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Home > Child Health > Conditions and Symptoms > Constipation in Children: Causes, Symptoms, and Complications

Constipation in Children: Causes, Symptoms, and Complications

July 24, 2020 - Updated on August 4, 2021
8 min read
By Daniel Shtraykher, DO, FAAP | Pediatrician

In this article:

  • How Does Constipation Occur?
  • How Common Is Constipation in Children?
  • Stages of Constipation
  • Types of Constipation
  • Causes of Constipation in Children
  • Symptoms of Constipation in Children
  • Medical Treatment for Constipation
  • Diagnosing Constipation
  • Child Abuse and Constipation
  • Risk Factors for Constipation
  • Complications Associated With Constipation
  • When to See a Doctor
  • Expert Answers (Q&A)
  • Final Word

Pediatric constipation is a common digestive problem that leads to a decrease in bowel movements in children.

constipation in children

The defecation rate varies with age. The normal bowel habit of a newborn child is above four excretions a day, which gradually decreases to one or two defecations a day during infancy.

Approximately 98% of children develop the ability to control their anal sphincter by the time they turn 4. The anal sphincter is a ring of smooth muscles at the end of the rectum that controls bowel movement. It remains tightly contracted at rest to hold in the stool and relaxes to allow defecation. (1)

How Does Constipation Occur?

Intestinal muscle contractions push the digested food through the colon toward the rectum, during which some of the water is absorbed from the stool.

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Weakening or slowing of these muscle contractions inhibits the movement of the stool. The longer the stool remains in the colon, the more water is absorbed from it. The hard and dry stool then becomes difficult to pass, leading to constipation.

How Common Is Constipation in Children?

Constipation affects 0.7%–29.6% of children worldwide (2) and is a major concern among parents as it can cause considerable discomfort in children if not treated promptly.

Stages of Constipation

Constipation occurs with varying severity:

  • Acute or short-term constipation has a sudden onset and generally resolves on its own or with the help of simple remedies.
  • Chronic constipation persists for more than 2 weeks, causes frequent vomiting and nausea, and usually occurs as a consequence of intestinal diseases that are beyond the scope of home treatment.

Types of Constipation

Pediatric constipation has two types:

1. Organic

Organic constipation is a rare type of constipation that develops due to biologic causes, which include structural disorders, neurologic problems, toxic/metabolic reasons, and intestinal disorders.

2. Functional

90%–95% of all cases of constipation are the functional type. (1) Functional constipation occurs due to behavioral or idiopathic causes. This means the symptoms are not a result of organic reasons such as injury, a blood disorder, infection, or anatomic abnormality.

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Causes of Constipation in Children

what causes constipation in children?

Children often develop constipation upon introduction to solid foods, in the midst of toilet training, and when starting preschool or a new school.

Constipation can occur due to various reasons that include:

  • Consuming a diet that lacks fiber and water but is rich in meat, white bread, cheese, bagels, and processed foods.
  • Withholding stool due to some distraction or being engrossed in play.
  • Illnesses, such as hypothyroidism, that cause loss of appetite.
  • Stress, emotional upsets, anxiety, or any kind of psychological trauma.
  • Medications such as cold medications, antacids, anticonvulsants, antidepressants, chemotherapy drugs, and narcotic pain medications such as codeine.
  • Medical conditions such as digestive problems, metabolic disorders, or anatomic malformation.
  • Family history on account of shared genes or the influence of environmental factors. (3)
  • Cow milk allergy, which is the most prevalent reason for constipation in children up to 3 years of age. (4)
  • Excessive dairy intake. (5)
  • Behavioral aspects including lack of routine, change in routine due to starting a new school, avoiding school toilets due to the unpleasant smell or lack of tissue paper, and reluctance to get toilet trained.

Symptoms of Constipation in Children

Constipation, in itself, is a symptom that may arise due to an underlying disease. In children, constipation is characterized by three markers: 

  • Dry, hard, or lumpy stools
  • Incomplete bowel movements despite daily excretions
  • Less than three defecations per week

The infrequent bowel movements may be accompanied by:

  • Bloating or swelling in the abdominal region
  • Pain while excretion
  • Lack of hunger
  • Nausea
  • Irritability and crankiness
  • Frequent urinary tract infection or loss of bladder control
  • Blood in hard stool
  • Soft or liquid stool marks on the child’s underwear, which may indicate leakage of feces

The child may show certain behavioral signs that indicate holding in the feces:

  • Clenched teeth
  • Crossed legs
  • Redness in the face
  • Squeezing the buttocks

Overflow incontinence occurs due to partial blockage of the child’s rectum by a huge mass of formed feces. The freshly created soft stool passes around it and causes soiling.

