A Spotlight on Childhood Constipation

25 Nov

How do we define constipation?

Constipation is a decrease in the number of stools passed in a day. Normal is anywhere between 3 times a day to 3 times per week. Symptoms include passing large hard stools, straining on the toilet and soiling clothes with liquid faeces due to overflow (liquid moving pass a large stool blockage in the bowel). Constipation ongoing for more than 8 weeks is defined as chronic (1).

Why do we need to talk about constipation?

10-20% of children in the UK are struggling with constipation with a peak around 2-3 years old when toilet training normally begins (2). It can be distressing for children and their parents and if left untreated can lead to complications such as anal fissures (a tear around the anus), haemorrhoids and rectal prolapse (3).

What causes constipation?

As a GP I often talk to parents who are worried about something sinister underlying their child’s constipation. The vast majority of constipation however is caused by what’s called functional constipation; meaning their is no underlying structural cause for it. We don’t fully understand why it happens but we know it happens more often in children who don’t have a balanced diet, drink enough water or have additional needs such as autism.

There are 2 rarer causes of constipation: Hirshsprung’s disease and Spina Bifida. These are normally picked up at birth but not always, so if you are concerned about these discuss with your GP (4).

How do we assess childhood constipation?

If you suspect your child is constipated you can keep a stool diary to document how often and what type of stool your child is passing. The charity ERIC provide a helpful guide to this called a Poo Diary to fill out and this can be helpful to bring with you to the GP, health visitor or school nurse (5).

Your GP will examine your child’s abdomen to rule out signs of another underlying cause. If they are happy there are no concerning features then they will move on to discuss treatment.

How do we treat childhood constipation?

For most children a change in diet will not be enough to treat constipation initially. Treatment normally starts with something called disimpaction. This means giving stool softeners in increasing doses until the bowel is “cleared out”. After this your child will normally need a lower dose of regular stool softeners for several months to maintain regular bowel movements. Your GP should talk you through the process of disimpaction and a helpful guide can be found through ERIC linked below (6).

Tips for maintaining good bowel habits after initial treatment are:

Encourage your child to drink 6-8 cups of water per day
Aim for a balanced diet including fruit and vegetables
Encourage regular trips to the toilet
Use a footstool to support their feet
Don’t stop giving laxatives too soon!

Still struggling with toileting issues?

For some children, particularly those with additional needs, constipation and toileting in general can become an on-going problem. As a parent you will need some extra support, this is usually through someone called a continence nurse who will personalise your treatment plan for your child.

Resources:

Stephanie Murdock

A Spotlight on Childhood Constipation

December Book Club Pick

Managing Heartburn Through Lifestyle