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Constipation is a condition that everyone has experiences at least once in their lifetime. A study conducted showed that as many as 1 in every 3 children in the United Kingdom has suffered from it. Unfortunately, there are many myths about it such as “it can cause death” or “it will make the body toxic”. The article will help you gain proper knowledge on the subject and hopefully put the falsehoods to rest.
What is Constipation?
Ever had the feeling where you go do your morning ritual only to find that the business is “unfinished”? When the body has a hard time removing the faeces from the system, it is termed constipation. During the digestive process, the colon absorbs water from the food passing through it. When the colon absorbs too much water due to the slow movement of the food, it turns hard making it difficult to pass it out.
Types of Constipation
Below are some of the classifications:
1. Acute constipation
Acute constipation can last for a couple of days without any long-term implications. This could be a result of medication, dehydration or poor bowel habits.
2. Chronic Constipation
Chronic constipation can last for more than a month at a time. It is often a symptom of an underlying health condition. This could range from an underactive thyroid, diabetes or even emotional problems like anxiety or depression.
3. Idiopathic Constipation
This terminology is used when doctors are unable to accurately pinpoint the cause of chronic constipation. Some of the prime suspects include poor muscle contractions of the colon or reduced sensitivity of the nerves near the bowels.
4. Pseudo-Obstruction
This happens when the muscular contractions in the intestines become inefficient. It is named as pseudo-obstruction as it mimics the symptoms of a physical obstruction even though none exists.
Causes of Child Constipation
Here are some of the common causes:
1. Formula Food
Babies that are on a formula diet may be allergic to ingredients in the formula such as cow’s milk. One can change the brand, shift to soy milk or switch to breastfeeding for a better bowel movement.
2. Anxiety
Some children can be anxious about using public bathrooms or going to the bathroom in a new place. This causes them to hold out when it makes sense for them to go and eventually lead to the hardening of stool.
3. Poor Fibre Consumption
Insoluble fibre helps the food move through the digestive system with ease, and low fibre in your child’s diet can lead to a difficult bowel movement.
4. Flawed Potty Training Approach
Some children can be difficult to deal with when it comes to potty training. If the approach used is too harsh, the child may withhold their bowel movement in an act of defiance. Consistent behaviour like this would make the act involuntary, and they may develop constipation as a result.
5. Dehydration
Children who play for long hours and refuse to drink water have very little water in their bodies. When the intestines absorb what little water there is in the digestive tract, it causes the stool to harden.
6. Haemorrhoids
Some children withhold their bowel movement to avoid the pain caused by a haemorrhoid. Others end up scratching the itchy surface of the haemorrhoid which can lead to scarring. This leads to the narrowing of the rectal cavity.
7. Solid Food
Infants who have switched from breastmilk to solid food can get constipated at times. This happens as some common baby foods often contain rice cereals which have poor fibre content. This can easily be rectified by giving some fibre-rich foods such as apricots, apples or pears.
8. Iron Supplements
Children are often given iron supplements to combat anaemia. Unfortunately, iron helps in the growth of “bad” bacteria present in the gut at the expense of the “good” bacteria present. This can cause a host of issues such as constipation and other forms of intestinal distress. The remedy to this is increasing the intake of Vitamin C in the diet of your children to help them absorb the iron efficiently.
Signs and Symptoms of Constipation in Children
While one symptom alone does not guarantee that your child has constipation, multiple symptoms are a good indicator that your child may suffer from it. These include:
- Infrequent bowel movement
- Strained bowel movement
- Blood in stool caused due to tears on the anal surface
- Refusal to eat
- Obsession to go to the toilet without success in bowel movement
- Marked reduction in going to the bathroom due to fear of pain
- Your child feels as though his/her bowels are still full
- Pain in the abdomen
- Your child complains of a blockage inside their tummy
- Stool that is hard and small
- Bloated feeling in the stomach
- Pain in the rectum while applying pressure due to tears and scarring
Diagnosis
Firstly, the doctor will find out about the medical history of your child. This will help the doctor verify if your child is suffering from constipation. Secondly, the doctor will do a physical examination where he/she will try to determine the extent of the problem.
