Constipation is common in childhood. It is prevalent in around 5–30% of the child population, depending on the criteria used for diagnosis. Symptoms become chronic in more than one third of patients and constipation is a common reason for referral to secondary care. Morbidity may be under-reported because people may not seek advice because they are embarrassed.
The exact cause of constipation is not fully understood but factors that may contribute include pain, fever, dehydration, dietary and fluid intake, psychological issues, toilet training, medicines and familial history of constipation. Constipation is referred to as ‘idiopathic’ if it cannot be explained by anatomical or physiological abnormalities.
Many people don’t recognize the signs and symptoms of constipation and few relate the presence of soiling to constipation. The signs and symptoms of childhood idiopathic constipation include:
infrequent bowel activity, foul smelling wind and stools, excessive flatulence, irregular stool texture, passing occasional enormous stools or frequent small pellets, withholding or straining to stop passage of stools, soiling or overflow, abdominal pain, distension or discomfort, poor appetite, lack of energy, an unhappy, angry or irritable mood and general malaise.
Painful defecation is an important factor in constipation but it is not always recognized; Families may delay seeking help for fear of a negative response from healthcare professionals.
Some children and young people with physical disabilities, such as cerebral palsy, are more prone to idiopathic constipation as a result of impaired mobility. Children and young people with Down’s syndrome or autism are also more prone to the condition. It is important that assessment and ongoing management for these children and young people happen in the same way as is recommended for all children and young people.
Without early diagnosis and treatment, an acute episode of constipation can lead to anal fissure and become chronic. By the time the child or young person is seen they may be in a vicious cycle.
Children and young people and their families are often given conflicting advice and practice is inconsistent, making treatment potentially less effective and frustrating for all concerned. Early identification of constipation and effective treatment can improve outcomes for children and young people. This guideline provides strategies based on the best available evidence to support early identification, positive diagnosis and timely, effective management. Implementation of this guideline will provide a consistent, coordinated approach and will improve outcomes for children and young people.
Tips to manage constipation in children
- Give plenty of water to the affected child.
- Try 2 to 4 ounces of half-strength pear or apple juice (diluted with water). Alternatively, add one-half ounce of table syrup to 3 ounces of warm water, then administer by mouth to soften the stool.
- Add two tablespoons of baking soda to a warm bath. Let your child relax for 5-15 minutes, soaking in the warm bath.
- Applying a warm, moist cloth to the anus can sometimes stimulate a bowel movement.
- To stimulate a bowel movement, a plastic swab tipped with cotton (Q-tip) with a small amount of Vaseline ointment can be gently inserted through the anus (not too far, just the cotton tip) and promptly removed. Your health care practitioner may prescribe a glycerin suppository for the same purpose but with greatest effect.