Children's Health

Constipation may occur with cramping and pain if the child is straining to pass hard, dry stools. He or she may have some bloating and nausea. There may also be small amounts of bright red blood on the stool caused by slight tearing (anal fissure) as the stool is pushed through the anus. All of these symptoms should stop when the constipation is relieved.

Chronic constipation

For reasons that can't always be identified, some children often develop constipation that does not get better or go away with treatment (chronic constipation). The most significant factor may be the painful passing of a hard, dry stool. After a while, the child may be unable to resist the urge to have a bowel movement and will pass a large mass of stool. The child may have to "push hard" during the bowel movement, which may be painful. Passing the stool relieves the pressure and pain until another mass of stool collects, and the cycle is repeated. Fear of pain may cause the child to try to hold the bowel movement.

Other causes of chronic constipation may include:

• A crack (fissure) around the anus, which can make bowel movements painful and cause the child to resist passing stools. Fissures are a common problem that gets worse every time the child passes a large stool.
• A brief illness with poor food intake, fever, and little or no physical activity, which may upset normal bowel habits.
• Emotional problems or toilet training problems, which can lead to voluntarily withholding stools. A child may have fought the toilet training process, been pushed too fast, or been punished for having accidents. Struggling with parents for control may cause a child to hold stools back as long as possible.
• Change in environment. At school, children may withhold stools because they are afraid or embarrassed to use school bathrooms, their schedules are too busy for them to take time for a bowel movement, or school activities interrupt their normal bowel movement time.

The child may be unable or unwilling to pass the stool regardless of its size. Liquid or loose stool may leak out, soiling the child's underwear. When this occurs in a child who is past the age of normal toilet training, it is called encopresis.

Chronic constipation usually requires several months of treatment and cooperation between the parents, the child, and the doctor to overcome the problem. Don't be discouraged if the problem comes back during these months. The rectum is made of muscle tissue; when a child has had chronic constipation, the muscle becomes stretched. It may take several months to get the muscle back into shape.

In rare cases, constipation in children may be caused by other health problems, such as:

• Cystic fibrosis.
• Hirschsprung's disease.
• Lead poisoning.
• Overactivity of the parathyroid gland (hyperparathyroidism).
• Underactivity of the thyroid gland (hypothyroidism).
• Spinal cord injury.

Check your child's symptoms to decide if and when your child should see a doctor.