constipation

WHAT IS THE CONSTIPATION?

Constipation is probably one of the most common problems in children and most children have had this problem at one time of the other. Bowel patterns i.e. when and how often stools are passed, in fact, vary from child to child – what’s normal for one child may be very different from what’s normal for another child. Normally, most children have one or two bowel movements in a day.

Constipation can be defined in terms of the following:

• more than three days without bowel movements
• stools that are large, hard and sometimes painful to pass
• incomplete bowel movements where the stool backs up in the bowel despite daily bowel movements.

In simpler terms, a constipated child has infrequent bowel movements or hard, dry stools. While constipation causes discomfort and pain, it is usually a temporary condition that is easy to correct. But, if left untreated, the condition’s symptoms can get worse.

Chronic constipation or constipation that lasts for a long period of time usually develops over several months or even years. Most of the children suffering from the condition need to undergo at least six months of therapy and have regular bowel movements before they can discontinue the therapy. In some cases, in spite of the therapy, the condition can relapse because of changes in routine, such as travel, change in diet or even start of school.

WHAT ARE THE SYMPTOMS OF CONSTIPATION?

The signs and symptoms of constipation might include the following:

• Less than three bowel movements a week
• Bowel movements that are hard, dry and painful
• Many days between two bowel movements
• Bleeding from the child’s bottom
• Stomachaches and cramping that is accompanied with nausea
• Soiling – traces of liquid or pasty stool in the child’s underwear.
• Blood on the surface of hard stool

WHAT SHOULD MOTHERS KNOW ABOUT THE CAUSES OF (CHRONIC) CONSTIPATION?

Constipation is a common problem and could be because of several reasons. The several factors that contribute to constipation among children are:

• WITHHOLDING: Mothers with toddlers should pay special attention to their child’s bowel movements and their behavior as toddlers often try and hold their stool especially when they’ve had a painful bowel movement. This painful experience convinces them that having a bowel movement is something that should be avoided. They do not want to undergo that same experience again and they, either cross their legs and become rigid or tend to hold their bowel movements for days.
• TOILET-TRAINING ISSUES: Mothers with children who are being toilet-trained have a different problem to address. The children might not want to take the time out from their playing time and go for a bowel movement; or sometimes they might even be afraid to use a bathroom that they are not used to; or they do not want to have a bowel movement at school/ daycare. Mothers need to anticipate such problems and work out ways to address them early so as to help resolve the constipation that results from holding back.
• NOT BEING ABLE TO RELAX: Another issue that mothers need to be aware of when it comes to their child’s bowel movements is that many children are not able to relax their bottom as they try to push the stool out. These children tend to push and hold the stool at the same time. An easy way out is to have the child blow a party noisemaker or pinwheel while sitting on the potty. This will help them relax their bottom.
• CHANGES IN ROUTINE: Children tend to follow routines and they learn to adapt themselves accordingly, however, changes in their daily routines affects their behaviour and this includes bowel movement routines as well. Changes in routines, such as travel, hot and cold weather, stress, start of a school etc. often lead to children becoming constipated.
• DIETARY CHANGES: A common reason for children becoming constipated is when they’re switching their diet from an all-liquid diet to a diet that includes solid foods. Moreover, a diet that doesn’t comprise fiber-rich fruits and vegetables or even fluid in the child’s diet may lead to constipation.
• ALLERGY TO COW’S MILK: Some kids tend to be allergic to cow’s milk and this, sometimes could lead to constipation. Apart from this, excess consumption of certain dairy products, such as cheese could also be a cause.
• ILLNESS AND/ OR MEDICATION: Children who are sick tend to lose their appetite and this could lead to constipation. Also, constipation may be a side effect of certain medications and could be because of certain medical conditions, such as hypothyroidism.

Another aspect that mothers should be aware is that children suffering from chronic constipation develop a stretched rectum. Over time it gets filled with a stool plug and the stretched muscles of the rectum are not able to push all the stool out of the rectum. Stool in the liquid form then seeps down around the stool plug and onto the child’s underwear without the child even being aware that they are about to soil. Treatment can help the child recover from this problem, however, since it is a chronic condition that has developed over a long period of time, it will take some time to correct. And if treatment is stopped too soon or withdrawn too quickly, the condition can definitely relapse.