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Medical Treatment for Constipation

medical treatment options for constipation

The first step in treating constipation is the removal of old stool from the rectum, which can be done by using:

  • Rectal enemas
  • Oral osmotic (water-retaining) and stimulant laxatives

OTC laxatives can be used for the management of constipation and should be discontinued once the condition improves. Consult your doctor before using OTCs or enema on your child.

Certain prescription or OTC drugs may cause constipation. In this case, the doctor may lower the dosage or recommend a suitable substitute.

Diagnosing Constipation

The doctor will consider the child’s medical history and relevant health factors as well as the severity and duration of constipation to identify the cause of constipation.

This is followed by a physical exam, which is generally the only diagnostic procedure required. It involves:

  • Measuring body temperature, heart rate, and blood pressure
  • Checking for signs of dehydration
  • Listening to abdominal sounds using a stethoscope
  • Checking the abdomen for pain, tenderness, swelling, lumps, or masses

The doctor may conduct some diagnostic tests to rule out specific problems, which include:

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  • Laboratory tests – urine test, stool test, or blood tests
  • X-ray
  • Barium enema
  • Digital rectal examination (DRE)
  • Sigmoidoscopy
  • Anorectal manometry

Child Abuse and Constipation

Global estimates show that nearly 4%–16% of children are physically abused, 5%–10% are sexually abused, and around 10% feel neglected. (6)

Child maltreatment poses severe mental stress on the child, which causes changes in gastrointestinal motility, alterations in autonomic function, visceral sensitivity, and hypothalamic-pituitary-adrenal dysfunction. (6)

Moreover, children may be unwilling to go to school toilets due to the lack of privacy or being bullied or teased there.

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Risk Factors for Constipation

Factors that predispose children to constipation include:

  • Lack of activity
  • Medical problems in the anus or rectum
  • Neurological disorders
  • Lack of fiber and fluids
  • Some medications

Complications Associated With Constipation

complications of child constipation

Chronic constipation may lead to the following complications:

  • Encopresis, or stool soiling, is a condition where toilet-trained children leak stool into their underwear, usually due to chronic constipation.
  • Enuresis is involuntary urination or bed-wetting, which occurs in nearly 40% of children with constipation due to a dilated colon and subsides after the impacted stool is excreted.
  • Urologic problems, such as urinary tract infections, rectal ulceration, intussusceptions, or prolapse, may occur due to the enlarged, dilated colon, which is characteristic of constipation.
  • A negative self-image may develop in the child. Chronic constipation can cause soiling that the child may be unaware of until it is almost complete. This problem has social ramifications. It can affect the child’s self-image and can have an impact on their social and emotional development. (7)

When to See a Doctor

Acute constipation is common but chronic constipation can indicate the following problems, which require special medical attention:

  • Problems in the spinal cord
  • Anus or rectum abnormalities
  • Hirschsprung’s disease (a condition in which the intestinal wall is devoid of nerve cells)

See your pediatrician or seek emergency care if your child:

  • Is younger than 2 months and constipated
  • Resists toilet training by withholding stool
  • Has severe stomach pain, vomiting, or blood in the stool
  • Has a sore anus
  • Needs laxatives frequently
  • Lacks appetite and thirst

Parents or guardians should be attentive to their child’s health problems. Sudden-onset constipation, without any apparent cause, could be indicative of abuse. Pediatric constipation is often associated with emotional, sexual, and physical abuse. (8)

What you may ask your doctor
  • Is it a chronic condition?
  • What would be the bowel function usually?
  • What steps can I take to provide immediate relief to my child?
  • Should I change my child’s dietary habits?
What your doctor may ask you
  • Since when did your child have the symptoms?
  • What is the child’s diet?
  • Does the child exercise in any form?
  • Is the child taking any medications?

