What is constipation?
Constipation means that stools are difficult or painful to pass and less frequent than usual. A child with constipation feels a strong urge to have a stool and has discomfort in the anal area, but is unable to pass a stool after straining and pushing for more than 10 minutes.
What is the cause?
Constipation is often due to a diet that does not include enough fiber. Drinking or eating too many mild products can cause constipation for many people. It may also be caused by repeatedly waiting too long to go to the bathroom, not drinking enough liquids, or not getting enough exercise. The memory of painful passage of stools can make young children hold back their stool. If constipation begins during toilet training, usually the child is strong-willed and the parent is putting too much pressure on the child to use the toilet.
How long will it last?
Changes in the diet usually relieve constipation. After your child is better, be sure to keep him/her on a non-constipating diet so that it doesn’t happen again. Sometimes the trauma to the anal canal during constipation causes an anal fissure (a small tear). If your child has an anal fissure, you may find a small amount of bright red blood on the toilet tissue.
Diet treatment for older children over 1 year old
For children over 1 year old:
- Make sure that your child eats fruits or vegetables at least 3 times a day. Some examples are prunes, figs, dates, raisins, bananas, apples, peaches, pears, apricots, beans, peas, cauliflower, broccoli, and cabbage. Warning: avoid any foods your child can’t chew easily and might choke on.
- Increase bran. Bran is a natural stool softener because it has a high fiber content. Make sure that your child’s daily diet includes a source of bran, such as one of the whole grain cereals, unmilled bran, bran muffins, graham crackers, oatmeal, high-fiber cookies, brown rice, or whole wheat bread. Popcorn is one of the best high-fiber foods for children over 4 years old.
- Decrease the amount of constipating foods in your child’s diet to 3 servings per day. Examples of constipating foods are cow’s milk, ice cream, cheese, and yogurt.
- Increase the amount of pure fruit juice your child drinks. (Orange juice will not help constipation as well as other juices will.)
Sitting on the toilet (children who toilet trained)
Encourage your child to establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially after breakfast. Some children and adults repeatedly get blocked up if they don’t have regular sit times.
If your child is resisting toilet training by holding back, stop the toilet training for a while and put him back in diapers or pull-ups. Holding back stools is harmful. Use rewards to help your child give up this bad habit.
If a change in diet doesn’t relieve the constipation and your child is over 1 year old, give a stool softener with dinner every night for one week. Stool softeners are not habit forming. They work 8 to 12 hours after they are taken.
Examples of stool softeners that you can buy without a prescription are MiraLax, Metamucil, Citrucel, milk of magnesia, and mineral oil. Give 1/2 to 1 tablespoon daily MiraLax in 4-8 oz water daily as needed. Your doctor may instruct you to take a stool softener until the proper high fiber diet is obtained.
Common mistakes in treating constipation
Don’t use any suppositories or enemas without your healthcare provider’s advice. These can irritate the anus, resulting in pain and stool holding. Do not give your child laxatives such as products that contain senna without consulting your healthcare provider because they can cause cramps.
Relieving rectal pain
If your child is very constipated and has rectal pain needing immediate relief, one of the following will usually provide quick relief:
- Sitting in a warm bath to relax the muscle around the anus (anal sphincter)
- Placing a warm wet cotton ball on the anus and moving it to stimulate the rectal muscle
- Giving your child a glycerin suppository (through the anus)
If your child is still blocked up after trying this advice, talk to your healthcare provider now about seen or using an enema.
When should I call my child’s healthcare provider?
Call immediately if your child develops severe rectal or abdominal pain
Call during office hours if:
- Your child does not have a stool after 3 days on the non-constipating diet
- You are using suppositories or enemas
- You have other concerns or questions