One thing that we see a lot of that often seems to catch
parents by surprise is constipation. Constipation in children is common enough
that some days it seems like all we talk about is pooping. When I was in
residency, we often referred to it simply as “The Big C.”
Occasionally difficulty stooling will be the presenting
concern. However, often the reason for the visit is something else like
abdominal pain or urinary symptoms and the underlying constipation causing the
symptoms is not obvious. It can be difficult to sort out what the child’s
stooling habits are if they are old enough to be going to the bathroom alone.
Children are often reluctant to discuss their stooling habits and words like “fine”
and “normal” may mean something different to them than it would to me or to the
parent. And sometimes children who report stooling daily without any problems
will be found to be full of stool if an X-ray is taken.
Constipation can start for a variety of different reasons.
Diet can be a contributing factor with intake of excessive amounts of high-fat,
low fiber foods and dairy products making constipation more likely. In general,
eating a high fiber diet, drinking a lot of water, and exercising is helpful in
preventing constipation. However, some people just seem to have more trouble
with it regardless of their diet or activities and occasionally constipation
can be caused by underlying anatomic or physiologic abnormalities.
Sometimes younger children can become constipated because
they had a painful bowel movement at some point and start holding their stool in
in an effort to avoid repeating the painful experience. This can be especially
problematic if it coincides with attempts at toilet training.
If one has been constipated for a long time, the constant
presence of stool stretches out the lower portion of the large intestine and
rectum and children can lose the ability to feel when they need to defecate.
This is called an “acquired megacolon” and can lead to stool accidents because the
child can not sense when some looser stool may have worked itself around the
edges of the resident poop. Stool can then
sneak out without them realizing it. This is obviously a concerning situation
for the child and parents.
If a child is having significant difficulties with
constipation, treatment with laxatives is often required. Relapses are common
if the laxatives are not used long enough or in sufficient doses and, in
general, the longer the constipation has been present, the longer it takes to
resolve.
If your child has frequent abdominal pains, stool accidents,
frequent urination, urinary tract infections, urinary accidents, painful bowel
movements, or blood in the stool, constipation is one of the potential causes
to consider. And don’t be shy when discussing poop with your child’s doctor. We
are used to it.
