Constipation

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What is constipation?

Constipation is having trouble passing stools (also known as bowel movements or pooping). It is very common in young children as their diets and preferences change. It is also common when children are learning how to use the toilet or starting school, as some children don’t want to poop at school and hold it in. 

What are the signs of constipation?

Your child may have: 

• pain when passing stools 
• hard, pebbly, rock-like stools 
• abdominal (belly) pain 
• very infrequent stools (only one in 3 to 7 days) 
• stool soiling in underwear 

Sometimes when constipation is very bad, children can get breakdown in the skin around their anus (the hole where the stool comes out) and you may see blood on their stool or toilet paper. 

If your child has been constipated for a while, the stool can fill up their intestines and stretch them out. Sometimes children need to be admitted to the hospital for a “bowel clean out” to clear out all of the stool.  

How do I prevent constipation in my child?

Talk to your provider or nurse to help you decide what would work best for your child. A good program for preventing constipation may take several approaches, time, and patience to find what works. Each child's bowel program is different. Try different methods until the successful one is found for your child. 

1. If your child is toilet-trained, have them sit on the toilet for 5 to 10 minutes after breakfast and dinner. (Eating stimulates the bowel to empty.) 
2. If your child's feet do not touch the floor when sitting on the toilet, put a box or stepstool under the feet so the knees are just a bit higher than the hips. This squat position helps in passing the stool. It also helps your child feel well supported so they can relax and not tighten muscles while balancing on the toilet. 
3. Praise your child for sitting the decided amount of time, even if they do not have a bowel movement. You may want to use a reward system, such as stickers. 
4. Clean the skin well after each bowel movement or accident. This prevents skin irritation. When the skin hurts, children may try to hold back the stool, making matters worse. 
5. Encourage active play and exercise; lack of activity tends to slow bowel function.

What should my child eat to prevent constipation?

Have your child drink lots of fluids like water and fruit juices, especially apple, pear, cherry, grape, or prune. Make sure your child is eating fruits, vegetables, and whole grain products every day, which help soften stools and make them easier to pass. Do not use high fiber supplemental powders or gummies; these can often make stools more bulky and difficult to pass in children.

Add bran (wheat or corn) to the daily diet for more fiber. Mix bran into cereal, pancakes, hamburger, casseroles, or other foods, or be taken alone. Pears, strawberries, beans, peas, and sweet potatoes are other good sources of fiber. 

• Children younger than 6 years: 2 heaping teaspoons of bran each day 
• Children 6 years or older: 3 heaping teaspoons of bran each day 

Limit binding foods such as apples, bananas, rice, cooked carrots, cheese, and gelatin (such as fruit snacks and Jell-O®). Limit milk and dairy products or switch milk products with non-dairy and soy products until constipation is gone. The lactose in milk products is binding to some children. 

What should I do to help my child pass a stool?

Talk to your child's nurse or provider about which of these methods to use and when and how to use them: 

• Stool softener: Medicine taken by mouth that prevents hardening of stool. It can be taken on a regular basis. Your provider can tell you which one and what dose is best for your child. 
• Laxative: Medicine taken by mouth that helps the body push out stool. 
• Suppository: Medicine inserted into the rectum that stimulates the bowel, and causes it to contract, pushing the stool out. 
• Enema: Liquid medicine is inserted into the rectum to stimulate the bowel. Do not use enemas until you have talked to the doctor or nurse. 

What else do I need to know?

Many children who have urine accidents also have constipation. Constipation can make the wetting problem worse because the bladder and the bowel are next to each other in the abdomen. When a child is constipated, the rectum may be quite full of hard stool, not letting the bladder hold as much urine as it can. The pressure of the stool may cause pressure on the bladder, making it feel like it should empty quickly.  

If your child needed to be in the hospital for their constipation, it was likely going on for a long time. It will take more time for your child’s intestines to start working normally again and shrink back down. Continue giving your child stool softeners and laxatives and making lifestyle changes for the weeks to months after they were in the hospital. Your provider will help decide what medicines are best for your child and how long they should continue taking them. Your child may need to see a doctor specializing in the digestive system (gastroenterologist) if constipation continues.  

When should I call the clinic?

Call the clinic if you have more questions or concerns, or if your child has: 

• Blood in the stool 
• Vomiting 
• Continued soiling in the underwear 
• New or worsening abdominal pain 

Or, if: 

• constipation continues and no stool is passed in 2 days 
• you start having battles with your child about stooling 

Questions?

This sheet is not specific to your child, but provides general information. If you have any questions, please call the clinic.

Reviewed 3/2024

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