Constipation is a common childhood problem. Normal bowel movements should be soft and easy to pass. Children who are constipated have hard, dry and sometimes painful bowel movements; they may go several days without a bowel movement. Some children with severe constipation soil their underwear. This soiling is involuntary and caused by liquid stool leaking around hard pieces of stool; this is called encopresis or pseudo incontinence.

Causes of Constipation

  • Functional: diet (lack of fiber, dehydration, malnutrition), slow transit motility, stool withholding, immobility
  • Structural Abnormalities: imperforate anus, anal stenosis, anal fissures, Hirschsprung’s disease
  • Endocrine, Metabolic, Immunologic Conditions: Celiac disease, cystic fibrosis, hypercalcemia, hyperparathyroidism, hypokalemia, hypothyroidism
  • Neurogenic Conditions: Cerebral palsy, hypotonia, spinal cord anomalies (spina bifida, spinal tumors, tethered cord)
  • Drugs: opiates, antacids, anticholinergics, tricyclic antidepressants, bismuth, phenobarbital, sympathomimetics

Constipation may be mild to begin with, but as a child goes 1-3 days without a bowel movement, the stool becomes hard and difficult to pass. As stool continues to accumulate, the rectum becomes dilated or stretched out. A dilated rectum loses its sensitivity, failing to let the child know he needs to have a bowel movement. Liquid stool leaks around the hard stool, which is difficult to control, and leads to soiling or accidents. Constipation is difficult to cure, but can be managed through prolonged treatment.

Management

The management of constipation requires an understanding of the nature of the problem. The goal of treatment is to empty the rectum daily with the use of laxatives and/or diet. The first step is to remove the fecal impaction. Once the impaction is removed, laxatives are started. There are many different types of laxatives; one is needed that will provoke a bowel movement on a daily basis.

Primary Children’s Colorectal Center provides a Bowel Management Program to treat children with constipation. We specialize in treatment of children with structural and neurological abnormalities and work closely with pediatric gastrointestinal specialists. 

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