Anxiety Linked to Constipation in Kids

Constipation and Anxiety in Children, How to Learn to Let Go

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Oct. 15, 2003 (BALTIMORE) --- Children who suffer from constipation can develop a fear of going to the potty -- anxiety that then makes them more likely to continue to suffer from the common problem, a new study suggests.

Researchers described the vicious cycle Wednesday at the American College of Gastroenterology's 68th Annual Scientific Meeting.

Moreover, some of these children develop generalized anxiety, report researchers from The Cleveland Clinic Foundation.

"Constipated kids were not generally anxious overall, but among those with defecation anxiety we saw an increase in general anxiety," says Gerard Banez, PhD, a child psychologist at The Cleveland Clinic Foundation. "This does not prove cause-and-effect, but does suggest that those constipated children with greater defecation anxiety also exhibit increased general anxiety."

Painful bowel movements can make a kid fearful of pain, Banez says. That fear can be generalized to sitting on the toilet, he says.

Up to 7.5% of children suffer from constipation, which accounts for about 3% of visits to pediatricians and up to 25% of visits to pediatricians who specialize in stomach disorders.

According to the researchers, constipation carries a host of physical and psychological consequences, and anxiety related to being able to go to the bathroom is thought to play a key role both in causing and further promoting constipation.

Banez and colleagues studied 98 boys and girls ages 6 years old to 18 years old. The researchers looked to see if children with constipation have more bathroom anxiety than well children. The youngsters filled out a questionnaire that asked about symptoms of bathroom and general anxiety, and the parents rated their children's bathroom anxiety.

Based on the youngsters' and parents' answers, researchers found that children with constipation had significantly more anxiety related to going to the bathroom than well children. Overall, 70% of the constipated children reported constipation anxiety, compared with 58% of well children. Similarly more parents of children who suffered from constipation reported their children as having defecation anxiety than parents of well children.

What to Do?

First, take your child to a pediatrician if he suffers from chronic constipation to rule out any medical causes, Banez says. Parents should also talk to a pediatrician about the possibility of defecation anxiety if a child seems to be withholding stool, is tearful at the urge to use the toilet or shows vigorous resistance to going to the toilet, he says.

If your youngster refuses to go to the bathroom, Banez suggests having the child sit on the toilet three to five times a day for a brief time, starting with as short a period as 30 seconds and gradually increasing to five minutes. Dr. Banez calls this 'positive toilet sitting.' The goal, he says, is to teach the child to relax while sitting on the toilet. It's acceptable during this phase for children to wear underwear or diapers, he says.

Banez also stresses the importance of diet. Prepare meals high in fiber -- possibly with a stool softener thrown in -- to promote softer stools.

Over time, a routine of scheduling trips to the toilet at least two to three times a day for approximately five to 10 minutes, especially after meals, can also help, he says. You might even consider offering incentives to constipated children for using the toilet, and reward them for going on their own, he says.

William Whitehead, MD, professor of medicine at the University of North Carolina at Chapel Hill, says he has had some luck treating constipation anxiety with biofeedback, though he points out that studies in Europe suggest that laxatives work just as well as the relaxation technique.

The question now, he says, is whether anxiety is the cause or the consequence of constipation. "This study doesn't really tell us, but it is still a major advance, the first trial I know of where they have linked defection and anxiety directly using such a systematic approach."

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SOURCES: 68th Annual Scientific Meeting of the American College of Gastrenterology, Baltimore, Oct. 12-15, 2003. Gerard Banez, PhD, Department of Child Psychology, The Cleveland Clinic Foundation William Whitehead, MD, professor of medicine, University of North Carolina, Chapel Hill.
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