Constipation in Children – Diagnosis and Treatment
Diagnosis
Doctors identify constipation in children by following several steps. They begin by taking a detailed health history.
They ask about symptoms like abdominal pain, hard stool, straining, soiling (encopresis), or fecal incontinence. They also ask about stool frequency, patterns, diet, and any history of anal fissure or impaction.
During the physical exam, the doctor checks for bloating, tenderness, or stool masses in the belly. The doctor may gently examine the rectum with a gloved finger to find stool retention, impacted stool, anatomical problems, or blood.
If needed, the doctor checks stool for hidden blood.
Further tests may be used if problems continue or are severe:
- Abdominal X-ray: The doctor checks for built-up stool or blockages.
- Anorectal Manometry: This test measures how well the anus and rectum muscles and nerves work.
- Transit Study: The child swallows small markers, and X-rays show how fast they move through the colon.
- Rectal Biopsy: The doctor looks for normal nerve cell function if Hirschsprung’s disease is suspected.
- Barium Enema X-ray: This outlines the colon to show narrowing or other changes.
- Blood Tests: Sometimes these help find issues like thyroid problems or cow’s milk protein allergy.
Common causes of constipation in children include withholding stool and changes in routine or diet. Doctors also check for rare but serious organic causes.
| Symptom | Exam or Test Used |
|---|---|
| Hard stool | Physical exam, abdominal X-ray |
| Abdominal pain | Health history, physical exam |
| Soiling (encopresis) | History, physical exam, anorectal tests |
| Stool retention | Digital rectal exam, transit study |
| Fecal incontinence | History, physical and nerve studies |
Doctors do not use all tests for every child. They choose exams based on symptoms and history to find the cause and the best treatment.
Treatment
Doctors manage constipation in children with several steps. They recommend a balanced diet with plenty of fiber.
Foods like beans, whole grains, pears, and vegetables help soften stools. Increase fiber intake slowly, and encourage the child to drink more fluids, especially water.
High-fiber foods for children:
| Food | Example |
|---|---|
| Fruits | Pears, apples |
| Vegetables | Broccoli, carrots |
| Whole grains | Oatmeal, brown rice |
| Beans | Black beans, lentils |
If diet and hydration do not help enough, the doctor may suggest fiber supplements or stool softeners. These work best when the child drinks at least about 1 liter of water each day.
Glycerin suppositories can help children who have trouble swallowing pills. Doctors may recommend a laxative for more stubborn cases. These medicines draw water into the intestines to soften stool.
If there is a significant blockage, a doctor-approved enema may be needed. Sometimes, doctors admit children to the hospital for stronger enemas if home treatments do not work.
Always follow a healthcare providerโs advice on medications. Do not use laxatives or enemas without professional guidance.
Alternative Medicine
Some families use gentle abdominal massage to help relax belly muscles and encourage bowel movements. Others try acupuncture, where thin needles are placed in the skin to help relieve abdominal discomfort.
Families sometimes use these methods along with lifestyle changes. Not all children respond the same way, so approaches may vary based on individual needs.
Getting Ready for Your Child’s Medical Visit
Steps You Can Take Before the Appointment
Check for any special instructions. Call the clinic ahead of time to ask about diet restrictions or other steps before your visit.
Keep a detailed record. Write down when the constipation began, how often your child has bowel movements, and what the stools look like. Note whether stools are soft or hard and dry. List what your child eats and drinks.
List any major life events. Record recent changes like starting school, moving, or other stresses that might affect your child’s routine.
Gather medication information. Make a complete list of medications, vitamins, and supplements your child uses. Include things you have already tried to help with constipation, such as juices or over-the-counter aids.
- Prepare your questions. Write down what you want to ask the doctor.
Think about toilet training. If your child is in this stage, note how itโs going. Record any struggles or concerns.
| Question | Example |
| Possible causes? | What is most likely causing the constipation? |
| Required tests? | Will any tests be needed? |
| Treatment options? | What can help my child? |
| Diet changes? | Do I need to change what my child eats or drinks? |
| Need for specialist? | Will we need a referral to Healthnile specialists? |
| Non-medicine ideas? | Can my child get better without medicine? |
Questions Your Doctor Might Ask
During the visit, the doctor may ask for details to understand the problem. Here are some questions you may hear:
- When did the constipation start, and how has it changed?
- Are the symptoms always there, or do they come and go?
- Are bowel movements hard, dry, or painful?
- Does your child ever have blood in the stool or on toilet paper?
- Is soiling or staining of underwear a problem?
- Does your child have to strain a lot using the bathroom?
- Have there been any changes to medications, routines, or diets?
- Is there a history of similar issues in the family?
- How does your child handle toilet training? Is there any resistance or anxiety?
- Is your child breastfed, formula-fed, or eating solid foods?
- What are your child’s typical bowel habits (how often, how much, ease of passing stools)?
Tip: Bring this information to the appointment to help the visit go smoothly and efficiently.
Steps You Can Take While Waiting for the Appointment
There are a few things you can try at home before you see the doctor.
| Tip | Why It Helps |
|---|---|
| Give prune juice | Natural mild laxative for children |
| Serve water often | Staying hydrated keeps stools softer |
| Reduce constipating foods | Less cheese, milk can help improve stool shape |
| Add high-fiber foods | More fiber helps move stool through gut |
| Increase movement | Physical activity helps bowel movements |
| Relax toilet training | Reduces stress related to bathroom habits |
Offer prune juice or diluted fruit juice. Prune juice is gentle and can help some children. You can mix it with other juices if the taste is a problem.
Adjust your child’s diet. For toddlers and older children, reduce cheese, milk, and other foods that slow digestion. Add more high-fiber fruits and vegetables, such as apples, pears, beans, and whole grains.
Encourage regular movement. Take your child for walks. Let them play outside to help their intestines work better.
Pause toilet training if needed. If your child struggles with toilet training and constipation, you can pause training for a while. This helps them relax and reduces stress about using the toilet.
Note: Feeding type matters for babies. Breastfed infants often have softer stools, while formula-fed infants may have firmer stools. Always check with a healthcare provider before making big changes for infants.