WHAT ARE THE POSSIBLE COMPLICATIONS OF CONSTIPATION?

Constipation in children can be uncomfortable and, sometimes painful, but it isn’t serious. However, if constipation becomes chronic, it could lead to certain complications, such as:

• Painful breaks called anal fissures in the skin around the anus.
• Rectal prolapse – a condition when the rectum (rectum is the last several inches of the large intestine) comes out of the anus.
• Habit of withholding stool or the tendency to avoid bowel movements that leads to stool being collected in the colon and rectum and eventually leak (a condition called encopresis).

WHAT CAN MOTHERS DO TO PREVENT CONSTIPATION?

Mothers should follow these to prevent constipation in their children:

• GIVE YOUR CHILD A FIBER-RICH DIET: A fiber-rich diet keeps the stomach running and ensures proper working of the digestive system. For children doctors recommend a daily consumption of 14-31 gms of fiber in a day. Fiber-rich foods include fruits, vegetables, beans and whole-grain cereals & breads.
• MAKE SURE YOUR CHILD DRINKS PLENTY OF FLUIDS: While fluids help, water is often the best fluid to consume.
• ENCOURAGE PHYSICAL ACTIVITY: A sedentary or an inactive lifestyle restricts normal bowel movements.
• CREATE & FOLLOW A TOILET ROUTINE: Set a time after meals for the child to use the toilet. Also make it comfortable for the child to release stool by providing a footstool.
• EXPLAIN TO YOUR CHILD THAT POOPING IS NECESSARY: Children have a tendency to get so wrapped up in play that they ignore the urge to go for a bowel movement and if such delays happen a lot, it can lead to constipation.
• REWARD YOUR CHILD: Like in everything else, here too, it’s important to reward the child for efforts and not results. Give small rewards to children for their every attempt to move their bowels.

HOW IS CONSTIPATION TREATED?

The treatment of constipation in children depends largely on the age of the child and how bad the problem is.

For a majority of constipation cases in children, there are three primary treatments and all these treatments usually happen together.

• A HIGH-FIBER DIET WITH PLENTY OF FLUIDS:
  A high-fiber diet for a child comprises plenty of fresh fruits and vegetables, high-fiber cereals, whole-grain breads, beans and other legumes (chickpeas and lentils). Another good source of fiber, that children enjoy eating a lot is popcorn, but that should be with minimal salt or butter.
  Along with a high-fiber diet, constipated children need to be give plenty of fluids because consumption of high-fiber food without enough fluid can make matters worse. The child should be drinking a lot of water throughout the day along with milk. And remember to limit sugary drinks.
• A STOOL SOFTENER:
  A stool softener is something that helps clear the bowels and are typically safe for children. Some children need to stay on a stool softener for a couple of weeks or more – your pediatric gastroenterologist is the best person to seek advice on the right dosing schedule that would work best along with the reinforced dietary modifications.
• A TOILET TIME – FORMING A HABIT:

Every child must be encouraged to use the toilet the first thing in the morning and after every meal or snack. One good trick to help make this a habit is to suggest them that it’s now time to go the toilet instead of telling them to go to the toilet.

A combination of the above approaches gives the best results – a high-fiber diet won’t ease up a serious case of constipation on its own without the help of a stool softener; and when the child stops taking a stool softener, but continues to stay on a low-fiber diet, not giving the child enough healthy fluids, the problem is most likely to happen again.

WHEN SHOULD YOU, AS A MOTHER, SEE A DOCTOR?

While constipation in children is, usually not a serious condition, chronic constipation can lead to certain complications or it might be a signal to a more serious health condition. You should immediately consult a pediatrician, or preferably a pediatric gastroenterologist if your child’s constipation lasted longer than two weeks and/ or is accompanied by the following symptoms:

• Fever
• Refusal to eat
• Appearance of blood in the stool
• Swelling in the abdomen
• Weight loss
• Complaints of pain while removing bowels