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Constipation

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Constipation

Corrine Langill, RN, BScN   CHEO

Manager, Health Promotion and Injury Prevention 

Children's Hospital of Eastern Ontario

Parents might be surprised to learn that many visits to the emergency department for stomach pain are actually caused by constipation.  And while constipation is rarely caused by a serious illness, it can cause much pain and distress.

Constipation is pretty simple: a build up of stool (poop!) in the bowel.  A child with constipation may:

  • Suffer stomach pain or cramps;
  • Have very large stools that are difficult to flush;
  • Have stools that look lumpy, cracked or in nut sized pieces;
  • Have trouble peeing, or need to pee often;
  • Leak stool in underwear;
  • Avoid going to the toilet.

Children can develop constipation for many reasons.  Most often, children get constipation because they:

  • Are not eating enough fibre (from fruits, vegetables and whole grains);
  • Are not drinking enough water:
  • Are not getting enough physical activity. 

But other things can cause constipation too, like:

  • Stress, travel or a change in diet;
  • Some medications (antacids, morphine, anti depressants);
  • Holding in stool or putting off going to the toilet when they feel the urge to poop.

How is constipation treated?

By the time parents notice symptoms, constipation has usually been a problem for a while.  It can take months to get better.  This is because having a large amount of stool in the bowel causes it to stretch to larger than normal size.  This makes it harder for the bowel muscles to push the stool out.  The bowel can get back to a more normal size, but only if stool doesn't build up again over the next 3-6 months.  Medication is usually needed for a few months, along with some other steps to resolve constipation.

Treatment happens in two steps:

  1. Clean out the bowel.  Children will need to take medication like Lax-a-day®, Restoralax® or Clearlax® 2-3 times a day for a few days (depending on their weight).  A prescription isn't needed, but you'll need to ask the pharmacist for these medications.  Please check CHEO's Constipation Fact Sheet (link below) for detailed information on dosage.
  2. Retrain the bowels and prevent constipation.  Children will need to keep taking the medication once a day for 2 months or so, to get back to a normal pattern of bowel movements. 

        It will also be important to:

  • Make sure your child eats plenty of fruits, vegetables and whole grains.  Simple, whole foods are best.  Make sure your child drinks enough water.
  • Help your child to get at least 1 hour of moderate physical activity every day.  This helps to keep the bowels moving.
  • Follow a regular bathroom routine.  It can take months to train the bowel back to a normal pattern.  Have your child sit on the toilet about 20-30 minutes after meals at home for 1 minute for each year of age.  A stool for feet can make it easier to let go of a bowel movement.  Read a book together or chat and catch up!

When to see a health care provider

Speak with your health care provider if your child: 

  • Loses weight;
  • Has blood in or on the stool;
  • Has pain that is hard to control or lasts a long time;
  • Has a fever.

Did you know?

  • Constipation can still happen even if a child is having a bowel movement (BM, stool or poop) every day.
  • Prebiotics, probiotics, behaviour therapy and other alternative treatments are not effective in treating constipation. 
  • Children sometimes hold their stool if they are feeling stressed about potty training, are too busy playing, embarrassed about using a public toilet or worried about having a painful bowel movement.
  • The bowel has a normal urge to empty after meals.

Do you have more questions?