Constipation: every parent’s favorite topic

It’s amazing how once you become a parent you begin to realize that talking about poop is just part of everyday conversation. Has your child pooped today? What was the consistency? What was the color? (I know! Your high school self would not believe this is what you now talk about with your significant other!) But what happens when you child can’t, or isn’t, pooping? 

Constipation is a very common problem for many children. Between 12-14% of kids have chronic issues with constipation, which is defined as a decrease in the frequency of bowel movements (poop) or the passage of painful bowel movements.  

We asked Kacie Kaufman, APRN, and director of the BRICK (Bowel Retraining in Constipated Kids) Clinic, about the common myths and facts of constipation, and Rebecca Rentea, MD, and Iris Lim-Beutel, MD, Colorectal and Pelvic Reconstruction trained Pediatric Surgeons, to discuss when this condition might be something more serious. 

Constipation is almost always caused by a medical condition.

False: Most constipation is functional in nature, meaning there is no identifiable medical cause. Often kids begin withholding poop because of pain or for social reasons such as school. It is very uncommon for there to be an organic cause of a child’s constipation such as colon disease or a neurological problem. In children, constipation can begin when there is a change in the diet, during toilet training or following an illness. Often kids don’t like using toilets outside of home, so they withhold till they get back home. Holding poop is a very common trigger for constipation. A diet low in fiber and fluids and some medications can also contribute to constipation.

Chronic constipation only happens to toddlers.

False: Constipation can occur at any age. It is especially common in preschool aged children who are being toilet trained and in school-aged children. Children at these ages are more prone to hold their poop due to avoidance of the toilet leading to painful poop. 

There are several symptoms parents should be aware of.

True: There are a variety of symptoms associated with constipation.  People think constipation means that a person goes days without pooping, but there are also other symptoms that parents need to be aware of. Symptoms such as a history of passing large sized poop that may or may not clog the toilet, fecal soiling (the leakage of stool that a child cannot control), abdominal pain and withholding behaviors such as stiffening legs or hiding in the corner can be associated with constipation. 

Older aged children are typically more private about their bathroom habits, so these kids often don’t get diagnosed until these other symptoms occur.

A child can be constipated even if they’re going poop every day.

True: Yes, this is definitely true. Constipation is not only determined by how often the child poops, but also by the volume or amount and the consistency of it.  If the child only passes a pea size poop once a day, then he or she is constipated.

Parents should do their best to monitor a child’s bathroom habits to find out if the child is having any trouble going poop, especially when they reach school age and older. Keeping a poop journal can be a helpful way of tracking.

Over-the-counter laxatives are safe to use.

True:  Over-the-counter laxatives are safe to give children. MiraLAX is commonly the first line treatment many health care providers recommend because it is a powder that is easy to administer in a drink of choice. It is colorless, tasteless and is well-tolerated for long periods of time without children becoming dependent on it. MiraLAX and other stool softeners work by pulling water into the stool to keep it soft and easy to pass. 

Constipated kids will find relief after going poop once.

False: Treatment of constipation is often a process and takes several months or more to improve. The first step in treatment is to do a bowel clean out and remove as much poop as possible from the colon.  A clean out should create lots of loose stool. After clean out, a daily maintenance dose of a stool softener/laxative is given to prevent build-up again. The goal with daily medication is to help the child pass soft daily stools and decrease withholding behaviors. It takes times for the colon to return to its normal shape and muscle tone.   

Bowel retraining is an important part of treating constipation.

True: Overtime the rectum gets stretched out from retained stool and there is loss of sensation and lack of communication from the gut to the brain. The normal urge to poop is lost, so kids can go several days without passing a poop. Scheduled bathroom breaks after meals are a good way to retrain the bowel.  Children should sit on the toilet for about five minutes and relax to see if they can go. Using a foot stool can be very helpful when sitting on the toilet as well. By getting kids on the toilet daily and treating their constipation effectively, kids will regain the urge to poop.   

Positive reinforcement and rewards can be very helpful with bowel training.  Offer kids a small reward or treat such as a piece of candy or electronic time immediately after completing a toilet sit. 

Constipation is fixable.

True: Constipation is definitely fixable, but it takes a commitment from both the child and parents. Often kids are taking medication daily for many months or longer to keep stools soft and regular.   

It's recommend that kids visit their pediatrician and try over-the-counter remedies first for constipation. The child may need to try a couple of different medications before they find relief. If symptoms persist, than a referral to a GI clinic, like Children’s Mercy’s BRICK Clinic or other gastroenterology clinics, can be made.

If symptoms do persist, it’s possible your child may have a more serious condition that will require surgical intervention. Because the conditions that result in constipation may be caused by different systems in the body, your child may need additional support from specialists that focus on the bladder, kidneys, spinal cord or other systems. 

The Comprehensive Colorectal Center at Children’s Mercy is one of the few pediatric comprehensive colorectal centers in the nation, and provides care for your all of your child’s congenital colorectal and complex colorectal needs in a multidisciplinary setting including mental health support.