowels, so lack of exercise is another cause. Social factors affect stooling patterns in many children. Embarrassment about using public toilets, strict school bathroom schedules, and ignoring the urge to go when playing can all lead to constipation. If a child has difficulty passing stool, they will be reluctant to go in the future due to fear of discomfort. A vicious cycle of withholding may develop, allowing an abundance of stool to accumulate in the rectum. As the rectum gets stretched, the nerves that signal the urge to go do not work properly, further fueling the vicious cycle. At this point, some children begin to experience encopresis.
During toilet training, some children (and parents) become anxious or overwhelmed with the process. Toddlers and preschoolers are among the most common age group where I diagnose constipation. If you are attempting to toilet train and you suspect that your child is holding in stool, it is probably best to take a step back and wait until a later time to pursue it. As much as you want them to achieve this milestone, it is more important for them to develop healthy bowel habits.
As you might imagine, trying to prevent constipation is preferable to treating it. There are some simple measures parents can take to encourage healthy bowel habits. First, feed your child a diet high in fiber and insist on lots of water intake. Limit milk intake to 16 ounces per day. Next, initiate a daily time of exercise. Finally, try to eat meals on a routine schedule and plan regular toilet breaks after eating. Our bodies have a gastro-colic reflex; when food goes into the stomach (gastro), the colon is stimulated to move (colic). This reflex makes the moments just after eating a likely time to have a bowel movement.
Keep in mind that there are some medical conditions associated with constipation including Hirschsprung disease, cerebral palsy, hypothyroidism, and medication side effects, to name a few. It is very important to discuss your child’s symptoms with his or her doctor so they can be properly evaluated prior to starting a treatment regimen. In the meantime, encourage a high fiber diet, plenty of water, exercise, regular bathroom breaks, and praises for potty time success.
high fiber and kid-friendly foods:
• popcorn
• oatmeal
• granola
• carrots (try dipping in hummus)
• potato with skin
• avocado
• apple with peel
• mango
• oranges
• pears
• strawberries
• raspberries
• blackberries
• raisins
• nuts
• baked beans
• black beans
• chili beans
*high fiber after school snack idea – trail mix with nuts, granola, raisins, and dried fruit