October 23, 2017

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.


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”


It can present in a few different ways.


  • 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.”



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


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/

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