Normal bowel habits are variable. Some people go to the toilet 2–3 times each day whereas others only go once a week. It is only when the stools become hard and/or very large and difficult to pass that constipation occurs. Constipation refers to the consistency of the stools and any difficulty in passing them.
What your child might complain of...
Stomach pain from constipation may come and go.
Pain when passing motions
When constipated, a child may not want to go to the toilet. This delay makes the motions even harder and more painful
Diarrhoea may result because the only way ‘new’ stool can get past the hard mass of faeces blocking the bowel is to become watery.
Soiling of underwear
Soiling of underwear can occur when the bowel wall gets stretched by the presence of a large mass of faeces. This can lead to loss of feeling in the nerves of the bowel walls so your child doesn’t realise they need to go to the toilet.
A poor appetite can result from feeling vaguely unwell.
Causes of Constipation
There are a number of factors that can cause constipation:
Diet – it is essential that all children have a diet high in fibre. Foods such as cereals, fruit and vegetables will add essential fibre to a child’s diet adding bulk to the faecal material.
Natural tendency – some children have slow gut movement which causes constipation.
Liquids – water adds fluid to the faecal material making bowel movements softer and easier to pass. If a child doesn’t drink enough fluid, consume enough fibre or has a diet high in fats, junk food or dairy products, dehydrated and hard stools can result in making going to the toilet difficult.
Physical Activity – If a child doesn’t exercise enough the bowel can become sluggish causing the stool to move through the colon much more slowly. Inactivity will not generate sufficient muscle movement to allow the effective passage of faecal material.
Painful Conditions – fissures and perianal infections may result in the child associating going to the toilet with pain. The child will be more resistant to visiting the toilet even if they have the urge to go. This will further compound their painful condition as they will begin to retain faecal material making it even more painful to pass a now larger and impacted stool.
Psychological avoidance – The child may develop a psychological avoidance to going to the toilet which will require much coaching and counselling by both a parent and medical practitioner. In addition, ignoring an urge to go will eventually diminish sensation in the rectum which will lead to further stool retention.
What are the consequences of constipation?
When a child is constipated stool builds up in the large intestine. The intestine stretches to accommodate this stool, becoming considerably larger than normal and the formed stool becomes impacted.
The stretched muscles are unable to create the normal peristaltic motion required to clear the bowel. It is very important that faeces do not build again during the recovery phase until the bowel is fully functioning normally.
What to do?
First the hard mass of faeces must be softened. Children’s Parachoc is a lubricant laxative with liquid paraffin. It contains no bowel stimulant so it’s suitable for long term use. It works by gently lubricating the bowel wall and softening the faecal mass. This makes stool easier for children to pass. Over time this enables the bowel wall to recover it’s normal muscle function.
What is Encopresis?
Encopresis is the inability to fully control the bowel, resulting in a soiling accident. This can occur in underpants and sometimes in the bath or pyjamas. It’s quite common as one child in every two or three primary school classes might have soiling difficulties.
When the bowel can’t clear stool normally it builds up in the large intestine. As the large intestine or rectum stretches it decreases the sensation of stool presence. With a child unaware they need to have a poo, the retained stool may leak out and a soiling accident happens.
What causes it?
There are several causes including the following:
- A lack of muscle co-ordination in the lower bowel (rectum) and anus. This makes full and effective evacuation of faeces difficult.
- A lack of sensitivity or feeling in the rectum so a child cannot tell when they need to have a poo. This leads to a build up of stool which can then leak out.
- Some children are afraid to have a poo because it hurts during past episodes of constipation. They may resist the urge of having a poo leading to stool build up.
How can you help?
A programme of regular sits on the toilet along with the help of a stool softener such as Children’s Parachoc will help more than 2 out of 3 children within 6 months and make more than 9 out of 10 children feel much better.
The treatment for encopresis is similar to that recommended for constipation:
- Emptying the large intestine;
- Establishing and maintaining regular bowel movements.
The training diary included in this guide is designed to help you monitor your child’s motions and medication use.
Is Encopresis a behavioural problem?
Children with encopresis are not soiling their pants deliberately. They can’t stop the ‘accidents’ from happening because they are less sensitive to the nervous stimulation that tells them they need to go to the toilet.
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