Coping with constipation

Constipation is a common problem in children, so  if you child is suffering, you are not alone! Around one in three children can become constipated at some point in their childhood*, with problems often starting at toilet training time, or after they have experienced a particularly painful bowel movement.

Unfortunately there are no hard and fast rules about how often a child should go, with much variation in the firmness and frequency of bowel movements inchildren. Some go three times a day and others three times a week, but whatever the frequency, your child’s stool should come out easily and look like a smooth sausage.

As parents there are signs to look out for if you think your child might be affected by constipation. Your child may:

  • resist pooing by adopting postures such as squatting, crossing their legs or refusing to sit on the toilet
  • have intermittent stomach cramps
  • lose their appetite
  • become irritable, or develop anal fissures (small tears of the skin at the anus) as the result of straining to pass a large stool. Anal fissures cause bleeding and pain when passing a stool.

Constipation and incontinence
Did you know that, long-term constipation is the major cause of faecal incontinence (soiling), which affects one in 40 children**?

This is due to the hard, dry faeces building up in the bowel to such an extent it causes a blockage, which results in the watery faeces forcing its way around the blockage without the child knowing. Sometimes mistaken for diarrhoea, this is actually constipation with overflow. 

Another cause of faecal incontinence is desensitisation of the bowel. If your child’s rectum is distended for a long period of time, it can be stretched so much it loses its sensitivity, causing it to miss its signal to empty. The faeces can then slip out without the child feeling it.

Constipation also contributes to the risk of night-time and daytime wetting. This is because a constantly full bowel puts pressure on the bladder, reducing its capacity to fill and thereby causing other bladder issues.

What causes constipation?
In the majority of cases, constipation is the result of lifestyle factors that are easily preventable. There are, however, some children with a naturally slow bowel who are more likely to develop the condition.

  • Diet, fluids and exercise: A diet low in fibre and/or fluids will increase a child’s likelihood of constipation, as will a sedentary lifestyle. Children who drink several bottles of cow's milk per day may also become constipated.
  • Avoiding going: If your child ignores the urge to go because they’re busy, or if they avoid going because of an anal fissure or a painful experience, their faeces will dry out more and harden in the rectum, further exacerbating the problem. Avoiding the school toilets, or being told to hold on when they feel the urge will have the same outcome.
  • Disease: In a very small number of children, constipation may be the result of neural conditions, spinal cord defects and certain other disorders, which your doctor will check for.

Prevention and management
Most cases of constipation are managed by adopting a few lifestyle changes.

Healthy bowel habits: Try to establish a regular bowel-emptying regime. One of the best ways to do this is to have your child sit on the toilet for about five minutes (perhaps with a favourite book, toy or electronic device) approximately 20 minutes after a meal (preferably breakfast) with a warm drink. This is when the gastro-colic reflux, a mass movement of contents through the bowel, is most likely to occur.

Give your child a footstool so their knees are slightly higher than their hips, and have them lean forward with a straight back and elbows on knees. This way their rectum and colon are in the optimal straight position for emptying. Some children might need a toilet insert or a frame to make them feel more secure.

Your child should only have to push gently, and should never have to strain hard to poo. Encourage your child to respond to their body’s urge to go to the toilet and discourage holding on.

A healthy diet:
To ensure a healthy diet with sufficient fibre and fluid, aim to give your child:

  • At least two servings of fruit each day (with peel on preferably), at least three servings of vegetables, cereals that are less processed, and wholemeal bread instead of white.
  • Ensure they drink enough to satisfy their thirst, and limit sugary or high-caffeine drinks which can irritate the bladder. For children over 18months, limit cow's milk intake to 500ml per day to improve your child's appetite at meal times.
  • Remove frightening or painful associations:
  • If a child has chronic constipation they may require long term laxatives under medical supervision to soften the stool and help make it easier for your child to go to the toilet.
  • Check with your child if they avoid the school or preschool toilets, and if there is a problem, speak to the school or preschool. Find out what the policy is regarding the toilets’ supervision, privacy, location, condition and when the children are permitted to go.

It is known that stressful school toilet environments can have a negative impact on a child’s developing bladder and bowel habits, and many children with negative associations with school toilets adopt unhealthy toilet habits that can, in some instances, persist into adult life***. To help children get on the right track, the Continence Foundation of Australia developed a child-friendly Toilet Tactics kit for schools. The kit supports the work of parents, and provides children with the skills and knowledge to adopt lifelong healthy bowel and bladder habits. It also illuminates teachers and parents about the importance of implementing, encouraging and reinforcing good bladder and bowel practices early.

If your child’s is constipated for an extended period of time, see your doctor or contact the free and confidential National Continence Helpline (1800 33 00 66), which is staffed by continence nurses who can provide advice, information and referrals.

*(N A Afzal, 2011)
** (S R Ali, 2011)
*** (Lundblad and Hellstrom, 2005)

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