Finally, some doctors will also run some diagnostic tests depending on the severity of the condition.
1. Colonoscopy
A camera is inserted into the rectum and used to do a full inspection of the colon.
2. Blood Test
This may be used if your doctor suspects that the constipation is due to anaemia or hypothyroidism.
3. Balloon Expulsion Test
This test is used to test the ability of your rectum to remove stool from your child’s body. A balloon is inserted by a medical professional with 150 ml of water or less and your child will be asked to go to the washroom. A timer is used to see how long it takes to be removed from the system.
4. Defecography
An X-ray will be taken of the region around the anus and rectum.
5. Colonic Transit
Some gastroenterologists use technology to track the intestinal muscular activity. Your child may be asked to swallow a small device with a camera to track how your food passes through the intestine.
Risk Factors
1. Irritable Bowel Syndrome
Also known as IBS, it is a chronic disease that affects the large intestine. When the muscles of the intestinal walls are weak, they are unable to contract efficiently which slows the food passage.
2. Inactivity
Studies have shown that physical activity helps in bowel movement. Children who have a sedentary lifestyle have a stronger likelihood of suffering from constipation.
3. Change in the Environment
Sometimes children are unable to have a proper bowel movement as they are unfamiliar with the environment. This can cause children to withhold their bowel movement.
4. Hirschsprung’s Disease
Some newborns do not have the requisite nerve cells for making the muscles contract in the intestines causing the failure of bowel movement.
5. Premature Babies
Premature babies do not have fully developed digestive systems and have a higher likelihood of having digestive problems.
6. Cystic Fibrosis
It is a genetic disease that is life-threatening, affecting the lungs and digestive system. Studies have shown that the low-fat absorption by the intestines leads to constipation in children with cystic fibrosis.
Complications
1. Anal Fissures
Prolonged straining can lead to tears along the rectal cavity known as anal fissures. They may cause pain or bleeding in some instances but normally heal by themselves in a few weeks.
2. Haemorrhoids
They are inflamed veins that exist near the anal cavity. Constipation often aggravates it as it applies pressure to these veins and results in itching, burning sensation and sometimes bleeding.
3. Rectal Prolapse
Chronic constipation would lead to straining of the bowels for proper evacuation. Sustained straining over a few years can lead to the rectum protruding out of the anus.
4. Faecal Impaction
Hardening of the stool sometimes lead to it getting stuck and prevents it from getting evacuated from the bowels.
Treatment
1. Lubricants
As the stool is already hardened, it becomes difficult for it to pass through the anus. Consuming coconut oil and olive oil do a great job in lubricating the surface of the stool for an easy bowel movement.
2. Stimulants
One of the causes of constipation is the slow movement of the food leading to excess absorption of water. Stimulants help in increasing the pace of the muscle contractions within the intestines to help speed up the process.
3. Therapy
Also known as biofeedback training, the focus of the therapy is to optimize your pelvic muscles on when to contract and relax while passing stool.
4. Surgery
In very severe cases, part of the colon may be removed. The shorter length of the colon would reduce the chances of constipation.
Home Remedies
Below are some tips that you can use to help alleviate your child’s condition with the help of readily available items such as:
1. Drinking Water
As constipation is primarily caused due to the dryness of stool, adequate water would help in the prevention of stool hardening.
2. Laxatives
Many over the counter laxatives are available that help increase the frequency of passing stool. However, they are best for mild cases, and severe cases should always be shown to the doctor.
3. Fruit Juice
Studies have shown that a substance called sorbitol, found in apple and pear juice helps to alleviate constipation. 
4. Probiotics
Though further research needs to be done, one study suggested that probiotics helped increase bowel movement as well as soften stools.
5. Stool Softeners
Stool softeners reduce the water absorption capacity of the intestines making the stool soft enough to pass through the rectum.
6. Massage
A non-invasive technique, massaging different areas of the colon helps strengthen the walls of the colon as well as loosens up the stool.
