Chronic constipation is the most common cause of fecal impaction. Constipation is difficulty passing stool or the infrequent passing of stool. Fecal impaction occurs when a dry hard stool becomes stuck in the rectum, most commonly in people who have chronic constipation.

Constipation (Fecal Impaction) in Children

Constipation in children is a common problem. While children of all ages can be affected, constipation occurs more often during potty training and in younger school-aged children. A child is typically considered to be constipated if he has infrequent bowels movements (less than 3 per week) or is experiencing hard, dry stools that are painful or difficult to pass. Most cases of constipation can be easily remedied if addressed right away, however constipation can sometimes be a symptom of intestinal disease or other medical condition.

Symptoms of Constipation in Children

While every child is different, there are some common symptoms that can occur that should alert you to the possibility of your child being constipated. Symptoms include:

• Fewer than 3 bowel movements per week
• Hard, dry stools that are difficult to pass
• Clogging the toilet (due to hard stools)
• Painful bowel movements
• Nausea or vomiting
• Decreased appetite
• Abdominal pain
• Blood on the stool surface: Caused by a tear in the anus (fissure).
• Liquid or clay-like stool in the underwear (can indicate stool backed up in the rectum)
• Avoidance of having a bowel movement (generally for fear that it will be painful)

Common Causes of Constipation in Children

Children can become constipated for a variety of reasons. Some factors that may contribute to a child’s constipation are:

• Early potty training: Toilet training that is started too soon can result in a child’s rebellion by holding in stool. Ignoring the urge to have a bowel movement can become an involuntary habit.
• Stool withholding: Some children withhold having a bowel movement due to not wanting to use an unfamiliar toilet, an unwillingness to break from playtime, or association with a previously painful bowel movement. Stool remaining in the colon can become hard and dry causing constipation.
• Diet: Lack of fiber or fluids in a child’s diet can cause constipation. Changes in diet, particularly from liquid to solid food, can also be a contributor.
• Change in routine: Travel, illness, starting or changing schools, or any stressful event can affect bowel function.
• Medication: Medicines such as over-the-counter cold medicines, antidepressants, and narcotic pain medicines can be a cause of constipation.
• Family history: Genetic factors can be contributors.
• Milk allergy: Children who are allergic to cow’s milk or who consume an abundance of dairy products (milk, cheese) may experience constipation.
• Medical disorder: In rare cases, a child’s constipation can be caused by a digestive system or metabolic problem, intestinal disease, a neurological condition, or associated with another existing medical condition.

Treating Constipation in Children

Constipation that lasts for more than a few days can result in the back up of stool in the large intestine causing it to stretch. When the intestine is stretched, it is unable to function properly, which causes pain. Children often withhold bowel movements because of pain that worsens the problem. Acute cases of constipation can typically be treated at home with one or more of these remedies:

• Plenty of water
• Prune juice: Mix with apple or pear juice if your child dislikes the taste.
• Reduce constipating foods such as milk and cheese
• Physical activity
• Warm bath: Add 2 tablespoons of baking soda and let your child relax in it for 10-15 minutes.
• Over-the-counter medications: Fiber supplements, such as Metamucil or Citrucel, or laxatives, such as Miralax or Lactulose, may be needed to stimulate bowel movement. Check with your child’s doctor for the correct dosage before administering any over-the-counter medications.

If your child is experiencing chronic constipation, or none of the home measures work, you should contact your doctor.

Bathroom Accidents in Children

If your child is past the potty training stage and is having stooling accidents, he may be experiencing a side effect of constipation called encopresis.

Involuntary Fecal Soiling (Encopresis)

Children who have chronic constipation sometimes begin to have bathroom accidents and soil their underwear. This condition is called encopresis. Stool retention in the colon causes the intestinal walls and the nerves within them to stretch. Stretching can diminish the nerve sensations, therefore making it difficult for the child to recognize when he needs to go to the bathroom. When the rectum becomes too full, the sphincter (the muscular valve that keeps the stool inside the rectum) is unable to hold in the stool. While larger, hard feces stays in place, liquid or softer stool may pass into the underwear. The child is often unaware of the soiling due to the decreased sensation.

Encopresis is often mistaken for a lack of self-control or an unwillingness to use the bathroom. Parents can become frustrated with a child who seems indifferent to the odor; however, the child’s brain may actually become accustomed to the smell. Children experiencing encopresis can become anxious, withdrawn, angry, or depressed due to feelings of shame or embarrassment.

If your child is having bathroom accidents, or you suspect that your child may be suffering from encopresis, it is important that it be addressed as soon as possible.

Treatment for Encopresis

Encopresis is a condition that involves both the physiological and psychological aspects of a child. The earlier treatment is started, the easier encopresis is to overcome. Treatment usually includes:

• Emptying the rectum and colon: Your doctor will recommend a course of action that may include laxatives, stool softeners, or enemas.
• A regiment of stool softeners: Enables the bowels to shrink back to normal size.
• Scheduled times for bowel movements
• Maintaining a balanced diet and physical exercise during treatment will be an important part of your child’s successful outcome. It may take several months for your child’s bowel functions to return to normal. With support, encouragement and time, your child can overcome encopresis.
• Counseling and behavior modification: Amy Allen Meyer, M.Ed., LPC, RPT-S, NCC – Licensed Professional Counselor and Play Therapist. Amy is an experienced Licensed Professional Counselor, Registered Play Therapist-Supervisor and National Certified Counselor who counsels children and adolescents, ages 2-18, and their families from her private practice in Frisco, Texas.

If you would like more information about gastrointestinal (GI) digestive disorders and nutrition in children, please contact Dr. Mona Dave’s Frisco Office.