Constipation

Constipation is a condition in which a child has infrequent bowel movement — fewer than three in a week — or bowel movements that are difficult or painful to pass.

Constipation is a common concern among parents of small children. In fact, almost 5 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.

Constipation that is prolonged and does not resolve with the usual therapeutic measures is called “intractable constipation.” It’s usually been present for many years and requires more comprehensive testing and therapy.

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

• Not having a bowel movement for several days or passing hard, dry stools
• 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

In general, there is no specific abnormality associated with constipation. It can be triggered by changes occurring in your child’s life and may not be related to an underlying medical condition. There are probably some genetic factors since this problem often seems to run in families. Contributing 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, such as iron preparations, some antidepressants, ADHD medications, and narcotics
• Underlying problems with the way the colon moves
• Neurologic problems associated with low muscle tone, or spinal cord injury or defect.

Most children with constipation do not need any specific testing. However, for children with constipation that does not resolve with dietary or therapeutic measures, more tests may be necessary 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
• 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. A fluid called barium is instilled 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 tissues in your child’s rectum or large intestine for examination under the 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 scan to look at the nerves of the spine

Once your clinician is able to determine the cause of your child’s constipation, treatment may include:

• Changes in diet, habits, or exercise
• Specific medications, laxatives, and stool softeners
• Behavioral therapy
• Surgical treatments (rarely needed)

The Boston Children’s Hospital world-renowned pediatric gastroenterology team can get to the root of your child’s discomfort and provide access to highly specialized care for constipation. Our Motility and Functional Gastrointestinal Disorders Center tailors treatment plans to meet the varied needs of every child’s unique condition.