- Functional constipation in children is quite common
- It's more a behavioural problem involving toilet training
- Treatment should encourage healthy bathroom behaviour
Constipation in children can be a delicate matter, but knowing the facts can help solve the problem.
Unlike adults, where constipation is more likely to be related to diet or disease, children tend to suffer from functional constipation, according to paediatric gastroenterologist Tim De Maayer from the Rahima Moosa Mother and Child Hospital – Wits University.
Functional constipation is when a child withholds their stool for various reasons – like when they're too busy playing or when the toilets at school are unfit. They then end up with a hardened stool that causes pain when they finally do go to the bathroom.
"This sometimes leads to overflow diarrhoea or incontinence, and a vicious circle when the poo they pass is painful, causing more retentive behaviour," explains De Maayer.
Another factor that can impact a child's bowel movements is potty training.
"Consequent to the main cause of constipation, toilet training is extremely important. We use medication to achieve soft stools so defecation doesn’t hurt, but the main principles are about training the child to listen to the bowel, evacuate immediately when the urge arises, and keeping the rectum empty."
READ | Constipation in children
What to look out for
Some symptoms to look out for include:
- Frequency of bowel movements less than three times per week
- More than one episode of faecal incontinence per week
- Large stools in the rectum or a palpable mass on abdominal examination
- Passing of stools so large that they may obstruct the toilet
- Painful defecation
- Retentive posturing and withholding behaviours like constantly changing positions, standing on tiptoes, and dance-like movements
Constipation in children is not well-taught professionally, according to De Maayer, who notes that doctors and dietitians alike tend to focus too much on fibre. Increasing its intake won't address the cycle described above, which is more of a psychological problem.
Constipation could also be a sign of something else, especially if it's in the first month of a baby's life, if treatment isn't working and if they're not thriving physically.
READ MORE | 4 tips for pooping better and healthier
What to do
De Maayer warns against using home enemas – which will be traumatising for a child and worsen their bathroom behaviour – and the prolonged use of stimulant laxatives like senekot and bisacodyl. Instead he advises using osmotic laxatives.
"Osmotic laxatives do not cause the bowel to become 'lazy' or make the child dependant on the medication. These medications essentially act as a high fibre intake, and most children with functional constipation require them for several months or more."
Most importantly though is that you should never punish your child for constipation or for soiling themselves because of it.
"Positive reward systems work best with toilet training, and it may be useful to get the child to sit on the toilet for five minutes after breakfast and/or supper, to make use of the gastrocolic reflex," advises De Maayer.
This is a physiological reflex that programmes the gastrointestinal tract to be more prone to the stretching of the stomach after a meal.
He also adds that it would be beneficial to inform the school if your child is suffering from constipation, especially if toilet facilities at the school are in poor condition, which could make the problem worse. Instead, the child could potentially use staff bathrooms to help break the cycle.
If the child is struggling with constipation for more than two weeks, there's any bleeding, bloating, vomiting, weight loss or constant pain in the abdomen, you should see a doctor as soon as possible.
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