When was the last time your child did a poo? Was it relatively easy for them to get the job done? Or did they have a lot of difficulty getting it out? Do they often go days between their number 2s? Or do they appear to have very little control and often soil their pants?
If any of the latter scenarios are familiar in your household then your child is likely to be suffering from constipation. They’re not alone – around 30% of children will experience constipation at some point in time.
Constipation can either be classified as acute or chronic.
When we think of constipation we generally think of going long periods of time without doing a poo, but it is possible to have constipation and still have daily bowel motions. The official diagnosis criteria for chronic constipation (known as the Rome IV criteria) requires a child to have experienced at least 2 of the following symptoms within the past 3 months:
- Less than 3 bowel motions per week
- Straining for more than a ¼ of all attempted bowel motions
- At least ¼ of all poos are lumpy and hard
- Experiencing a sensation of blockage when attempting a bowel motion
- Experiencing a sensation of incomplete defecation when attempting a bowel motion
- Requiring an intervention such as an enema to assist with doing a poo
Chronic constipation can also lead to further complications, the most common being faecal incontinence (soiling). This happens when the lower bowel or rectum is stretched by large hard poos being held in the bowel. The end result being that poo leaks out without the child being aware that it is happening. Other common complications include bed wetting and urinary tract infections.
Causes of Constipation
The underlying cause of constipation in children can be broken into two groups – primary and secondary.
Primary forms of constipation include:
- Functional constipation. This is the most common form of constipation. As the name implies, the bowel is functioning normally, and it is typically dietary and lifestyle factors that are the cause.
- Slow-transit constipation. This is believed to be caused by neuromuscular disorder of the colon. It typically causes a person to have a bowel motion less than once a week.
- Defecation disorders. This is an inability to pass bowel motions due to either functional or anatomical abnormalities of the anus or rectum.
Secondary causes of constipation include:
- Medication. Constipation is a common side effect of many medications, iron supplements being one in particular that is commonly used in children.
- Neurological disorders
- Hirschsprung’s disease. This is a rare condition where nerve cells are not present within a child’s colon.
Functional Constipation
As mentioned above, this is the most common type of constipation. The bowel is healthy and capable of working normally but diet and lifestyle factors prevent regular bowel motions. These factors include:
Lack of fibre
Fibre provides the bulk to poos, and also helps to draw water into the poo which helps to soften it. Poor fibre intake is the most common cause of functional constipation.
Poor fluid intakes
Our body absorbs fluid from poos as they pass through the large intestine to maintain adequate hydration. If fluid intakes are low then hard poos are the result.
Lack of physical activity
Levels of physical activity can also play an important role in bowel habits. Moving our bodies helps stimulate the muscles of the bowel to push poos along.
Poor toileting behaviours, including withholding poos
Constipation can often be the result of poor toileting habits in children, including withholding behaviours. It can become a vicious cycle, where the child is afraid to go because constipation has caused painful hard poo in the past, so they withhold. This in turn can cause faecal impaction which results in large hard poos that are even more difficult and painful to pass.
Food intolerances
Cow’s milk protein intolerance or an intolerance to one or more FODMAP foods may be the underlying cause for constipation. Investigations into food intolerances are complex and should be done with an Accredited Practicing Dietitian to ensure that you aren’t unnecessarily restricting your child’s diet.
Over this series of articles, I’ll talk in detail about strategies on how to improve your child’s poos so that they are regular and easy to pass.
Get in touch with our paediatric dietitian Michelle Bulman who can help you make positive changes to your child’s diet.
