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Pediatric constipation

As many as 1 in 10 children experience constipation at some point, meaning they have hard stools that are painful or difficult to pass or they have infrequent bowel movements. Chronic constipation that lasts for several weeks and does not get better with treatments can indicate a more serious gastrointestinal (GI) problem that requires treatment. At the only Pediatric Neurogastroenterology and Motility Disorders Program in North Texas, we specialize in advanced treatments like anorectal biofeedback.

Overview

What is constipation?

Constipation occurs when stool sits in the rectum (the last part of the large intestine) for too long. It is a motility disorder, which means something affects stool movement (motility) through the digestive tract. The stool becomes hard, dry or lumpy, making it difficult or painful to pass. A child may strain or push too hard to poop, causing a tear in the anus (anal fissure) or hemorrhoids. Or they may hold in the poop and have infrequent bowel movements. Untreated chronic constipation can cause some toilet-trained children to involuntarily leak stool into their underwear (encopresis).

Signs and Symptoms

What are the signs and symptoms of constipation in kids?

Most children poop at least once a day or every other day. A child with constipation has fewer than two bowel movements per week. Other signs of constipation in children include:

  • Abdominal pain (stomachache) or bloating

  • Blood in stool or on toilet paper or a diaper (hematochezia)

  • Withholding behaviors like clenching butt cheeks, rocking on their heels, standing on their tiptoes or changing positions to avoid having a bowel movement

  • Daytime wetting (urinary incontinence) or bedwetting (nocturnal enuresis)

  • Hard, dry, lumpy stools or large stools that clog the toilet

  • Lack of appetite and abnormal weight loss

  • Leaking stool into their underwear (encopresis)

  • Painful bowel movements or straining to poop

  • Spitting up (in infants) or vomiting (in older children)

Diagnosis

How is constipation diagnosed in kids?

When constipation is intermittent and doesn’t cause significant problems, our doctors may make a diagnosis based on your child’s symptoms and a physical examination, including a rectal exam.

Determining the cause of chronic constipation is more complex and requires advanced motility studies and other tests. You can have confidence knowing your child undergoes testing in our state-of-the-art pediatric gastroenterology (GI) laboratory. We also have the region’s only certified pediatric motility lab that evaluates how well the GI tract is working. Our team knows how to keep your child comfortable during these tests.

Advanced diagnostic tests for children with chronic constipation include:

  • Anorectal manometry: Assesses pressure and nerve sensation in the anus and rectum.

  • Enema: A radiology (X-ray) procedure that uses a contrast dye to check for an intestinal blockage or narrowing.

  • Colonoscopy: A lower endoscopic procedure to examine the large intestine.

  • Rectal suction biopsy: Determines if a child is missing nerve cells in rectal tissue that stimulate the rectum to hold or release stool.

  • Sitz marker study: Tracks a digestible capsule as it moves through the large intestine.

  • Colonic manometry: Measures the force of muscle contractions in the large intestine (colon).

Causes

What causes constipation in children?

Behavioral issues like withholding, dietary problems like lack of fiber and water, as well as physical inactivity, are the most common causes of constipation in children.

Withholding means a child holds in a bowel movement. They may be afraid that going to the bathroom will hurt. They may not want to stop what they are doing to take a bathroom break. When stool sits too long in the large intestine, it starts to absorb liquids from it. This makes the stool hard, dry and more difficult to pass.

Constipation can also be a side effect of some medications.

For some children, chronic constipation is a sign of a digestive system problem that requires treatment. These conditions include:

Treatment

How is constipation in children treated?

If tests indicate your child has a digestive system problem, our doctors will treat that condition. Some children need surgery while others need specific medication. We have one of the country’s top-rated Pediatric GI Programs, according to U.S. News & World Report.

Our pediatric constipation treatment program is the only one in the Dallas metro area using anorectal biofeedback to treat chronic constipation in children. Our specialists help your child learn to control their anal and rectal muscles. This therapy helps reduce and prevent stooling accidents and constipation.

Other treatments for pediatric chronic constipation include:

  • Behavioral modifications like using the bathroom at set times to retrain the bowels and stop withholding behaviors

  • Dietary changes, increasing fluids and fiber

  • Enemas to cleanse the large intestine of backed-up stool

  • Laxatives and/or stool softeners to help your child pass a stool without pain or straining

  • Increased physical activity to stimulate the bowels to move

Doctors and Providers

Our experienced team of GI motility disorder specialists expertly diagnose and treat constipation in children.

Frequently Asked Questions