What is constipation?
Bowel movements may vary for each individual and across cultures depending on the intake of fibre in the diet. Normal bowel movements may vary from 3 per day to 3 per week. When a person has infrequent or hard stools or has to exert considerable effort while passing stool, he is said to have constipation.

Children with constipation have bowel movements that are hard, dry and painful to pass. These stools may occur every day or may be infrequent. The condition is very common, occurring in at least 2% of 7-year-old children, and probably similar numbers in other age groups.

What are the causes?
Constipation may be due to various physiological and psychological conditions. It often begins when a child holds back a bowel movement. Perhaps the child has had hard, painful stools. A diet change, viral illness, hot weather, or travel can lead to hard stools. A bad diaper rash can cause painful passage of stool. Older children may start holding bowel movements when they go to school. At any age, fear of discomfort or embarrassment can make a child try not to have a bowel movement. If this continues, it may lead to constipation. Once a child is toilet trained, he must be encouraged to go to the toilet regularly every day.

Stool that is held back gradually fills up the colon and stretches it out of its normal shape. Stool retained in the colon for some time becomes dry as the colon absorbs water from it. The longer the stool is held in the colon, the larger and harder it becomes, making bowel movements even more painful. In the normal colon, muscles try and push stool out. Nerves tell the child that stool needs to come out. However, stretched-out, flabby colon muscles cannot push. Hard stool gets stuck. Sometimes only liquid stool may pass around the rocklike stool. Stretched nerves become less sensitive. The child may no longer realise that he needs to have bowel movement, and he may be afraid to try to go.

What are the symptoms?
Some children with constipation may not have any bowel movements for several days; they have a very large, hard stool that can clog the toilet.

The most common symptoms a person with constipation may experience are:

* Infrequent passage of stool
* Difficulty in bowel movement
* Bloated feeling in the stomach after a meal
* Feeling of incomplete evacuation
* General feeling of discomfort and malaise.

A child may refuse to go to the toilet, or may hide to have his stool in a private place. He may cross his legs, make faces, stretch, clench his buttocks, or writhe on the floor. It sometimes seems that he is trying to push stool out but is unable to do so. In most cases he is actually holding the stool back.

Other symptoms include stomachaches, cramps, vomiting, nausea, poor appetite, headaches and weight loss. Some children with constipation may wet their beds at night. These children may have urinary tract infections because stool masses press on the urinary bladder and can block normal urine flow.

How is it diagnosed?
There are no specific tests to diagnose constipation. Parents should be aware when the child is having trouble in passing stool. The doctor is then informed who will prescribe medications.

How is it treated?
The large, rocklike stool in the colon must be softened and broken down before it can be passed. Mineral oil or milk of magnesia is often used for this purpose. Cleanouts can be very messy since the child often cannot control the passage of the stool and medicine mixture. Younger children may have to wear diapers again during the cleanout. Older children may have to remain home from school so as to be able to reach the bathroom quickly. There are many ways to accomplish the initial cleanout. The doctor is the best person to decide upon this.

Ongoing treatment
The goals of this is to prevent stool buildup, allow the colon to return to its proper shape and function, and encourage the child to have bowel movements in the toilet. This takes several steps:

1. Decrease the medicine dose as your doctor directs. Slight adjustments of the dose may be needed to prevent stool build up and to keep the stools soft but not too runny.
2. The child should sit on the toilet, trying to have a bowel movement, for five minutes, fifteen to thirty minutes after a meal or snack. Try to do this at least twice a day. He should concentrate on pushing with the belly muscles and relaxing the muscles of the anus. After meals, especially after breakfast, is the best time for this because a full stomach makes him feel the need for a bowel movement. A large hot drink may increase this feeling. The best position for a bowel movement is with the child’s bottom sinking into the toilet as long as this position is comfortable.
3. Increase fibre intake by encouraging whole grains, fruits, vegetables, peanut butter, dried fruits, and salad.
4. Increase fluids in the diet, especially juices.
5. Increase physical activity if it seems below average for your child’s age. Exercise helps move stool down the colon.
6. It is important to encourage the older child to take responsibility for his actions. He should be responsible for taking the medicine without a fight, for sitting on the toilet, and for cleaning up stool accidents.

In most cases of temporary constipation, the doctor may prescribe a laxative so that passage of stool becomes easier. A balanced dietary pattern, regular exercise and good bowel habits will help to prevent constipation in the future. If there is an underlying cause for constipation, the treatment is directed towards it.

 

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