Expert Answers (Q&A)

Answered by Candice W. Jones, MD, FAAP (Pediatrician)

Can constipation cause a child to vomit?
Vomiting is not a common sign of constipation. A child who is vomiting should be evaluated by a doctor.

What can be done if the child is withholding poop?
The pain of passing a hard stool can cause a child to withhold poop. This can lead to a more serious problem called encopresis, where stool is packed into the rectum. The child experiences leakage of stool and is unaware of it until they find it in the underwear.

It is important to prevent and treat constipation but also work on holding habits by setting a schedule for the child to sit on the toilet regularly.

What is the best remedy to soften a child’s stool naturally?
In most cases, constipation is preventable and easily treated. Parents should make sure their children are:

  • Getting plenty of fluids
  • Eating 5–6 servings of fruits and vegetables daily
  • Eating whole grains
  • Exercising
  • Going to the bathroom regularly
  • Not holding their stool

Also, over-the-counter medications can help, but you should seek the recommendation of your doctor before giving them to your child.

Is it normal for a child to go without a bowel movement for 2–3 days?
It happens commonly with constipation. However, every child is different, and the focus should be on stool consistency, which is hard in constipation.

Can a gastrointestinal condition cause constipation in children?
Some gastrointestinal conditions are known to cause constipation in kids, such as Hirschsprung disease, celiac disease, neuromuscular diseases, and thyroid disease.

About Dr. Candice W. Jones, MD, FAAP: Dr. Jones is a board-certified physician practicing as a general pediatrician in Orlando, FL. Dr. Candice is committed to the health and well-being of underserved children, and adolescents in areas affected the greatest by health inequalities. In 2016, she launched DrCandiceMD.com, a website focused on kid health education.

Dr. Candice completed her residency in pediatrics at the Johns Hopkins School of Medicine in Baltimore, MD. She earned her medical doctorate at the Morehouse School of Medicine in Atlanta, GA.

She is a spokesperson for the American Academy of Pediatrics (AAP), a member of its Council on Communications and Media (COCM), and a member of the Florida Chapter of the American Academy of Pediatrics (FCAAP).

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Final Word

Functional constipation in children can be treated through behavior interventions, parental education, regular follow-ups, and adjustment of medication. Parents need to support their child in taking steps that facilitate the occurrence of complete bowel movements at regular intervals.

Continue Reading Continue ReadingHow to Relieve Constipation in Children?
References
  1. Xinias I, Mavroudi A. Constipation in Childhood. An update on evaluation and management. Hippokratia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574579/. Published 2015.
  2. Rajindrajith S, Devanarayana NM. Constipation in children: novel insight into epidemiology, pathophysiology and management. Journal of neurogastroenterology and motility. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042216/. Published January 2011.
  3. Peeters B, Benninga MA, Hennekam RC. Childhood constipation; an overview of genetic studies and associated syndromes. Best practice & research. Clinical gastroenterology. https://www.ncbi.nlm.nih.gov/pubmed/21382580. Published February 2011.
  4. Kamer B, Dółka E, Pyziak K, Blomberg A. Food allergy as a cause of constipation in children in the first three years of life – own observations. Medycynawiekurozwojowego. https://www.ncbi.nlm.nih.gov/pubmed/22002048. Published 2011.
  5. Dehghani S-M, Ahmadpour B, Haghighat M, Kashef S, Imanieh M-H, Soleimani M. The Role of Cow’s Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial. Iranian journal of pediatrics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533146/. Published December 2012.
  6. Rajindrajith S, Devanarayana NM, CrispusPerera BJ, Benninga MA. Childhood constipation as an emerging public health problem. World journal of gastroenterology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974585/. Published August 14, 2016.
  7. blackmer, alison beck, and Elizabeth annefarrington. “Constipation in the Pediatric Patient: An Overview and Pharmacologic Considerations.” Journal of Pediatric Healthcare, Dec. 2010. https://www.jpedhc.org/article/S0891-5245(10)00263-4/fulltext#sec4.
  8. Rajindrajith S, Devanarayana NM, Lakmini C, Subasinghe V, de Silva DGH, Benninga MA. Association between child maltreatment and constipation: a school-based survey using Rome III criteria. Journal of pediatric gastroenterology and nutrition. https://www.ncbi.nlm.nih.gov/pubmed/24253365. Published April 2014.
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