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Constipation



What is Constipation?

Most people think of constipation as difficulty in going to the toilet, or not passing stool (poo) regularly, and if this is your understanding then you are correct. However, you can also be constipated and still go to the toilet every day.

The diagnosis of constipation can be made if any of the following apply:

  • The child has two or fewer bowel openings per week
  • At least one episode of fecal incontinence per week
  • A history of stool withholding
  • A history of painful or hard bowel movements
  • The presence of a large faecal mass in the rectum (your doctor will be able to feel this when your child is examined)
  • A history of large stools that may block the toilet

People who are constipated are likely to have quite hard poo and it can sometimes hurt to go to the toilet. Sometimes a small amount of poo is passed regularly but some people can also find it very difficult to poo and can go for days or weeks without going to the toilet. Some children will go without having a poo for several days and then have a very large one. When you are constipated you can also have lots of smelly wind! A small number of children will get an anal fissure (a tear) with constipation, and might see some blood on wiping.

Overflow Diarrhoea

In children that have had constipation for a while (weeks to months) the poo can actually become loose (overflow diarrhoea). This is because the hard poo has backed up in the bowel and the liquid poo seeps around the outside. When this happens it can be difficult to control and some people can have accidents (soiling).

Faecal Impaction

Faecal impaction usually happens after being constipated for a while when the poo backs up in the bowel and gets stuck. It can sometimes be associated with tummy pain as the bowel works harder to get rid of the poo. Sometimes it is also associated with a loss of appetite or even vomiting. Your doctor can often feel a lump of poo in your tummy when they press on it.

 

What kind of problems can you have with constipation?

  • Hard poo
  • Very small “rabbit dropping” type poo
  • Very large, difficult to pass poo
  • Pain on going to the toilet
  • Fresh blood on wiping
  • Frequent loose poo
  • Smelly poo/smelly wind
  • Tummy pain
  • Tummy bloating
  • Vomiting

NICE have issued some advice and resources that can help parents manage a child with constipation:

NICE advice

In addition, there are other web-sites that have resources that you might find useful:

ERIC

ERIC stands for Education & Resources for improving childhood continence.

The following video explains in very simple terms how retentive constipation develops and what you can do to treat it. It explains how a normal bowel works and then what happens if constipation develops. The video is American (sorry!) and talks about 2 drugs, “miralax” and “senna”. Senna is also used in the UK. Miralax is similar to movicol which is routinely used in the UK to treat constipation. Please also refer to the treatment section below for additional detail. We hope these tools will help you understand how to treat your childs constipation.

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