To Poo or Not to Poo, and When to Worry

We, as a society, pay considerable attention to what goes into, and comes out of, our bodies and the bodies of our children.

When there is either too little, infrequent or painful passage of stool, it is termed constipation. However every child who has not pooped for a day is NOT constipated. In children, fortunately, most causes of constipation are temporary.

Simple dietary adjustments - eating more fiber-containing fruits and vegetables and drinking more fluids - usually alleviates the complaint. In a select population, laxatives may assist with expediting recovery.

Symptoms of childhood constipation may range from the absence of bowel movements for a few days, to vomiting, crankiness around stool times, abdominal pain and/or internal swelling. Some red flags to keep in mind are poor weight gain, a tender belly, painful cracks at the anal opening (fissures) or a swelling/protrusion at the anus.

Constipation comprises 10-15 percent of pediatrician visits and up to 25 percent of pediatric gastroenterology practice. One of the most commonly seen causes of constipation is “withholding,” a behavior where children may lay on the floor stiff, cross their legs, or hold on to the toilet seat; all in an attempt to clench their buttocks to avoid the painful poop. This behavior may begin with early toilet training, diet or routine change, medications or school bathroom avoidance.

A subset of kids in the following categories may also be especially at risk for constipation:

  • Sedentary/obese children
  • Those not getting enough fiber or fluid
  • Those on medications for depression/ ADHD
  • Children with abnormalities of the rectal area

In these cases, therapies will depend on the underlying disorder.

Treatment of constipation is fairly simple, yet requires consistency and attention to “intake” and “output.” Teaching children to follow the body’s “pooping signals” is very important to the long-term success of any regimen. Most physicians recommend a combination of a stool softener, a lubricant and a mild stimulant. With these, you achieve soft stools that do not hurt while exiting and thus engage the child in being an active part of the stooling process.

The long-term consequences of untreated constipation in children include colonic distention and stretching that may lead to stool leakage (encoparesis), urinary tract infections from rectal pressure, chronic abdominal pain/missed school days and the psycho-social effects of the above on normal childhood behavior and development. The bottom line is that pooping should be easy and natural. Your friendly neighborhood GI provider is always available to discuss these issues further.

Amana Nasir, MD, is a pediatric gastroenterologist with Mercy Children’s Hospital St. Louis.

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