Intractable Constipation

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Contact the Division of Gastroenterology, Hepatology and Nutrition

Constipation is a common concern among parents of small children. In fact, almost five percent of pediatrician visits are related to constipation and at least 25 percent of visits to pediatric gastroenterology specialists are due to problems with constipation.

“Intractable” constipation is constipation that is prolonged and does not resolve with the usual therapeutic measures. It has usually been present for many years. It requires comprehensive testing and therapy and is one of the areas in which Boston Children’s GI Motility Center specializes. Our world-renowned pediatric gastroenterology team can get to the root of your child’s discomfort and provide access to highly specialized care.

Symptoms of Constipation in Children

While children may experience symptoms differently, constipation symptoms may include:

  • Not having a bowel movement for several days or passing hard, dry stools
  • Hospitalization because of stool impaction
  • Abdominal bloating, cramps or pain
  • Decreased appetite
  • Clenching teeth, crossing legs, squeezing buttocks together or turning red in the face as your child tries to hold in a bowel movement to avoid discomfort
  • Fecal incontinence, including small liquid or soft stool smears that soil your child's underwear

What Causes Constipation in Children?

In most cases of constipation, there is no specific abnormality. Constipation can be triggered by changes occurring in your child’s life and may not be related to an underlying medical condition. In such cases, causes may include:

  • Poor diet, full of high-fat, low-fiber foods and/or not enough liquids
  • Changes in diet, such as a switch from breast milk to formula, or beginning to eat solid foods
  • Lack of exercise
  • Emotional issues related to using public bathrooms, toilet training or stress
  • Changes in bowel routines
  • Avoidance: Hard, dry stools can be painful to push out, and the child might avoid using the bathroom to avoid the discomfort. Eventually, the intestine will not be able to sense the presence of stool.

Medical conditions and problems that can cause constipation in children include the following:

  • Hirschsprung's disease: A condition that occurs when some of your baby’s intestinal nerve cells don’t develop properly, causing them to interfere with the movement of food and stools in the intestines
  • Congenital abnormalities of the intestinal tract, rectum or anus, like imperforate anus
  • Problems of the nervous system, such as cerebral palsy
  • Endocrine problems, such as hypothyroidism
  • Certain medications (for example, iron preparations, some antidepressants, ADHD medications and narcotics such as codeine)
  • Underlying problems with the way the colon moves
  • Neurogenic problems like tethered cord

Diagnosing Constipation at Boston Children's

Most patients with constipation do not need any specific testing. However for intractable patients, our comprehensive team of doctors will conduct sophisticated motility tests to understand exactly how your child’s entire gastrointestinal system is working. These tests may include:

  • Anorectal manometry: A test that measures rectal nerve reflexes, which are the key indicators of this disease.
  • Colonic manometry: An advanced test that shows how the whole colon is moving. 
  • Colorectal transit study: This procedure uses X-rays to monitor the movement of markers through the intestine and colon. 
  • Barium enema: A procedure to examine the large intestine for abnormalities. We place a fluid called barium into the rectum as an enema. Barium is a chalky liquid that coats the inside of the organs so they show up clearly on an X-ray.
  • Biopsy of the rectum or large intestine: We take a sample of the cells in your child’s rectum or large intestine and examine them under a microscope.
  • Colonoscopy: We gently insert a long, flexible, lighted tube through the rectum and up into the colon to view the entire colon.
  • MRI of the spine: A specialized x-ray to look at the nerves of the spine

Learn more about our GI motility testing and approach at Boston Children’s.


Individualized Treatment for Constipation

Our GI motility center tailors treatment plans to meet the varied needs of every child’s unique condition. Once we are able to determine the cause of your child’s constipation, our team of doctors will offer a highly customized approach to treatment that may include:

  • Changes in diet, habits or exercise
  • Specific medications, including new medications
  • Behavioral therapy
  • Appendicostomy (A surgical procedure to flush out and empty the colon by creating an opening outside the belly)
  • Other surgical procedures

Learn more about the GI motility treatments we offer.

Make an Appointment

For an appointment, more information or to obtain a second opinion for your child, please contact the Motility and Functional Gastrointestinal Disorders Center at 617-355-6055 or request an appointment online.

Dr. Regan
Download this guide to managing stomach pain and other common gastrointestinal conditions
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