Constipation occurs when stools, or bowel movements, become hard and are difficult to pass, making it hard for your child to “go.” Constipation is a frequent problem in children, but does not usually require surgery. Constipation can be a symptom of a more serious problem, such as Hirschsprung’s disease or abnormalities in the form or function of the anus (opening for the stool), but these problems are not common. It is normal for an older child to have a bowel movement, or pass stool, every one to two days. An infant on breast milk may have bowel movements ranging from one to six times in a day to once per week.
Signs and Symptoms
- Lumpy, dry, pellet-like stool
- Pushing hard or straining to pass stool
- Nausea or bloating
- Stomach pain
- Pain when trying to “go”
- “Stool avoidance,” where your child will avoid trying to have a bowel movement (this may be from pain)
- Liquid or loose still which leaks around a hard ball of stool
- Bright red blood in the toilet or diaper from a tear in the skin or lining of the anus, called an anal fissure
- Urinary tract infections
Constipation most frequently develops when:
- Your child’s diet is changed to baby food or table food in the first year of life
- There is not enough liquid or fiber in your child’s diet
- Your child eats foods that are constipating such as cheese, white bread or white rice
- Potty training is begun
- Regular bowel habits with time to go to the bathroom after eating does not occur
- An older child does not get enough exercise
- Your child waits too long to have a bowel movement
At the time of your child’s visit a history and examination will be done, which may include a rectal examination (examining the anus and rectum, the section of the large intestine that connects to the anus). X-rays may also be needed.
After the initial examination, additional tests may be needed to see if your child has a surgical problem that is causing the constipation. The following tests may be requested or performed by your surgeon and explained during your child’s consultation in our office:
- Rectal biopsy
- Magnetic resonance of the anus
- Anal manometry
Therapy is aimed at establishing a regular pattern of going to the bathroom with soft, sausage shaped bowel movements, and may include the following:
- Be sure your child is drinking enough water (this should be measured):
- Young child (10-35 pounds) 4 - 6 cups each day
- Older child (over 35 pounds) 6 - 8 cups each day
- Adolescents and adults 8 -10 cups each day
- Fruit juices such as apple, pear, or prune may be given in children older than 6 months
- Prune juice should be given in smaller amounts than apple or pear juice:
- Less than 6 months may receive 7 ml (1/2 tablespoon) – 30 ml (two tablespoons) daily
- Between 6 and 9 months may receive 22ml (1 1/2 tablespoon) – 45 ml (three tablespoons) daily
Fiber in the diet should be increased gradually after your child is drinking enough liquids.
- Two servings of fruit and three of vegetables high in fiber should be eaten daily, such as berries, pears, peaches, green beans, cauliflower and dried beans such as lentils.
- Whole grain breads, cereals and brown rice are also helpful to form soft bowel movements.
- Constipating foods to be avoided include those high in fat or sugar, white flour, white rice, cheese and bananas.
- Children will sometimes not eat whole wheat bread, brown rice or other foods high in fiber. Whole wheat flour and white flour may be used in equal parts when baking. Brown rice may be used to substitute a portion of white rice when cooking. Also, one tablespoon of unprocessed bran may be added to cereals or casseroles.
Establish a daily routine for going to the bathroom and remind your child to come in from play if there is an urge to have a bowel movement. If your child’s feet do not reach the floor a small stool is helpful to bring the knees higher to than the hips. This relaxes the muscles and makes it easier to move their bowels.
Families can call Child Life Services at 253-403-5315 to schedule a pre-surgery tour.