Constipation is not uncommon in childhood. For most children, it is temporary & doesn’t last long. However for some, it can lead to other problems like withholding, soling, and the restarting of day/ night wetting after being toilet trained.
WHAT IS CONSTIPATION?
It is the slowing down of stool matter (body waste) through the large intestine causing it to dry out and become hard.
WHAT DOES CONSTIPATION LOOK LIKE IN CHILDREN?
It is a hard, dry stool that causes pain when moved out of the body.
It can be an infrequent poo or a poo that comes out accidentally after the child has been toilet trained.
Some children may have hard poo with some watery or diarrhoea poo.
SOME SIGNS OF CONSTIPATION MAYBE WHEN YOUR CHILD:
- Has skid marks in their underwear
- Says it hurts or feels “sharp” when they do a poo
- Withholds or tries to hold poo in. Children might back up against a wall, crossing their legs, toilet refusal, hide, getting distressed, cry out and become distressed when needing to poo.
- Complains of tummy aches
- Bowel movement when sleeping after the age of 3 years.
WHAT CAUSES CONSTIPATION?
There are 4 main times when children may become constipated:
- Moving from breastmilk to formula milk
- Introducing solid foods
- Commencing toilet training
- Commencing school
OTHER CAUSES INCLUDE:
- Illness, often with fevers
- Lack of exercise,
- Poor diet intake
- Not enough water intake or
- Withholding. This is where kids avoid going to the bathroom to do a poo when they have the internal urge to go. If children feel unsafe or have had a scary or unpleasant experience on the toilet (falling, toilet seat pinch, explosive diarrhoea, smells etc) they may not wish to experience that again and therefore withhold when the next urge comes. Whatever the initial cause, withholding will always cause the poo to harden and the next time the child actually does pass the poo, it will hurt thus reinforcing the need to withhold next time causing a cycle of pain.
MEDICAL CONDITIONS THAT CAN CAUSE CONSTIPATION INCLUDE:
Food or Cows milk allergy
Other medical conditions.
TREATMENT OF CONSTIPATION
When we treat constipation we treat two areas the “medical condition” and the “behaviour”. By behaviour I don’t mean them being naughty, it is the body and brain connection of pooing.
WITHHOLDING, SOILING, AND WETTING ARE NEVER MISBEHAVIOUR.
All children with ongoing constipation should be seen by their GP first to rule out an underlying medical condition.
Encouraging your child to eat a wide variety and of foods with lots of different colours. Include fibre-rich foods like fruit and vegetables. However, do not increase specific fibre as this will just make the problem worse.
We want our children to drink more water and exercise.
Good sitting posture on the toilet is also really important. A small toilet seat that our kids feel safe to relax on, one that doesn’t move or pinch their bottom. A sturdy footstool so that the knees are slightly raised above the hips. Sitting posture should be with a straight back so the arms can rest on the knees.
If you have attempted all these basic things, and your child is still constipated – it’s time to get more help. Contact Me and we make a plan for next-level treatment. If we get onto constipation early it usually resolves with no lasting impacts on the child.
WHAT IS “WITHHOLDING”?
When poo becomes hard it can really hurt to pass. For some kids, this will lead to fear about actually doing a poo. This can then lead to them refusing to go to the toilet – we call this “withhold”.
Unfortunately, this then causes the poo that is in the bowel to become harder and increase in volume. So when the next poo comes out it hurts, even more, reinforcing to the child that doing a poo hurts and they will do more “withholding” next time.
Withholding behaviours can look different for each child. They might push up against a wall, standing on tiptoes, crossing their legs, or clench their bottom. Some children will go on all fours while others will want a nappy.
PARENTS COULD TRY TO:
- Encouraging kids to drink more water,
- Encourage kids to increase their fruit and Veg intake by offering a wide variety of colours, tastes and textures in their diet. DO NOT especially increase fibre (all bran etc) as this can increase the constipation loading.
- Encourage kids to increase their exercise with outdoor games.
- Try to solve the problem quickly and safely as the longer children feel pain the harder it is to retrain the body and brain connection and the longer it may take to treat and repair.
- If non of the above are working – make an appointment with a pediatric continence nurse to consider some different options and make a plan to move forward.
FINAL TAKE-HOME MESSAGE.
If the problem is an ongoing issue it is best to find help quickly.
See your GP first. If there are no medical issues present, then you can call me for ongoing support or another Paediatric continence specialist in your area.
Get help early this will prevent the need for long treatment plans
No child ever wets or poos themselves intensionally. Every child wants to belong and be a part of their family and community. No child wants to be different. No child is “too lazy” to go to the toilet.
If you think that your child has constipation issues, please seek help early. There is support and help for you and your child.
Contact me if you would like more help or information with any wetting, or soiling issues.
Mayo clinic – constipation
Continence Foundation of Australia