Advice for children with constipation

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How does the bowel work?

  • The food we eat gets mashed around in the stomach and turns into a soupy mixture.
  • This moves into the small bowel, where all the nutrients (the good stuff) are taken out to be used by the body to keep us healthy.
  • As it travels along the large bowel, water is absorbed and the poo turns into a smooth sausage shape ready to be passed.
  • The poo in the large bowel moves along every time the gut muscles squeeze.
  • When the poo reaches the rectum, the rectum stretches and that sends a message to the brain saying we need a poo.

What can go wrong?

  • If we don’t respond to this message, the poo just stays there.
  • The gut muscles keep squeezing so more poo arrives, as poo builds up in the large bowel more water is absorbed, and the poo becomes harder and gets stuck.
  • Messages are only sent to the brain when the rectum stretches. If it stays stretched, you won’t get a new message telling you need a poo.
  • Very soon you have got a poo traffic jam, also known as constipation.

Constipation is very common in children, it affects up to 1 in 3 children (see NICE Guidelines), even babies. Don’t wait for it to get better by itself. TAKE ACTION!

What's your poo telling you?

Poo checker stool chart

How can you tell if a child is constipated?

  • Children should pass soft poo every day, or at least every other day.
  • Passing types 1 - 3 means poo is sitting in a traffic jam.
  • Pooing fewer than 4 times a week also means poo is in a traffic jam.
  • Pooing more than 3 times a day can be a sign that the bowel is full, and is leaking out a bit at a time.
  • Soiling - it might be hard bits, soft stuff or even liquid bypassing the traffic jam, called overflow. The child won’t have any control over this.
  • Big poos, or lots of poo all at once.
  • Tummy ache or pain when they poo.
  • Distended/swollen tummy.
  • Really smelly poo/wind, or bad breath.
  • They might not feel like eating, or even feel sick.
  • The full bowel might press on the bladder and cause frequent small wees/urgency/day or night time wetting/Urinary tract infections.
Illustration showing normal and constipated bowels

HAVING JUST TWO OF THE ABOVE SYMPTOMS MEANS CONSTIPATION!

How to treat constipation:

  • Keep a Poo Diary for 2 weeks: what it looks like, how much, where it goes.
  • See your GP: Take the poo diary and tell them all your child’s symptoms.
  • The GP should examine your child and ask questions to find out if the constipation could be caused by an underlying condition.
  • The GP should prescribe a macrogol laxative like Movicol, Laxido or CosmoCol which softens poo and helps move it along (as per NICE Guidelines).

Taking laxatives:

  • The macrogol must be mixed with the right amount of water first, but then other food/drink can be added – read: How to use macrogol laxatives.
  • Most children start with disimpaction – this means taking lots of medicine to clear out the backlog of poo – read: A Parent’s Guide to Disimpaction.
  • When the bowel is clear they will need to keep taking a smaller dose each day to keep their poo soft and moving along.
  • Your child might need to stay on laxatives for a long time, but don’t worry, laxatives won’t hurt them. However, in the long term, undertreating constipation will.

Getting the poo in the loo

  • Get there at the right time - 20 to 30 minutes after meals and before bed.
  • Sit in the right way: feet flat and firmly supported on a box or stool, knees higher than hips. Secure sitting position - they might need a children’s toilet seat.
  • RELAX to let the poo out. So keep toys, games and books beside the toilet.

TRY TO MAKE EACH TOILET SIT ‘ACTIVE’ BY ALTERNATING
PLAY ACTIVITIES AND EXERCISES:

  • Massaging the tummy in clockwise circles, and rocking forwards and backwards on the toilet can really help.
  • Laugh/cough/blow to help push down with the tummy muscles.
  • Make it a fun time! Look at ERIC’s Toileting Reward Chart for more ideas to motivate your child. 10 to 15 minutes should be long enough for a toilet sit.

Promoting a healthy bowel:

  • Encourage your child to drink 6 - 8 water based drinks every day.
  • Include fruit and vegetables in their diet.
  • Exercise and move around!

More info

Advice for children with constipation in other languages

Last Reviewed: February 2024

Next Review: February 2027

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