Does your child wait to go to the bathroom because he is too busy playing? Is your daughter putting off going to the bathroom for fear of a painful bowel movement? Did you start toilet training on a good note only to face stubborn refusal later? Has this now resulted in painful constipation for your child? You are not alone. 

Constipation is the reason for 3 percent of all pediatric office visits, and it is always important to find the cause of constipation. While constipation may happen at any age, it usually happens during certain milestones. Toilet training and the start of school are two times when children may hold their stool. During toilet training, trying to force a child to go on the toilet when he is afraid can lead to constipation. If your child resists, wait a few months and then try again.        

If children experience the discomfort of a hard stool, they may not want the painful experience again. Children tighten their buttocks, rock up and down on their toes, and turn red in the face trying to hold in the stool. This just makes matters worse.

Stool holding leads to more constipation. Stool begins to collect in the colon and rectum, and may result in discomfort (abdominal pain should be checked for other causes). When the colon is full of stool, some liquid may leak and stain their underwear. Sometimes this stool is thought to be diarrhea, but is really a symptom of severe constipation. 

At this point, a pediatrician needs to be called during office hours. He or she will probably start treatment to flush stool out of the colon with things such as lubricants (such as mineral oil), rectal suppositories or enemas. After initial treatment, a few routines will help maintain regular bowel movements for your child:

  • Encourage regular mealtimes and bedtimes.   
  • Encourage regular toilet times for your child—ideally after mealtime. (A routine can encourage your child’s success in keeping a regular stool pattern.)    
  • Encourage your child to drink plenty of water.     
  • Offer your child a diet that includes fruits, vegetables and foods high in fiber. (Fiber adds bulk and holds more water in the stool, making it softer and easier to release.)

Always check with your pediatrician before using lubricants and stool softeners (Sometimes helpful for 6 to 12 months after trouble with stooling.) 

As frustrating as the problem may be, handling the situation with patience and support will help your child form regular bowel habits.

Download our constipation brochure designed to help parents deal with childhood constipation by answering questions and outlining management instructions for parents to follow.

This article was written by Sue Griffard, RN, a pediatric nurse on the St. Louis Children’s Hospital Answer Line.


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