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What is constipation?
You’ve just learned your child or teen has a very common problem: constipation. Constipation means that stool is
building up in the bowel and causing distress. Parents sometimes feel a little embarrassed about this, but constipation happens to most children at some point. The good news is that constipation is rarely caused by a serious illness.
Constipation can still happen even if a child is
having a bowel movement (BM, stool or poop!) every day.
A child or teen with constipation may:
- Suffer with stomach pain or cramps (these can be severe)
- Have very large stool (sometimes needing a plunger to get it down the toilet)
- Have stool that is Type 1, 2 or 3 on the stool chart
- Have trouble passing urine (going pee)
- Need to pass urine often
- Have blood on stools
- Have problems with behaviour
- Leak stool into underwear
- Avoid going to the toilet
Bristol Stool Chart
Bristol Stool Chart developed by Dr. Ken Heaton University of Bristol, 1997 Creative Commons license 2.5
How doesconstipation happen?
Constipation is often caused by:
- Not eating enough fibre, fruits, vegetables and grains
- Not getting enough physical activity
- Stress, travel, change in diet
- Some medications (e.g. antacids, morphine, anti-depressants)
- Holding in stool (‘withholding’)
- Putting off going to the toilet when feeling the urge to ‘poop’. Children may do this when they are feeling stressed about potty training, are too busy playing, embarrassed about using a school or public toilet or afraid of having a painful or unpleasant bowel movement.
Delaying a bowel movement causes stool to become hard, dry, and difficult to pass. This sometimes causes a large mass of stool in the rectum (the part of the bowel that holds stool). When this happens, it is called fecal impaction. Stool builds up behind the impaction and may leak, soiling a child`s underwear. This is often mistaken for diarrhea.
How is constipation treated?
By the time you notice symptoms, constipation has usually been a problem for a while, and may take months to get better. Having a large amount of stool in the bowels causes them to become larger than normal, and this makes it harder for the bowel muscles to empty stool. The bowel will get back to a more normal size if stool doesn’t build up over the next 3-6 months. Children and teens usually need non-prescription medications for a few months, along with some other steps to resolve constipation. Children and youth can take medications by mouth or through the rectum (bum). We usually suggest medications by mouth. These medications are available in drugstores, but you will have to ask the pharmacist for them.
Treatments that are not effective (there is no research evidence to support the use of these treatments):
- Prebiotics or probiotics
- Intensive behavioral therapy
- Other alternative treatments
Initial bowel clean-out
The first step is to clean out the bowel. The doses below should only
be used for 3 days at most.
- 3 day PEG 3350 clean out (Lax-a-Day®, Restoralax®, Relaxa®, Clearlax®), for children over 6 months of age. The
amount you give depends on your child or teen’s weight.
7 - 10 kg
2 teaspoons (10mL) in 100 mL fluid 2 times a day for 3 days
11 - 13 kg
3 tsp (15 mL) in 150 mL fluid 2 times a day for 3 days
14 - 19 kg
4 tsp (20 mL) in 200 mL fluid 2 times a day for 3 days
20 - 34 kg
1 capful (25 mL) in 250 mL fluid 2 times a day for 3 days
35 - 50 kg
1 capful (25 mL) in 250 fluid 3 times a day for 3 days
more than 50 kg
2 capfuls (50 mL) in 500 mL fluid 3 times a day for 3 days
1 capful = 5 teaspoons (tsp) or 25 mL
After this step, move on to step 2. This is very important, even if your child has been in distress for only a few days.
Retrain the bowels and prevent constipation
- PEG 3350 (Lax-a-day®, Restoralax®, Relaxa®, Clearlax®): Your child or teen will need to continue with these treatments once a day for 2 months or so to get back to a normal pattern of bowel movments. The amount you give depends on your child’s weight.
7 - 10 kg
2 teaspoons (10 mL) in 100 mL fluid once a day
11 -13 kg
3 tsp (15 mL) in 150 mL fluid once a day
14 - 17 kg
4 tsp (20 mL) in 200 mL fluid once a day
more than 17 kg
1 capful (25 mL) in 250 mL fluid once a day
1 capful = 5 teaspoons (tsp) or 25 mL
- Check your child’s stools (use the Bristol stool chart). Decrease the dose of medicine if the stools are very loose or your child or teen gets cramps
- You can continue this medication for longer than 2 months if the constipation doesn’t get better.
Healthy diet with plenty of fruits, vegetables and whole grains. Simple, unprocessed food is best.
Regular physical activity helps keep the bowels moving. Children need at least one hour of moderate physical activity each day.
Bathroom routine. It can take months to train the bowel back to a normal pattern. Take advantage of the body’s normal urge to empty after meals. 20-30 minutes after each meal at home, have your child sit on the toilet or potty for 1 minute for each year of age (for example, 3 minutes for a 3 year old). Give your child a foot stool if needed. This will make your child more comfortable and give some support to let go of a bowel movement. Join your child to read a book together or chat and catch up! Younger children may like stickers on a chart for sitting on the toilet after each meal.
Constipation that goes on for a long time may lead to other problems or signal an underlying condition.
Contact your Health Care Provider if your child or teen:
- Has severe pain or pain lasting more than 30 minutes
- Gets a fever
- Has vomiting
- Loses weight
- Wakes up from sleep to pass stool
- Keeps crying and you can’t do anything that soothes your child
- Develops painful cracks in the skin around the anus (anal fissures)
- Has intestine drooping out of the anus (rectal prolapse)
- Is still constipated (stool type 1, 2 or 3 on the stool chart) after following the treatment plan (above) for 2 weeks
- Passes blood or mucous with soft stools
- Has abdominal swelling
Want more info?
- Telehealth Ontario 1-866-797-0000
- Health Information from Registered Nurses, 24 hours a day, 7 days a week TTY: 1-866-797-0007
- Ottawa Public Health Info Line 613-580-6744
- Québec Info santé 811
- Eat Right Ontario