October 23, 2017
ARTICLE:

Constipation (part one)

By Dr Megan Yap - Paediatrician

So I promised I would try to blog about constipation today.  I like to try to keep these blog posts relatively SHORT, so they are easy enough to read and you guys aren’t put off by a 20 page document that will take you an hour to get through.  Sooo…. For this reason and in the interests of brevity, I might do this topic over a couple of posts.

 

Constipation – this is another REALLY common medical problem for children.  It is when the child’s poo is either HARD, or not regular.  To make things complicated (I know right?  Why can’t something just be simple for once?!), there is a HU-UGE variation in “normal” between different children in terms of the consistency of the poo and how often it occurs.

In little ones, babies who are breastfed might have a poo 8 or more times a day (usually discovered after a feed in the nappy), OR they might only poo once every 10 days (a significantly BIGGER bowel motion than the ones that occur 8 times a day obviously!)

Babies who are fed FORMULA and older kids, should really poo each day (ideally) or every second day.

When we talk about the appearance/consistency of the poo (ie are they hard/soft; pebbly/sausage-like etc), sometimes we use something called the “Bristol stool chart.”  I have put an image of this up in the gallery of images above – just scroll through and have a look.  People usually laugh when they see it – I have no idea why, but poo is just funny!!  Generally we only worry about the firmness and frequency of bowel motions IF it seems to be causing problems for the child – eg it hurts to pass, it is infrequent, causes tummy pain, there is incontinence or a history of recurrent urinary tract infections etc.

WHAT CAUSES CONSTIPATION?

Well, quite a few things in fact.

  • Commonly, if kids have ONE poo that hurts to pass, they get frightened and don’t WANT to go to the toilet again to poo. “Holding-on” to the poo, results in the intestine (the gut; the tube that your food moves through as it gets digested) having more time to draw water out, making it drier and therefore harder and more painful to pass.  A vicious cycle.
  • Some kids just have a slower than usual gut motion. This can be “normal.” More often than not, no serious cause for constipation can be found
  • Bad habits – a lot of parents come in and say their kids are “just too busy playing” to bother going to the loo. This can set up an undesirable cycle. Regular, timed toileting should be encouraged – even if the child doesn’t always poo in this time.
  • Diet – if kids aren’t keen on fruit and veggies and/or their diet is low in fibre (and sometimes if they have too much of one food eg chocolate/dairy) this can make constipation more likely
  • In infants, sometimes a switch from breastmilk to formula might trigger constipation
  • Change in environment/schedule – if kids don’t want to go to an unfamiliar (eg public) toilet, or at school, or if you are away on holidays, this can set them up for constipation. Troy and I (before we had kids) used to laugh and call it “Traveller’s bum” – where you just aren’t comfortable in hotel or out in a public toilet in a foreign country.  It happens in adults too
  • Medical reasons – in a very small number of kids, there might be a medical reason why they are constipated.
    • Hirschprung’s disease is when the parts of the bowel lack the normal nerve endings that make them move normally
    • Spinal cord defects
    • Thyroid problems
    • Anal fissures cause pain on passing a bowel motion making kids “hold on”

WHAT DOES CONSTIPATION LOOK LIKE IN YOUR CHILD?

It can present in a few different ways.

Commonly:

  • Tummy cramps (pain that comes and goes – usually related to the bowel constricting against a hard stool)
  • Loss of apetite
  • Straining on the toilet (or when passing a poo into the nappy) and sometimes pain or even blood in the poo
  • You might notice a “holding on” behaviour – like squatting, tip-toeing, leg crossing or toilet refusal
  • Hard pebbly poos that are difficult to pass
  • Soiling of the underpants

Now this last point might sound like it doesn’t make sense.

Poo coming out in the pants when… it can’t come out?  Wha-?

So what happens is that your child’s rectum (the last part of the intestine that holds the poo before it passes into the toilet) becomes distended (stretched) from holding a large amount of poo for a long time.  When it gets stretched like this, it loses sensitivity and the child actually doesn’t feel like they NEED to go to the toilet as usual.  So sometimes you get a liquid poo that passes around the outside of the core of hard poo (we call this “overflow” diarrhoea), or the bowel motion might just pass into the underpants without them even knowing or feeling it.  We also call this “incontinence” or “encopresis.”

