Constipation in Children

Constipation in infants and children means they have hard stools or have problems passing stools. A child may have pain while passing stools or may be unable to have a bowel movement after straining or pushing.

Considerations

Constipation is common in children. However, normal bowel movements are different for each child.

In the first month, infants tend to have bowel movements about once a day. After that, babies can go a few days or even a week between bowel movements. It’s also difficult to pass stools because their abdominal muscles are weak.

So babies tend to strain, cry, and get red in the face when they have a bowel movement. This does not mean they are constipated. If bowel movements are soft, then there is likely no problem.

Signs of constipation in infants and children

Being very fussy and spitting up more often (infants)

Difficulty passing stools or seeming uncomfortable

Hard, dry stools

Pain when having a bowel movement

Belly pain and bloating

Blood on the stool or on toilet paper

Having less than 3 bowel movements (going for toilet) a week.

Moving their body in different positions or clenching their buttocks

NB: Make sure your infant or child has a problem before treating constipation!

Some children do not have a bowel movement every day.

Also, some healthy children always have very soft stools.

Other children have firm stools, but are able to pass them without problems.

Causes of Constipation

Constipation occurs when the stool remains in the colon for too long. Too much water gets absorbed by the colon, leaving hard, dry stools.

Constipation may be caused by:

Ignoring the urge to use the toilet

Not eating enough fiber

Not drinking enough fluids

Switching to solid foods or from breast milk to formula (infants)

Changes in situation, such as travel, starting school, or stressful events

Medical causes of constipation may include:

Diseases of the bowel, such as those that affect the bowel muscles or nerves

Use of certain medicines and other medical conditions that affect the bowel

Children may ignore the urge to have a bowel movement because:

They are not ready for toilet training

They are learning to control their bowel movements

They have had previous painful bowel movements and want to avoid them

They don’t want to use a school or public toilet

Home Care

Lifestyle changes can help your child avoid constipation. These changes can also be used to treat it.

For infants:

Give your baby extra water or juice during the day in between feedings. Juice can help bring water to the colon.

Over 2 months old: Try 2 to 4 ounces (59 to 118 mL) of fruit juice (grape, pear, apple, cherry, or prune) twice a day.

Over 4 months old: If the baby has started to eat solid foods, try baby foods with high-fiber content such as peas, beans, apricots, prunes, peaches, pears, plums, and spinach twice a day.

For children:

Drink plenty of fluids each day. Your child’s health care provider can tell you how much.

Eat more fruits and vegetables and foods high in fiber, such as whole grains.

Avoid certain foods such as cheese, fast food, prepared and processed foods, meat, and ice cream.

Stop toilet training if your child becomes constipated. Resume after your child is no longer constipated.

Teach older children to use the toilet right after eating a meal.

Stool softeners (such as those containing docusate sodium) may help for older children. Bulk laxatives such as psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives may help your child have regular bowel movements. Electrolyte solutions like Miralax can also be effective.

Some children may need enemas or prescription laxatives. These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief.

Do not give laxatives or enemas to children without first asking your child’s provider.

When to Contact a Medical Professional

Contact your child’s provider right away if:

An infant (except those who are only breastfed) goes 3 days without a stool and is vomiting or irritable

An infant younger than 2 months is constipated.

Non-breastfeeding infants go 3 days without having a bowel movement (Contact your child’s provider right away if there is vomiting or irritability.)

A child is holding back bowel movements to resist toilet training.

There is blood in the stools.

What to Expect at Your Hospital Visit

Your child’s provider will perform a physical exam. This may include a rectal exam.

The provider may ask you questions about your child’s diet, symptoms, and bowel habits.

The following tests may help find the cause of constipation:

Blood tests such as a complete blood count (CBC)

X-rays of the abdomen

The provider may recommend the use of stool softeners or laxatives. If stools are impacted, glycerin suppositories or saline enemas may be recommended also.

Rectal Prolapse

Rectal prolapse occurs when the rectum sags and comes through the anal opening.

Causes

The exact cause of rectal prolapse is unclear. Possible causes may include any of the following:

An enlarged opening due to relaxed muscles in the pelvic floor, which is formed of muscles around the rectum

Loose muscles of the anal sphincter

An abnormally long colon

Downward movement of the abdominal cavity between the rectum and uterus

Prolapse of the small intestine

Constipation

Diarrhea

Chronic coughing and sneezing

A prolapse can be partial or complete:

With a partial prolapse, the inner lining of the rectum bulges partly from the anus.

With a complete prolapse, the entire rectum bulges through the anus.

Rectal prolapse occurs most often in children under age 6.

Health problems that may lead to prolapse:

Cystic fibrosis

Intestinal worm infections

Long-term diarrhea

Other health problems present at birth

In adults, it is usually found with constipation, or with a muscle or nerve problem in the pelvic or genital area.

Symptoms of Rectal Prolapse

The main symptom is a reddish-colored mass that sticks out from the opening of the anus, especially after a bowel movement. This reddish mass is actually the inner lining of the rectum. It may bleed slightly and can be uncomfortable and painful.

Exams and Tests

The health care provider will perform a physical exam, which will include a rectal exam. To check for prolapse, the provider may ask the person to bear down while sitting on a toilet.

