Childhood Constipation

January 4, 2016 Uma Pisharody, MD, FAAP

Chronic constipation is so common in childhood, it’s the reason one in four patients see pediatric gastroenterologists like me.  This blog is meant to summarize the answers I give to the most common questions parents ask, regarding this common problem. (I’d also like to preface the discussion by mentioning that this blog is not intended for the parents of infants with constipation, which is a subject to be dealt with separately.)

How do you know a child has chronic constipation?

I would diagnose a child as having chronic constipation when, for over a month, he/she has been struggling to pass stools. The key word, “struggle” is important here, as what constitutes a struggle for one child may be different for another.  A child is constipated, if the number of stools they pass per day has significantly decreased from their previous baseline, or if their stools have become firmer or larger than they used to be. And if this change is causing them to struggle and strain, they are constipated.

What causes it?

The vast majority (97 percent) of childhood constipation is due to “functional constipation.” This is the term given to describe constipation that results NOT from medical disease, but rather a combination of biological and psychosocial triggers. For instance, a toddler, having to take a break from playtime to have his diaper changed, might start to associate stooling with the negative consequence of less playtime and learn how to hold his stools in for hours to days. Other children may have have become afraid of sitting on the toilet or stooling for various other reasons, too lengthy to be discussed in detail here.

The other type of constipation which is very rare, is termed “organic constipation.” This occurs when the intestinal tract is afflicted by medical diseases such as neuromuscular or autoimmune problems, to mention a few.

Are there tests my child should have for his/her constipation?

Since by far, the vast majority of kids have functional constipation, testing is usually not necessary. If, however, your child’s constipation is not improving despite therapy, tests should be considered. As a pediatric gastroenterologist, I probably seek testing more often than general pediatricians, because it’s the children who are not getting better who are most often referred to me. When testing is done, routine x-rays are usually not very helpful in figuring out what caused the constipation. Blood tests are the usual method we select first, and then occasionally, other special tests looking at muscle and nerve function.

How is it treated?

Since most chronic, childhood constipation is functional, the key to success is repeatedly showing the child positive behaviors and outcomes from stooling on a regular basis. Medicine can’t fix functional constipation, but it certainly can help, by keeping stools soft, so as to reassure these children that their stools will never hurt them.  The treatments that I recommend depend on the age and developmental maturity of each child that I meet.

First and foremost, I want children to stop holding-in their stools. I want them to learn to relax and to look forward to stooling. Treatments are tailored to meet this goal, after discussions with the family, based on individual experiences and the feedback that I receive from each child.

How can I learn more?

To learn more about how pediatric gastroenterologists approach constipation, please visit these helpful pages:

If you would like to have one of the pediatric gastroenterologists at Swedish see your child regarding his/her chronic constipation, please feel free to set up an appointment.

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