Children with chronic constipation resist the urge to have a bowel movement. They do this by tightening their anal muscles, squeezing their buttocks together, and standing up straight or lying down flat. After a while, the urge to have a bowel movement goes away.
As they continue to do this, stool builds up in the lower bowel. The stool becomes harder and larger, and passage of stool causes great pain. The pain increases the child's desire not to have bowel movements.
If the child doesn't pass the huge stool after some time, the rectal and anal muscles may get tired and partly relax. Soft or liquid stool may leak out around the held stool that has collected in the lower bowel. It is often foul smelling and may stain the child's clothing. This is called stool soiling. The child cannot prevent it.
This question isn't always easy to answer. Chronic constipation may start as simple constipation caused by not eating enough fiber or drinking enough fluids. One large stool can cause a crack in the anus that makes having a bowel movement painful, so the child resists the urge. Sometimes, a tendency toward constipation runs in families.
An illness that leads to poor food intake, physical inactivity or fever can also result in constipation that lasts after the illness goes away. A few children withhold stools because of emotional problems. In many children, no cause can be found. Whatever the cause of stool withholding, once it begins, the large, hard stools that result make the pattern continue.
The first step in treatment involves removing the stool that has gathered in the lower bowel. This must be done before your child can begin to learn or relearn normal bowel habits. Your doctor will probably do this in the office. He or she may use an enema, a suppository or high doses of laxatives to remove the stool.
After the stool is removed, it is important to be sure that your child can have bowel movements easily in order to prevent another large collection of stool. During this part of retraining, your child's bowel should be kept empty so it can regain tone and function. The treatment includes changing your child's diet and giving daily laxatives to help soften the stool.
Your child should drink more fluids and eat more fiber. Recommended amounts of fluid each day are:
Only foods from plants contain fiber. These foods include fruits, vegetables, whole-grain cereals and breads, nuts, seeds, and beans.
Be sure to discuss the issue of constipation and your child at their next wellness visit.