Tests that may be done include:

  • Colonoscopy to confirm the diagnosis
  • Blood test to check for anemia if there is bleeding from the rectum

Treatment

Call your provider if a rectal prolapse occurs.

In some cases, the prolapse can be treated at home. Follow your provider’s instructions on how to do this. The rectum must be pushed back inside manually. A soft, warm, wet cloth is used to apply gentle pressure to the mass to push it back through the anal opening.

The person should lie on one side in a knee-chest position before applying pressure. This position allows gravity to help put the rectum back into position.

Immediate surgery is rarely needed. In children, treating the cause often solves the problem.

For example, if the cause is straining because of dry stools, laxatives may help. If the prolapse continues, surgery may be needed.

In adults, the only cure for rectal prolapse is a procedure that repairs the weakened anal sphincter and pelvic muscles.

Peptic Ulcers

A peptic ulcer is an open sore or raw area in the lining of the stomach or intestine. The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori). 

There are two types of peptic ulcers:

Gastric ulcer — occurs in the stomach

Duodenal ulcer — occurs in the first part of the small intestine

Causes

Normally, the lining of the stomach and small intestines can protect itself against strong stomach acids. But if the lining breaks down, the result may be:

Swollen and inflamed tissue (gastritis)

Most ulcers occur in the first layer of the inner lining. A hole in the stomach or duodenum is called a perforation. This is a medical emergency.

The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori). Most people with peptic ulcers have these bacteria living in their digestive tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

The following factors raise your risk for peptic ulcers:

Drinking too much alcohol

Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs)

Smoking cigarettes or chewing tobacco

Being very ill, such as being on a breathing machine

Radiation treatments

Stress

A rare condition, called Zollinger-Ellison syndrome, causes stomach and duodenal ulcers.

Symptoms of Ulcers

 Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.
Abdominal pain (often in the upper mid-abdomen) is a common symptom. The pain can differ from person to person. Some people have no pain.

Pain occurs:

In the upper abdomen.

At night and wakes you up

When you feel an empty stomach, often 1 to 3 hours after a meal

Other symptoms include:

Feeling of fullness and problems drinking as much fluid as usual

Nausea

Vomiting

Bloody or dark, tarry stools

Chest pain

Fatigue

Vomiting, possibly bloody

Weight loss

Ongoing heartburn

Exams and Tests

To detect an ulcer, you may need a test called an upper endoscopy (EGD).

This is a test to check the lining of the esophagus (food pipe), stomach, and first part of the small intestine.

It is done with a small camera (flexible endoscope) that is inserted down the throat.

This test most often requires sedation given through a vein.

In some cases, a smaller endoscope may be used that is passed into the stomach through the nose. This does not require sedation.

EGD is done on most people when peptic ulcers are suspected or when you have:

Low blood count (anemia)

Trouble swallowing

Bloody vomit

Bloody or dark and tarry-looking stools

Lost weight without trying

Other findings that raise a concern for cancer in the stomach

Testing for H pylori  is also needed. This may be done by biopsy of the stomach during endoscopy, with a stool test, or by a urea breath test.

Other tests you may have include:

Hemoglobin blood test to check for anemia

Stool occult blood test to test for blood in your stool

Sometimes, you may need a test called an upper GI series. A series of x-rays are taken after you drink a thick substance called barium. This does not require sedation.

Treatment of Peptic Ulcer Disease

Your health care provider will recommend medicines to heal your ulcer and prevent a relapse.

The medicines will:

Kill the H pylori bacteria, if present.

Reduce acid levels in the stomach. These include H2 blockers such as ranitidine (Zantac), or a proton pump inhibitor (PPI) such as omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), rabeprazole (AcipHex) or pantoprazole (Protonix).

Take all of your medicines as you have been told. Other changes in your lifestyle can also help.

If you have a peptic ulcer with an H pylori infection,

he standard treatment uses different combinations of the following medicines for 7 to 14 days:

Two different antibiotics to kill H pylori.

PPIs such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium).

Bismuth subsalicylate (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria.

You will likely need to take a PPI for 8 weeks if:

You have an ulcer without an H pylori infection.

Your ulcer is caused by taking aspirin or NSAIDs.

Your provider may also prescribe this type of medicine regularly if you continue taking aspirin or NSAIDs for other health conditions.

Other medicines used for ulcers are:

Misoprostol, a medicine that may help prevent ulcers in people who take NSAIDs on a regular basis

Medicines that protect the tissue lining, such as sucralfate

Prognosis

Peptic ulcers tend to come back if untreated. There is a good chance that the H pylori infection will be cured if you take your medicines and follow your provider’s advice. You will be much less likely to get another ulcer.

Possible Complication Of Ulcers

Complications may include:

Severe blood loss

Scarring from an ulcer may make it harder for the stomach to empty

Perforation or hole of the stomach and intestines

When to See a Doctor

Get medical help right away if you:

Develop sudden, sharp abdominal pain

Have a rigid, hard abdomen that is tender to touch

Have symptoms of shock, such as fainting, excessive sweating, or confusion

Vomit blood or have blood in your stool (especially if it is maroon or dark, tarry black)

You feel dizzy or lightheaded.

You have ulcer symptoms.

Prevention

Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your provider first.

The following lifestyle changes may help prevent peptic ulcers:

DO NOT smoke or chew tobacco.

Avoid alcohol.

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