Constipation

In most cases, the cause of constipation is functional; in other words, there is no physical abnormality causing constipation. Some children experience functional constipation for the following reasons:

• Dietary changes. Constipation following dietary changes usually occurs during the first year or two of life. This often happens after the introduction of rice cereal, solid foods or during the change from breast milk or formula to cow's milk.
• Stool avoidance behavior. Stool avoidance behavior occurs when children experience painful bowel movements or fear having a bowel movement. Other reasons a child may avoid a bowel movement include fear of toilet training, anxiety in public restrooms and being too distracted by school work or play to go to the toilet. The child is able to hold the stool in, but over time it becomes too large. The passage of a large stool is painful and can perpetuate the cycle of pain leading to stool withholding. A large stool may also cause small tears in the anus that result in blood on the toilet paper or in the toilet water. Over time, the rectum becomes stretched and the child cannot feel the urge to have a bowel movement. In some cases, children with constipation begin to experience fecal soiling of their underpants. This is called encopresis. Children who are trying to withhold stool will often be quiet and still while assuming an unusual posture. Some children will stand stiffly while others hide. Infants and toddlers often cry while straightening their legs.

The good news is that, most of the time, constipation in childhood is not serious.

Symptoms of constipation include:

• Avoidance of bowel movements
• Abdominal pain
• Dry, hard stool
• Encopresis(soiling of the underpants)
• Lack of appetite
• Passage of large stool that clogs or almost clogs the toilet

Children with constipation may pass a large amount of liquid stool, even if they are not sick. Parents may misinterpret this as diarrhea.

Diagnosis of Constipation

If your child has symptoms of constipation, a pediatric gastroenterologist will talk with you and your child and complete one or more of the following exams and tests to confirm a diagnosis:

• Physical exam. The pediatric specialist will ask you about your child's symptoms and conduct a physical examination.
• Rectal exam. The physical exam may include a rectal examination to check for impacted stool. During this exam, the doctor inserts a lubricated, gloved finger into your child's rectum.
• X-ray. Your child's pediatric gastroenterologist may also recommend an abdominal X-ray to confirm the presence of impacted stool.
• Fluoroscopy. In rare cases, a pediatric radiologist will perform a type of fluoroscopy called a barium enema to look for structural abnormalities of the large intestine (colon).
• Motility test. A pediatric gastroenterology specialist can perform a motility test called anorectal manometry to test the sphincter muscles that control bowel movements.