Young Caucasian girl sat on the toilet as her mum stands by the door and watches over her.

Paediatrics: constipation in children

By Cristiano Antonino On Sep 29, 2022

Constipation is the infrequent and painful evacuation of hard, bulky stools. It is a frequent problem in childhood. 5% of paediatrician visits are due to the problem of evacuation

The most frequent cause of constipation in children is the experience of painful evacuation and, consequently, the decision to postpone evacuation indefinitely in order not to feel pain.

The child learns to ‘suppress’ the urge to evacuate, and to this end implements a series of behaviours (lifting oneself up on one’s toes, crossing one’s legs), which are defined as ‘retentive-fecal’ attitudes.

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Parents of constipated children recognise them and can describe them very well

Voluminous faecal masses thus accumulate in the last tract of the intestine (rectum) and increase in volume and consistency, making evacuation very laborious and painful, maintaining the vicious circle constipation-pain-stipsis: constipation gives pain and pain gives sitpsi.

When large masses of faeces remain in the rectum, they cause small amounts of liquid faeces to leak out – without the child noticing – and ‘press’ upstream.

The child will often have soiled panties: this phenomenon is called “soiling” and will disappear when the constipation disappears.

Constipation, how it is diagnosed

The paediatrician who assesses your little patient, in order to find out if he or she has constipation, will do an exploration of the rectum with his or her finger, with the aim of first of all detecting the presence and extent of the so-called faecal impaction (i.e. whether masses of faeces have accumulated in the last part of the intestine): the treatment of constipation starts with the removal of the impaction.

The paediatrician will also look for any rare anatomical abnormalities.

What to do for a constipated child

Parents should be aware that the treatment of constipation is prolonged and usually requires at least a year and a great deal of patience; that the medicines that the paediatrician may prescribe are well-tolerated and widely tested.

The cornerstone of constipation therapy is to make evacuation no longer painful, but comfortable.

This can be achieved by

make stools softer with the administration of ‘softeners’ and fibre, and with the intake of copious amounts of fluid;
prevent the formation of excessively large rectal masses; this is achieved by having the child evacuate every 2 (maximum 3) days;
treat, if any, anal pathologies that make evacuation painful, such as fissures;
invite the child to evacuate in the bathroom at home where he has maximum comfort and privacy, at fixed times of the day (late afternoon, after dinner) and without rushing him;
educate the child to assume the most suitable position for evacuation. The most suitable position is the ‘primal’ squatting position: soles of the feet well supported, knees apart. This posture favours the abdominal press (the “pushing”) and the release of the sphincters.

There used to be Turkish baths, which were much better than today’s toilets.

The use of the potty responds to these postural characteristics much better than the toilet, which forces the child into an unnatural posture with hands on the donut so as not to fall off, knees together and feet dangling.

The use of commercially available reducers, which are attached to WCs, does not substantially change the child’s posture.

If the child considers a return to the potty to be a “regression”, it is advisable to attach a horseshoe-shaped stool to the reducer, to be placed at the foot of the toilet, which allows the child to keep his or her knees apart and the soles of the feet firmly on the stool.

This stool is not commercially available, but can be commissioned from a craftsman.

Does nutrition help with paediatric constipation?

Parents wonder whether they can help their child with constipation to acquire eating habits that are helpful in the treatment of constipation.

They often make great efforts to induce the child to consume foods rich in fibre.

However, it is important to avoid conflict situations at mealtimes, as the moment of evacuation is already a cause of stress for the child and the family.

It can be recommended that the child increase consumption of fruit and vegetables like all family members, and to try to identify the child’s favourite food; often diced fruit seasoned with sugar and lemon and served with ice cream is more appreciated than minestrone, which is often recommended and not liked by children.

In this connection it should be noted that pears are often liked and have the advantage of an average higher fibre content than other fruits.

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