 

PREVENTION AND MANAGEMENT

So I thought today I’d just go through the EASY, non-medication based ways to help treat/prevent constipation.  Then NEXT week I can go through what medications are out there to treat it and how they work.

Establish a healthy toilet habit

  1. Sit them on the loo for 5-10 minutes after each meal every day EVEN IF they don’t feel like they need to poo
  2. Reward children for good behaviour/habits with things like sticker charts and praise
  3. Making sure when they sit on the toilet, their feet are FLAT on the floor (or if they are not, then flat on a footstool); give them something to do if necessary to keep them there for the allocated time

Make sure kids are not scared or in pain

  1. A toilet rail, a seat insert (to make the hole smaller so they don’t fall in) or a stool can make kids more confident
  2. If your child is already constipated – using something to soften the stool so it is not painful is helpful – I will discuss this next week

Diet

This doesn’t work for every child.  And some kids who DO have a good diet, still get constipated.  Still, it doesn’t hurt to

  • Give at least 2 fruit servings a day (leave the peel on if you can)
  • 3 serves of veggies a day
  • High fibre cereals and bread (rather than the more processed variety
  • Restrict dairy intake to a max of 500 mL/day for kids older than 18 months (so they will eat their proper food)

 

Next Monday I’ll go through some of the products that are on the market, how they work and what I usually recommend.

Until later!!

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

Have you used our service? We are always looking for ways to improve so please take the time to complete our survey.

 

What does a developmental ...
Have you ever wondered why your child does things that just don’t seem right or exhibits behaviour that you haven’t observed in other ...
What's the difference between a ...
General paediatricians can treat (or are involved in the care of) most medical and developmental problems in children; it's a skillset in itself ...
Easter holiday programs
Easter holiday programs. Holiday workshops are a great way to break up seemingly endless days at home, while at the same time providing a fantastic ...
Tummy Pain in children
Nothing worse for a parent than knowing your child is in pain or ill and not knowing what to do about it or whether to worry.  Tummy pain is a very ...
HEAD LICE (AND NITS)
So was contemplating what health topic I might blog about today and was scrolling back through past posts. My thought process was, “Ooooh!! I ...
Autistic Spectrum Disorder – ...
Hi there everyone, Here is the long anticipated “Part 2” to our enthralling article on Autistic Spectrum Disorders. Had an absolutely epic ...
Autistic Spectrum Disorder – ...
So it’s a big couple of weeks for parents and kids hasn’t it?  School has gone back for the year and things are returning to normal after what ...
Sleep problems
Sooooooo on the topic of “restfulness” – many of my patient’s parents and friends struggle with their children’s sleep (or lack thereof) and ...
Iron deficiency
Well hello again everyone! So today I thought I’d let you guys know about iron deficiency in children.  Quite a few bloggees recently ...
Mummy (parental) guilt
Hello again all you awesome peeps out there that look after little people. Today I am going to blog about “Mummy guilt.” If you are a dad, or ...
Screen time and electronic device ...
Helloooooooo there parents and carers! Electronic screens and “smart” devices.  Smart phones/iPhones, iPads, tablet android computers… These ...
Does my child need to see a ...
The first five years of your child’s life are critical for brain development. Early stimulation from all senses create the foundations for learning ...
Failure to thrive
The term “Failure to Thrive” is enough to strike fear in a parent or carer’s heart… Or at least it does in mine (but then, I’m an Asian mum ...
Itchy girls bits (vulvovaginitis)
So a really good mate of mine (who I haven’t caught up with for aaages – sorry Vick!!) texted me and suggested that I blog about thrush in little ...
National Disability Insurance ...
As many of you may be aware, the NDIS has started its roll out throughout Queensland. In fact there are over 7,000 people enrolled in Queensland ...
Constipation (part two)
Hi again mums and dads! So to continue on from where we left off last week on this “hard” topic (ha ha!), we were going to discuss the ...
Constipation (part one)
So I promised I would try to blog about constipation today.  I like to try to keep these blog posts relatively SHORT, so they are easy enough to ...
Sore throats
Sore throats are pretty common.  You know that ache of the start of a sore throat when it begins and you groan as you realise what is coming right?  ...
Being sun smart with kids
It is no news to Queenslanders that Australia is the “skin cancer capital of the world” – something we have all heard more than once.  But did ...
Excessive screen use and our kids
With advancing technology, our children seem to be spending more and more time using screens. The American academy of Paediatrics recommends NO ...