My child is constantly constipated


Dr .Hesham Farouk

 Specialist Pediatrician  -Aster Clinic Discovery Gardens & Arabian ranches

In this topic I’ll try to remind you about constipation relief symptoms; medicine constipation; causes & remedy:

Constipation in otherwise healthy infants and children is a common problem despite confusion about how to precisely define constipation and constipation-related disorders.

Most children have bowel movements 1 or 2 times a day. Other children may go 2 to 3 days or longer before passing a normal stool. For instance, if your child is healthy and has normal stools without discomfort or pain, ­having a bowel movement every 3 days may be her normal bowel pattern.


Constipation is a common problem in children. It accounts for 20–30% of pediatric outdoor office.

It is common in both rich and poor countries despite the belief that developing countries consume food rich in fiber.

Normal bowel movement in breastfed babies may range from several times a day to once in every 10 days.

Constipation can be both functional and pathological. Functional constipation has no underlying cause and is the most common type of constipation found in children.

 Definition of Functional constipation


Functional constipation is defined as presence of two or more of the following ROME III criteria in the absence of any organic etiology, and the duration of constipation should at least be 1 month in children <4 years of age, and at least once per week for at least 2 months in children ≥4 years of age

Child with age < 4 years Child with age ≥ 4 years
  • ≤2 defecations/week

  • One episode of incontinence per week after

  • Excessive stool retention

  • Painful or hard bowel movements

  • Presence of a large fecal mass in the rectum

  • Large-diameter stools that may obstruct the toilet

  • ≤2 defecations in the toilet per week

  • One episode of fecal incontinence per week

  • Retentive posturing or excessive volitional stool retention

  • Painful or hard bowel movements

  • Large fecal mass in the rectum

  • Large-diameter stools that may obstruct the toilet

Types of Constipation

Below are some of the classifications:

1. Acute constipation

Acute constipation can last for a couple of days without any long-term implications. This could be a result of medication, dehydration or poor bowel habits.

2. Chronic Constipation

Chronic constipation can last for more than a month at a time. It is often a symptom of an underlying health condition. This could range from an underactive thyroid, diabetes or even emotional problems like anxiety or depression.

3. Idiopathic Constipation

This terminology is used when doctors are unable to accurately pinpoint the cause of chronic constipation. Some of the prime suspects include poor muscle contractions of the colon or reduced sensitivity of the nerves near the bowels.

4. Pseudo-Obstruction

This happens when the muscular contractions in the intestines become inefficient. It is named as pseudo-obstruction as it mimics the symptoms of a physical obstruction even though none exists.


  • So What is faecal impaction(Soiling) ?

When there is no adequate bowel movement for several days or weeks, a large compacted mass of faeces builds up in the rectum
and/or colon which cannot be easily passed by the child.
Symptoms include failing to pass a stool for several days followed by a large, often painful or distressing bowel motion. Between bowel movements, children with faecal impaction often soil their underclothes.


  • Risk factors for constipation:

It is important to remember that these risk factors will differ from child to child and that a combination of factors may be
involved in each individual case.

  • Flawed Potty Training Approach

Some children can be difficult to deal with when it comes to potty training. If the approach used is too harsh, the child may         withhold their bowel movement in an act of defiance. Consistent behavior like this would make the act involuntary, and they may develop constipation as a result.


  • Constipation in your family

If other family members suffer from constipation, this can increase your child’s risk of becoming constipated

  • Medicine    :              Some medicines can cause constipation, such as codeine, certain cough medicines, anticonvulsants (drugs to control seizures) and antihistamines (drugs for treating allergies).

Diagnosis  :


Parents guide:


  • Don’t let your child wait to do a poo
    Give your child enough time so they don’t feel rushed.
  • Set aside a time each day for your child to sit on the toilet – perhaps after breakfast or lunch
  • Make going to the toilet fun by keeping special treats reserved for the toilet, such as a favorite book or getting them to blow bubbles.
    If your child says that it hurts to poo, tell them to stop trying and then try again later.
  • Encourage your child to get lots of active play to increase bowel activity
    Increasing dietary fibers:
    Eating foods that are high in fibers increases the bulk of the stools, making them softer (by helping them to
    retain water) and easier to push out.
  • Try to include a variety of high-fiber foods in the family’s diet such as wholegrain cereals,
    wholegrain pasta and rice, whole meal / granary breads and fruit and vegetables
    Include dried fruit and fruit eaten with skin on as well as vegetables, particularly beans, peas, sweet
    corn and pulses such as lentils
  • For babies, try puréed fruit and vegetables


  • How to calculate how much fiber (in grams)

    your child should be eating per day
    Child’s age in years + 5 grams for children older than 2
    E.g. if your child is 7 years old, the calculation would be
    7 + 5 = 12
    A 7 year old child should therefore be eating 12 g of fibre
    per day

  • Increasing fluid intake:


LaxativRaising fluid intake increases the water content of the stools making them softer and easier to pass.
Encourage your child to drink 6–8 glasses of water, squash and fruit juice, each day (approx. 2 pints / 1 litre).
For school-age children, ask their teacher about bringing a bottle of water into school each day.
For babies, try giving boiled water in between feedses

Many over the counter laxatives are available that help increase the frequency of passing stool. However, they are best for mild cases, and severe cases should always be shown to the doctor.

  •  Fruit Juice

Studies have shown that a substance called sorbitol, found in apple and pear juice helps to alleviate constipation.


  •  Probiotics

Though further research needs to be done, one study suggested that probiotics helped increase bowel movement as well as     soften stools.

    . Stool Softeners

Stool softeners reduce the water absorption capacity of the intestines making the stool soft enough to pass through the      rectum.

     . Massage

A non-invasive technique, massaging different areas of the colon helps strengthen the walls of the colon as well as loosens up   the stool.

Clinical approach:


1. Lubricants

As the stool is already hardened, it becomes difficult for it to pass through the anus. Consuming coconut oil and olive oil do a great job in lubricating the surface of the stool for an easy bowel movement.

2. Stimulants

One of the causes of constipation is the slow movement of the food leading to excess absorption of water. Stimulants help in increasing the pace of the muscle contractions within the intestines to help speed up the process.

3. Biofeedback therapy

Also known as biofeedback training, the focus of the therapy is to optimize your pelvic muscles on when to contract and relax while passing stool.

4. Surgery

In very severe cases, part of the colon may be removed. The shorter length of the colon would reduce the chances of constipation.