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.
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
- A brief illness with poor food intake, fever, and
little or no physical activity, which may upset normal bowel
- 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
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:
Check your child's symptoms to decide if and when your
child should see a doctor.