Constipation in children




Continence nurse advisor with the National Continence Helpline (1800 33 00 66) and maternal and childcare nurse Janine Armocida said there were no hard and fast rules about how often a child should open their bowels, with much variation in the firmness and frequency of bowel movements in children.

“Some go three times a day and others three times a week. Whatever the frequency, your child’s stool should come out easily and look like a smooth sausage. Check out the Bristol Stool Chart,” Ms Armocida said.

She said that issues with constipation could start as early as toilet training time, and that problems could also start after a child experienced a particularly painful bowel movement.

Some signs that suggest your child is constipated:

Ms Armocida said there were some key signs parents should look
out for. The child:

  • resists pooing by adopting postures such as squatting, crossing
    their legs or refusing to sit on the toilet,
  • has intermittent stomach cramps,
  • loses their appetite,
  • becomes irritable, or
  • develops small tears of the skin at the anus as the result of straining to pass a large stool. Anal fissures cause bleeding and pain when passing a stool.

How are constipation and incontinence linked?

When a child comes to see a continence nurse for day or night time wetting, constipation is one of the first things they are checked for, Ms Armocida said.

“This is because a constantly full bowel puts pressure on the bladder, reducing its capacity to fill and causing other bladder issues.”

Somewhat counterintuitively, long-term constipation was one of the major causes of faecal incontinence (soiling), which affects one in 40 children (SR Ali, 2011), Ms Armocida said.

“This is because hard, dry faeces can cause a blockage, resulting in watery faeces forcing its way around the blockage without the child knowing. Sometimes mistaken for diarrhoea, this is actually constipation with overflow,” she said.

Ms Armocida said most cases of constipation were able to be prevented or managed by adopting a few lifestyle changes. She stressed the importance of establishing a regular morning toileting routine, and of listening and responding to the body’s signals.

1. Make time to establish a regular bowel habit

Try to establish a regular bowel-emptying regime. One of the best ways is ask your child to sit on the toilet with their favourite book or device about 20 minutes after a meal and a warm drink. After breakfast is best, because this is when the urge will be strongest. Your child should only have to push gently, and should never have to strain hard to pass a stool.

2. A healthy diet and exercise

Ensure a diet with plenty of fibre from a variety of sources and ample fluids (limiting sugary or high-caffeine drinks which can irritate the bladder). Ensure your child has adequate exercise each day.

3. Don’t ignore the urge

It’s important your child doesn’t put off going when they feel the urge, because the stool will dry out and get harder as it sits in the rectum, risking a painful experience next time. By establishing a good routine in the morning, there is less risk the child will put off going when they are at school or kinder.

4. Remove frightening or painful associations

If a child has chronic constipation, they may require long term laxatives under medical supervision to soften the stool and help make it easier to go to the toilet.

If your child is constipated for an extended period of time, see your doctor or contact the free and confidential National Continence Helpline (1800 33 00 66), which is staffed by continence nurse advisors who can provide advice, information and the location of your closest continence service.

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As published in Peninsula Kids – Spring 2017


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