Difficult, infrequent, and sometimes painful passage of hard faeces
- A low-fibre diet is a risk factor
- Age, gender, and genetics are not significant factors
All children differ in their bowel habits. Some children pass faeces several times a day, and others may do so only once every few days. Both these situations are normal provided that the faeces are not too runny or so hard that they cause discomfort. The presence of hard faeces that are difficult or painful to pass indicates that your child has constipation, a common condition that affects people of all ages. Constipation in children is usually only a temporary problem, and often no cause is found. It is rarely an indication of a serious underlying disorder.
What are the causes?
A common cause of temporary constipation is a change in diet, particularly if there is insufficient fibre or fluid in the diet. Constipation is rare in babies, but the condition may occur during the change from formula or breast milk to cows’ milk. Sometimes, temporary constipation occurs during toilet training, when it is common for a toddler to try to avoid defecation. This phase may be associated with a toddler passing faeces in inappropriate places (see Encopresis). Illnesses that cause high fever and vomiting can also cause temporary constipation due to dehydration.
Underlying disorders that may cause persistent constipation include cerebral palsy, in which there is brain damage that impairs muscular control, and Hirschsprung’s disease, a rare disorder in which the nerve supply to the lower bowel fails to develop normally.
What are the symptoms?
If your child has constipation, you may notice the following symptoms:
Difficult passage of small or bulky hard, dry faeces.
Soiling of clothes due to leakage of faeces associated with constipation.
Sometimes, loss of appetite.
Your child may be afraid to pass faeces if he or she suffers severe discomfort while defecating, especially if a painful tear develops in the anal tissue (see Anal fissure) caused by straining to pass stools. In these cases, constipation may become a long-term problem.
What can I do?
In most cases, constipation in children does not require medical treatment. You should encourage your child to drink plenty of fluids. If the child is over the age of 6 months, make sure that there is plenty of fibre in the diet. If constipation is linked to problems with toilet training, patience and time will usually solve the problem. Seek medical advice if constipation persists for a week despite self-help measures.
What might the doctor do?
The doctor will probably examine your child’s abdomen and may perform a rectal examination, in which a gloved finger is gently inserted into the rectum. He or she may prescribe a short course of drugs to soften the faeces (see Laxatives) and reduce the discomfort of defecation. Softened faeces will also allow an anal tear to heal. Once the pain of defecation is relieved, your child should feel confident to pass faeces normally again. If constipation persists or your doctor suspects a disorder such as Hirschsprung’s disease, your child may need an abdominal X-ray, or a specialized contrast X-ray or a biopsy (removal of a tissue sample for examination) of the bowel for a definite diagnosis. Hirschsprung’s disease may be treated by surgery to remove the abnormal area of bowel. Severe constipation caused by a condition such as cerebral palsy may require lifelong treatment with laxatives. In other cases, constipation usually clears up within 1–2 weeks of changing the child’s diet or of laxative treatment.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.