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Children’s Constipation

‘When waiting overnight is not an option!’

The last thing a parent wants to do when their child is not feeling well is to make them wait for relief. Parents and caregivers can help young ones with constipation not only feel better faster, but avoid further complications by being aware of the reasons and signs of constipation.

Constipation is a serious medical issue. Research shows that children with chronic constipation have a worse quality of life than those with more serious medical conditions such as inflammatory bowel disease and gastro-esophageal reflux disease.1 Constipation affects 25–30% of young children,2 which means approximately one in three children will struggle with this condition. Constipation also increases the risk of urinary tract infections. The statistics are staggering. The Journal of Pediatric Health Care3 stated that constipation accounts for nearly 5% of all pediatric outpatient visits, as well as more than 25% of all referrals to gastroenterology specialists. In 2009 alone, functional constipation had a worldwide prevalence of 7–30% with approximately 30–75% of chronic constipation in children resulting in fecal impaction.

Since 2008, researchers have found that the number of constipated children seen by primary care doctors has nearly doubled. Caring for children with constipation is also expensive, with associated healthcare costs reaching an estimated $3.9 billion a year.4

Stool Withholding

Another common issue seen with children’s constipation is stool withholding. The Oman Medical Journal5 cites a variety of complicated and challenging social and physical issues as the main reasons for bathroom avoidance in children, referred to as “stool withholding.” Children refusing to use the restroom is a fairly common issue faced by many parents and can lead to chronic constipation and incontinence, accounting for 3% of referrals to pediatric clinics in teaching hospitals.

Stool withholding is usually related to children having once passed a hard or painful stool and then subsequently fearing that same experience each time they use the restroom. Doctors believe that chronic constipation and incontinence can lead to larger generalized bathroom anxiety. Stool withholding can also develop into far more serious problems, including dangerous constipation, bedwetting issues, other leakages, and even urinary tract infections. It is important to treat constipation in children as soon as possible, before these issues occur.

Children who attend school also face additional issues with constipation. Children can find using a public school bathroom troubling for a variety of reasons: fear of embarrassment, fear of getting lost, concerns about toiletries that are different from those they use at home, and fear of missing out on activities in class. When children “withhold” their urine or feces, it can quickly become a medical issue that sometimes leads to complications. The Journal of Pediatric Health Care3 explored some of these complications, such as bed-wetting, which can affect as many as 40% of children involved.

1

Incredibly large stools

2

Firm stools that resemble logs or pellets

3

Leakage and stool accidents

4

Bedwetting and urine accidents

5

Urinary tract infections (UTIs) that reoccur

6

Extremely frequent and/or urgent urination

7

Infrequent bowel movements

8

More than two bowel movements a day with no full evacuations

9

Complaints of belly pain

10

Underwear stains or complaints of anal itchiness

11

Very wet or loose stool

12

Issues with toilet training, or children hiding feces

1 Plugged Up: Doctors See Signs of Worsening Constipation in Children, October 25, 2010; http://www.hopkinschildrens.org/Plugged-Up-Doctors-See-Signs-of-Worsening-Constipation-in-Children.aspx

2 Chronic constipation easy to overlook, hurts children, Published: Monday, October 15, 2012, 8:00 PM. http://www.cleveland.com/healthfit/index.ssf/2012/10/chronic_constipation_easy_to_o.html

3 Journal of Pediatric Health Care / “Constipation in the Pediatric Patient: An Overview and Pharmacologic Considerations.” / November-December 2010.

4 Excerpt from Society of Gastroenterology Nurses and Associations: 2010. Primary Care: Constipation and Encopresis Treatment Strategies and Reasons to Refer

5 Oman Medical Journal / September 11, 2011 / pgs. 376–378 2.