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Constipation, or the infrequent passage of stools, is a common problem in children. When a constipated child passes stool, it is usually hard and painful from sitting in the rectum for a long time. To avoid passing another painful stool, children will tighten their bottom and withhold stool which sets up a cycle of developing large, hard stools that are painful to pass. For some children, the large intestine fills with hard stool and liquid stool leaks around the hard stool, through the anus and into the child’s underwear. This is called fecal soiling, or encopresis.
For most children the exact cause of constipation is unknown. Some things that might contribute to constipation include:
In a few rare cases, constipation might be due to structural, neurologic, endocrine or metabolic disorders.
Fecal soiling is usually a result of constipation which has occurred for a long time or has been difficult to manage. Children with fecal soiling have a large amount of stool in the large intestine, resulting in unintentional soiling accidents. There are a few other cases of fecal soiling such as spinal abnormalities or anorectal abnormalities but these are less common.
Anyone can develop constipation, but it is more common in boys. Common times for constipation to develop are when solid foods are started, around toilet training, birth of a sibling, the start of a new school year, when on vacation or after a time of illness.
The Poo in You - Constipation and Encopresis Educational Video
Children who are constipated can show a variety of behavioral and physical symptoms. They include:
In most cases, constipation and fecal soiling can be diagnosed after a health care provider completes a detailed history and physical examination. Occasionally other tests might be needed. These may include:
A diagnosis can usually be made at the first visit after a complete health history and physical examination.
The focus of treatment for children with constipation is changing the child's behavior and making sure the child is not afraid of having a bowel movement. If necessary, diet changes are also made, sometimes with the help of a registered dietician. Often medications are used for a period of time to help retrain the bowel. Generally a combination of medications are used which may include stool softeners, stimulants, enemas or suppositories to remove any impacted stool and help a child have more regular bowel movements.
For the child with fecal soiling, treatment is more extensive. It often begins with a bowel cleanout followed by a program that is designed to empty the colon on a daily basis. For some children, the colon has been stretched out and it can take up to a year before it regains its original size and shape. Most children respond well to treatment and after a period of rehabilitation have normal bowel movements without soiling.
The treatment for children with fecal soiling requires sensitivity to the child's emotional needs. Children are often embarrassed and do not feel comfortable talking about their stool problem. Providers at Children's Colorado are skilled at communicating with children around sensitive matters. Learn more about the Digestive Health Institute
Gastroenterology - Pediatric
Gastroenterology - Pediatric, Pediatrics
Certified Pediatric Nurse Practitioner