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Constipation

Constipation is when there is difficulty in emptying the bowels, usually associates with hardened faeces.

What is constipation?

Constipation is when there is difficulty in emptying the bowels, usually associates with hardened faeces.

How common is this in children and what contributes to it?

  • It is a common problem in children but is usually temporary.
  • Factors promoting constipation are:
    • Inadequate fluid intake.
    • Inadequate fiber in diet.
    • Lack of exercise.
    • Resisting the urge to have a bowel movement.
    • Underlying illnesses eg Hirschprung disease or hypothyrodism.
    • Medications eg narcotic analgesic.

How do I know if my child has constipation?

Signs and symptoms include:

  • No bowel movement for days or passing stools that are hard and dry.
  • Cramping abdominal pain.
  • Painful defaecation process as manifested by clenching buttocks, rocking up and down on toes, and turning red in the face.
  • Faecal soiling (known as encopresis) of child’s underwear.

What problems can it cause?

  • Small tears in anal area (known as anal fissures) which can bleed and cause pain.
  • Refusal to have a bowel movement.
  • Social embarassment from faecal soiling.
  • Complications arising from underlying illnesses eg intestinal obstruction in Hirschprung disease.

How is constipation in a child managed?

Evaluation

  • Important to evaluate situation to exclude and treat underlying illnesses.

Diet

  • Increase fluid and fiber (found in fruits, vegetables and whole-grain cereals) in diet for older children.
  • In young babies who are not yet on solids, ensuring adequate milk intake is important. A change of formula in formula fed babies may be considered after consultation with the doctor.

Toilet retraining

  • To reestablish a regular bathroom routine.

Exercise

  • Getting more exercise may also be helpful.

Medication

  • If condition is serious, oral laxative to soften the stool or an enema to remove it may be prescribed by the doctor as initial therapy.

How is toilet retraining done?

  • Child should sit on the toilet on a daily basis for at least 15 minutes.
  • During this time he can read a book.
  • Consistency, patience and persistence are necessary to succeed.

How can this constipation be prevented?

  • High fiber and adequate fluids in diet.
  • Exercise.
  • Bowel habit training.

What are the warning signs to be aware of?
Consult your doctor if:

  • Episodes last more than 8 weeks.
  • Child is restricted in normal activities.
  • Anal fissures occur.
  • Small amount of intestinal lining protrudes through the anus (including haemorrhoids).
  • Inability to expel stool from anus.
  • Presence of encopresis.
Last reviewed : 28 August 2020
Content Writer : Dato’ Dr. Lim Nyok Ling
  : Dr. Lim Sern Chin
Reviewer : Dr. Zainab bt. Kusiar

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