Prevention Tips
Prevention is always better than cure and the below three are the golden rules when it comes to preventing constipation. If these three rules are followed in letter and spirit, your child is unlikely to have problems in the future.
1. High-fibre Diet
You can increase the amount of dietary fibre in your child’s food as it helps in easy bowel movement. Bananas, apples, mashed potatoes, etc. are some of the foods that can be incorporated into your child’s diet.
2. Good Toilet Habits
When your child goes to the toilet frequently, the chances of constipation reduce as it lowers the chance of your child holding it in. You can devise a routine where your child would have to go to the toilet when they get up or at a pre-decided time during the day. Over time, their body will learn the routine and they will not hold in their poop even if they are in a different environment.
3. Regular Exercise
Along with a fibre-rich diet and good toilet habits, an active child keeps the digestive system active. Even if your child doesn’t play sports, a simple 30-minute stroll in the park every day can help.
Diet of Kids to Prevent Constipation
Diet is critical when it comes having a healthy digestive system and nothing says it better than fibres. Fibre is divided into two types: soluble and insoluble fibres. Soluble fibres have a host of health benefits such as maintaining a healthy blood pressure. Sources of soluble fibre include carrots and oatmeal. Insoluble fibres do not have much nutritional value but help in improve bowel movement. Sources of insoluble fibres include corn, beets and green beans. Though fibres are good, overloading your child with fibre too quickly may lead to digestive issues such as bloating. The best approach is to increase the fibre content of their diet in a restrained manner.
All foods that slow down digestion can be either avoided or minimised. This mainly includes protein and fat-rich foods such as dairy products, junk food, frozen food and fried food.
| Dietary Foods | Fibre Content | Amount |
| Green Peas | 4.4 Grams | ½ Cup |
| Baked Sweet Potato | 3.3 Grams | ½ Cup |
| Green Beans | 1.5 Grams | ½ Cup |
| Mashed Potato | 1.6 Grams | ½ Cup |
| Unpeeled Apple | 3.6 Grams | 1 whole fruit |
| Banana | 3.1 Grams | 1 whole fruit |
When Should You Call the Doctor?
In most cases, constipation will clear up on its own by following the treatments given above. However, there may be some cases where a doctor’s intervention may be needed for your child.
1. Blood in Stool
This is a sign that there has been a tear in the rectal walls and is often painful. While there is no need to panic, going to the doctor will help as they would be able to chalk out a good recovery plan.
2. Black Stool
Provided that your child isn’t eating too much chocolate or has had iron supplements, black stool can be an indicator of internal bleeding.
3. Prolonged Constipation
If your child is suffering from constipation for more than a month, the home remedies may not be enough to bring relief. One common mistake that is made is giving laxative in such situations. The stool is already hardened and is likely to cause tears if this approach is taken. Many doctors would give a combination of stool softeners and laxatives to remedy the situation.
4. Anaemic
Children who are anaemic often require iron supplements to increase the iron in their blood. Unfortunately, the most common side effect of these supplements is constipation. Stopping the medication would not be advisable and a doctor would best be able to tell how to handle the situation.
5. Unintentional Weight Loss
This could be an indicator of a serious disease such as Irritable Bowel Syndrome (IBS) or Chron’s disease.
6. Abdominal Pain
Unbearable pain in the abdomen would affect the productivity of your child and destroy their mental peace of mind. Constipation in children can often be confused with serious diseases such as intestinal obstruction.
7. Leakage of Stool
This is one of the symptoms of faecal impaction. The stool in such conditions has solidified and the doctor would need to manually break the stool to remove the blockage.
Constipation can have a profound impact on a child’s psyche and can often make them feel anxious. Parents often make the situation worse by getting worried themselves making the child’s anxiety worse. Though some of the complications mentioned above sound scary, constipation is relatively easy to tackle. Even when the condition is chronic in nature, a good diet can help your child have a normal childhood.
Read this article in Arabic: الإمساك عند الأطفال
