When young children are having fun, it's hard to convince them to stop, even when they should take a toilet break. Replies like "Just five more minutes, please mommy?" and "Wait, I'm not finished yet!" are common, and sometimes parents just give in to a child's innocent persistence.
Unfortunately, a child's habit of withholding bowel movements can contribute to constipation, a common problem among children.1
Constipation happens when stools spend too much time in the colon – this causes the colon to absorb too much water, resulting in hard and dry stools that are difficult to push out from the body.2
Over time, constipation can worsen, so it's important for parents to be on the lookout for warning signs. These include behaviours such as straining while passing stool or clenching buttock muscles which indicate efforts to withhold bowel movements. Other symptoms include stomach pain and cramping, urinary leakage which can be caused by build-up of stools pressing against the bladder, or stool in the underwear caused by stool building up and leaking.3
What causes constipation?4
- A lack of fibre can cause constipation, as fibre helps to keep stools soft, easing bowel movements.
- Some types of medicine can contribute towards constipation. Parents seeking a doctor's advice for their child's constipation should inform the doctor of any medication their child might be taking.
- Withholding bowel movements causes stool to be pushed back into the rectum or anus, the lowermost part of the digestive tract. This causes muscles in the rectum and lower colon to stretch and become less effective. Meanwhile, the colon continues to absorb water from the stool, and it becomes hard, dry and difficult to pass. Children may withhold bowel movements for many reasons, from being stressed about toilet training to not wanting to interrupt their playtime, or because they are afraid of experiencing a painful bowel movements.
- Medical conditions such as diabetes can disrupt the body's regular process.
- Functional constipation occurs in children during three periods: during a significant dietary transition such as the introduction of solid foods; when they are being toilet trained and learning to control their bowel movements; when they start school and avoid using the bathroom at school for bowel movements.
Managing and preventing constipation
Parents can help to keep their child's tummy healthy and reduce the risk of constipation by making some changes in their child's diet and behaviour.
- Introduce fibre into their daily diet. The Malaysian Dietary Guidelines for Children and Adolescents recommends two servings each of fruits and vegetables daily for children below the age of seven.5 Good high-fibre options include prunes, raisins, peas, beans, broccoli, leafy vegetables and whole grain cereals.6
- Give them plenty of water, especially when they are active or unwell. Children aged 2-3 years should drink up to two glasses per day while children four years and above require 6-8 glasses.5
- Encourage children to use the toilet regularly, such as after meals.4
- Try to include prebiotics and probiotics in their diet – prebiotics such as galactooligosaccharides (GOS) and fructooligosaccharides (FOS) help support the growth of healthy bacteria in the gut, known as probiotics7, which in turn help support healthy gut functions.8
If these measures don't help, or if the constipation gets worse, it's important to seek a doctor's advice.
Overall, children need to be reminded to use the toilet regularly but remember that toilet training can be stressful for children and worsen constipation so it's important to make it part of a positive routine rather than a forced experience.
1Anthony G Catto-Smith (2005). Constipation and toileting issues in children. Med J Aust. 182 (5): 242-246.
2WENDY S. BIGGS et al, Evaluation and Treatment of Constipation in Infants and Children, Am Fam Physician 2006;73:469-77.
3M.M. Tabbers et al, Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN, JPGN 2014;58: 258–274.
4Constipation in Children. National Digestive Diseases Information Clearinghouse (NDDIC), http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/ Last accessed 21 May 2014.
5Malaysian Dietary Guidelines for Children and Adolescents - Summary. Ministry of Health Malaysia, http://www.moh.gov.my/images/gallery/Garispanduan/MDG Children and Adolescents Summary.pdf.
6Managing constipation in children. Presented by Dr Lim Chooi Bee at the Medical Progress General Update. http://pub.mims.com/Malaysia/topic/Medical-Tribune-MY/Managing-constipation-in-children?_s1=Hl2I0ZbWQPG-qvUrzwn7gtI7Jqo1 Last accessed 14 May 2014.
7Prebiotics: How to feed your family's friendly gut flora. http://www.parentingscience.com/prebiotics.html Last accessed 13 May 2014.
8Roberfroid M et al. Prebiotic effects: metabolic and health benefits. Br J Nutr 2010 Aug;104 Suppl 2:S1-63.