Constipation is a common problem that affects both adults and children. However, it can be particularly concerning in children, as they may not always be able to express their discomfort or understand what is happening to them.
Constipation occurs when a child has difficulty passing stool or has infrequent bowel movements.
During summer, while there may be an increase in gastrointestinal problems due to various factors such as changes in routine, dehydration, and altered diet, constipation may exacerbate the issue.
“When left untreated, constipation can cause abdominal pain, bloating, appetite loss, anal fissures, faecal impaction, and negatively impact a child’s mental well-being,” says Dr Yogesh Kumar Gupta, paediatrics consultant at Fortis Hospital in Bengaluru.
Why do children get constipated?
There are several reasons why a child may become constipated.
Dr Gupta told South First that constipation is a common issue in children, especially in an urban setting, and it is also the most common reason for recurrent abdominal pain in children.
He says that changing dietary habits like erratic meal timings, eating junk food, and even early forceful toilet training in a toddler can precipitate or worsen pre-existing constipation.
“I see at least three to four children per day with issues related to constipation. It’s not just babies, even teenagers come with complaints that need to be addressed,” explains Dr Sanjay G, a paediatrician from Bengaluru.
Lack of fiber
Doctors say that one of the most common causes of constipation is a lack of fibre in children’s diet. Fibre helps to add bulk to stool and makes it easier to pass through the digestive system.
If a child is not getting enough fibre, their stool may become hard and difficult to pass.
Another cause of constipation in children is dehydration.
When the body is dehydrated, it can lead to hard, dry stools that are difficult to pass.
Children who do not drink enough water or other fluids may be more prone to constipation.
Lack of physical activity
A lack of physical activity can also contribute to constipation in children. Exercise helps to stimulate the muscles in the digestive tract, which can help move stool through the system.
If a child is not getting enough exercise, their bowel movements may become sluggish, leading to constipation.
Some medications can also cause constipation as a side effect. This may include pain relievers, antihistamines, and certain types of antidepressants.
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Problems with chronic constipation
Dr Yogesh says that chronic constipation can also be a manifestation of underlying structural malformation of the gastrointestinal tract, especially if constipation starts in early infancy. In addition, some hormonal imbalances can also lead to constipation, with a special mention of hypothyroidism.
Constipation doesn’t only mean the absence of stools for three to four days. Along with that, passing of hard stools and infrequent stools also comes under this, says Dr Vijay Kumar CH, Paediatrician from ESI Hospital in Balanagar, Hyderabad.
He says that many children come to him with exfoliation of the skin in the perianal region.
“Many children do not pass motions for five to six days. In such cases, the defecation is not only painful, but there also might be bleeding in the skin region. The passing of stone like pellet stools or large faecal masses may be passed, leading to tearing of the skin around the anal region. Also, there are instances of children crying constantly, unable to sit or stand due to stuck stools, where half the stool is out and the other remains hanging,” says Dr Kumar.
What are some treatment options?
Doctors stress that instead of treating the constipation, parents should stress on preventive measures. They say that most parents and children themselves neglect fluid intake.
“Especially water and other liquids. One has to increase oral fluids. Being summer season, there will be dehydration and that can lead to constipation. So, plenty of fluids is important,” says Dr Vijay.
Meanwhile, Dr Yogesh also insists on drinking plenty of water, eating a healthy balanced diet with fruits, vegetables, and fibre-rich foods, engaging in regular toilet routine, and avoiding foods high in sugar, salt and fat, especially junk food.
For functional constipation, which 90 percent of children have, a high-fibre diet of green leafy vegetables, vegetables with high fibre content, wheat-containing chapatis, non-vegetarian food can be given, say doctors.
Additionally, they insist on cutting down milk. Dr Vijay says, “Parents should cut down on milk and milk products, mainly ghee and curd at night.”
Dr Vijay also insists on regular bowel routine to be inculcated in a child as young as three years old. “They should be given a glass of warm water with a pinch of salt as soon as they are out of bed and then made to sit on the toilet seat for at least 15 minutes, even if they don’t have the sensation to pass stools. This habit will ensure that constipation is prevented,” Dr Vijay adds.
What can schools do?
Doctors South First spoke to say that all schools must ensure that they have conversations around constipation and talk about the importance and dangers of holding their stools.
“I have seen many children not pass stools in the morning. They are hurrying to catch the bus and parents don’t insist too. Due to this, when they feel like going to the bathroom during school hours, they either shy away from asking to use the toilet or fear that the teacher may not allow them to leave the classroom. Schools must insist on students drinking a glass of water before they take their chalk to teach,” says Dr Vijay.
When children postpone going to the bathroom, then they won’t empty their bowels on time. This leads to retention of the stools, which leads to constipation.
Treatment for chronic constipation
Dr Yogesh says that when dealing with chronic constipation in children, it is crucial to seek medical attention. The treatment options could involve laxatives, stool softeners and enemas, and behavioural changes such as setting up a regular bowel routine.
“Toilet training and dietary modifications may be prescribed. In some cases, additional testing or referral to a paediatric gastroenterologist may be necessary,” he adds.
He also adds that the treatment of habitual constipation needs time and patience. So parents are advised to stick to the type and duration of the treatment advised.
Abrupt stoppage of treatment can lead to a relapse of symptoms, especially in habitual constipation.