But my child isn’t constipated!

We find that many of our patients have issues with constipation, and their parents don’t think their child is constipated. Once children can effectively clean themselves after using the restroom, most parents understandably do not know how often their child has bowel movements, nor do they know the size or consistency of the bowel movements. As long as the child isn’t complaining of abdominal pain or trouble with bowel movements, parents often assume their child can’t possibly be constipated. In fact, children with urinary complaints are one of the groups most commonly affected by constipation.

Certainly, we know that constipation has an impact on many of the conditions we treat. Constipation plays a role in urinary tract infection, daytime wetting, bedwetting, urinary frequency/urgency, and even penile pain. If your child has any of these conditions and reports fewer than six bowel movements per week, hard stool, large stool, small pebble-like stool, or straining to have a bowel movement, constipation may be affecting your child (Please see Bristol Stool Scale). In addition, children that have soiling (called encopresis) often have issues with constipation. This includes stool marks "streaking" the underwear, liquid stool accidents, or formed stool in their underwear.

What causes constipation?

Common causes of constipation in children include not enough fiber in their diet, too little fluid intake, lack of physical activity, ignoring the urge to have a bowel movement, and some medications and chronic medical conditions.

Children often do not enjoy eating foods that are high in fiber. Children tend to choose foods that are highly processed, including fast foods that are particularly low in fiber. Unfortunately, children are also becoming less physically active, which makes for a sluggish colon. In addition, many children do not like to have bowel movements when they are away from home or hold in bowel movements if they don’t want to interrupt play. Children often simply don’t set aside time to have a bowel movement. All of these factors contribute to constipation.

How is constipation treated?

When treating constipation, it is important that dietary and lifestyle changes are implemented. Sometimes medications are prescribed to initiate a bowel clean-out to enhance the success of dietary and lifestyle changes. Children who have severe constipation, encopresis, or are not affected by initial efforts to treat constipation are often referred to a pediatric gastroenterologist. These specialists can perform further testing and prescribe more aggressive programs to assist in the treatment of constipation.

Increased dietary fiber is an important part of constipation treatment. A general rule for fiber intake in children is to take your child’s age (in years) and add five. This equals the number of grams of fiber your child should get daily. For example, a five-year-old should have a daily fiber intake of 10 grams (5 years + 5 = 10 grams of fiber). It is also important that your child take in plenty of fluids when increasing fiber intake. For more information, see the Fiber Fact Sheet (PDF) for information on how much fiber is in foods.

Physical activity is an important aspect of preventing constipation. Encourage your child to get plenty of exercise and minimize time playing video games and watching television that encourage a sedentary lifestyle.

Medications, if prescribed for constipation include laxatives, over-the-counter fiber supplements, and/or mineral oil that lubricates the stool. If prescribed for your child, these medications are used to initiate a formal bowel program, and should be used with increased dietary fiber, physical activity, and setting aside time for bowel movements.