When the "Going" Gets Tough: Constipation

It’s a common problem that kids (and honestly parents, too) don’t like to talk about. But constipation can be a big issue with no easy answer.

Constipation is diagnosed as having two or fewer stools per week. If the stools are large or very small and hard, going can even be painful. When it’s not addressed, chronic constipation in childhood can cause serious complications: anal fissures, withholding of stool and stool incontinence. 

What causes constipation?

I often see constipation in my school-age patients for a variety of reasons. Sometimes it’s due to changes in their schedule which interrupts their established bathroom routine, and sometimes it’s because kids will hold in their stool because they don’t want to use the toilet at school. 

What does stool withholding mean and why does it become a problem?

Stool withholding happens if a child is busy playing or doesn’t like to use a public bathroom. It also happens when kids are just afraid to go. They’ve experienced pain with a previous stool, so they try to hold it in and avoid the pain, ultimately causing a bigger problem. 

This cycle causes the body to adapt in a variety of ways that can perpetuate stool withholding. Your child’s rectum can stretch out to hold more stool. As it sits there, it becomes drier, larger and more difficult to get out. Some kids can even lose the muscle strength to get the stool out or lose the sensation that they have to stool. Also, as the stool does come out, it can cause tears to the lining of the rectum that can cause bleeding and more pain.

If this withholding gets bad enough, it can lead to stool incontinence or encopresis, which is often mistaken as diarrhea. If there is a large caliber stool sitting in the rectum, some softer stool can pass around the large stool and leak out of the anus.

How do you know as kids get older?

Many times, kids are having problems and parents just don’t know. Kids become more independent and use the restroom on their own, so parents aren’t as aware of frequency or caliber of their children’s stools. (Let’s face it, pooping isn’t something you discuss on a regular basis.) 

Instead, watch for behavior changes which indicate they might be withholding stool, like stiffening their body, becoming fidgety at times they typically stool, or crossing their legs while held straight out. If they are having encopresis, their underwear may be soiled. If they become very constipated, they can have an upset stomach and/or decreased appetite.

What can I do as a parent? 

School-age children who are using the bathroom independently aren’t often very forthcoming about their stool pattern and many of them don’t know that there is a problem. Here are four things you can do:

1. Ask your child about their stools. You can also encourage them to keep a daily poop calendar, noting how often they are going, the consistency and the size. 
2. Talk with your child’s health care provider. Most kids with chronic constipation, especially if they have stool withholding or encopresis, will need medical treatment. This includes cleaning out the existing hard stool and working on softening the stool.
3. Be patient and avoid disciplining. This is a medical condition and is not your child’s fault. There can be shame and guilt associated with this condition, especially if they are having stool incontinence.
4. Help establish a bathroom routine. Ask your doctor about how to establish and effectively execute scheduled bathroom times.

Starting the conversation sooner rather than later can help your children establish life-long bathroom habits that will keep them healthy. If you have question about how to help your child, speak with their Methodist Physicians Clinic health care provider.