Childhood constipation

Overview

Childhood constipation is when a child has hard, dry bowel movements (poo) that are difficult or painful to pass, or goes fewer than three times a week. It is a common problem in children and usually not serious.

Yes, constipation is one of the most common digestive problems in children. It can happen at any age but is especially common around the time of potty training and starting school.

Constipation can affect children of all ages, from babies to teenagers. It is slightly more common in boys than girls, and often happens during toilet training or when routines change, like starting school.

Symptoms

Common symptoms

• Hard, dry or lumpy stools
• Straining or pain when doing a poo
• Fewer than three bowel movements per week
• Feeling like not all the poo has come out
• Belly pain or bloating

Symptoms in children

• Holding in poo – crossing legs, clenching bottom, or hiding
• Foul-smelling wind and poo
• Soiling (leaking liquid poo) – a sign of long-term constipation
• Poor appetite or feeling sick
• Pain when doing a poo – may scream or refuse to sit on the toilet

Symptoms in older adults

• Although this article is about children, older adults may also experience similar symptoms like infrequent bowel movements and straining, but causes and treatments often differ.

Causes

Main causes

• Not eating enough fibre (fruits, vegetables, whole grains)
• Not drinking enough water or other fluids
• Deliberately holding in poo – often due to fear of pain, a busy schedule, or not wanting to use a strange toilet
• Changes in routine – travel, starting school, or potty training
• Side effects of some medicines (but never stop any medicine without talking to a doctor)

Risk factors

• Age – common in toddlers and preschoolers
• Family history of constipation
• Certain medical conditions like an underactive thyroid or Hirschsprung's disease (rare)
• Not being active enough
• Stress or emotional upset

When to see a doctor

See a doctor urgently if:

• If your child has any of the emergency symptoms listed above – call your local emergency number immediately.
• If your child has not done a poo for 5 days or more and is in pain.

Book a routine appointment if:

• If constipation does not improve after a few days of home treatment (more fibre, water, and gentle exercise)
• If your child has soiling (leaks poo) regularly
• If your child complains of pain during or after doing a poo
• If you are worried about your child's eating, weight, or growth

Diagnosis

The doctor will ask about your child's symptoms, diet, and bowel habits. They may do a gentle physical exam, including pressing on the belly, to check for any lumps or tenderness. Usually no tests are needed.

Tests that may be done

• Sometimes the doctor may recommend an X-ray of the belly to see how much poo is in the bowel.
• In rare cases, if there is concern about an underlying condition, a blood test or rectal exam (looking inside the bottom) may be done.

What to expect at your appointment

The doctor will work with you to make a plan. They may suggest keeping a diary of poo, diet, and symptoms. Most of the time, treatment starts at home with diet and lifestyle changes, and maybe a short course of laxatives (medicines to soften poo) if needed.

Treatment

Treatment for childhood constipation focuses on making stools softer and easier to pass, and encouraging regular toilet habits. It often involves simple changes to diet and daily routine. Some children may need medicine for a short time to help clear the constipation and prevent it from coming back.

Self-care at home

• Give your child more fluids – water, diluted fruit juice, or soup throughout the day.
• Add more fibre to meals – fruits (prunes, pears, berries), vegetables, whole-grain bread, oats, beans and lentils.
• Encourage gentle physical activity – running, playing, cycling, or swimming helps the bowels move.
• Set a regular toilet routine – encourage your child to sit on the toilet after meals, even if they don't feel the urge, for 5 to 10 minutes.
• Make the toilet experience positive – use a footstool so their feet are flat, keep toilet visits relaxed, and reward success with praise, not pressure.
• Avoid punishing or pushing – this can make constipation worse.

Medical treatments

If diet and lifestyle changes are not enough, a doctor may recommend laxatives – medicines that help soften or flush out poo. These are meant to be used for a short time under a doctor's guidance. Never give your child any laxative without medical advice. Sometimes a 'disimpaction' treatment is needed: a stronger medicine to clear a large blockage, followed by a maintenance dose to keep stools soft.

When is surgery considered?

Surgery is rarely needed for childhood constipation. It may be considered if an underlying condition like Hirschsprung's disease (a birth defect in the bowel) is found, or if severe complications like a tear in the bowel occur – this is extremely uncommon. Your child's doctor will discuss all options if surgery is ever needed.

Living with this condition

Managing constipation often means changing the whole family's diet and habits. It can take weeks or months for regular bowel habits to become normal. Be patient and consistent. Celebrate small steps. If your child has soiling, it is not their fault – it's a sign that the bowel is full, and they need medical help to empty it.

Lifestyle tips

• Make drinking water a habit – give a water bottle to take to school.
• Create a calm, unhurried bathroom routine.
• Teach your child not to ignore the urge to poo – explain it's like a 'poo message' from their body.
• Encourage daily physical activity as a family.
• Limit screen time and encourage active play.

Diet and exercise

A diet rich in fibre from fruits, vegetables, and whole grains is helpful. Aim for at least 5 portions of fruit and veg a day. Also include high-fibre foods like prunes, apricots, beans, and oats. Exercise like walking, running, and active games helps the bowels work better. Even gentle activity after a meal can stimulate a bowel movement.

Mental health and emotional wellbeing

Constipation can be upsetting for both child and parent. The child may feel embarrassed, frustrated, or distressed by pain and soiling. Some children develop a fear of poo (stool phobia) and hold it in, making constipation worse. It's important to talk openly, provide reassurance, and not shame the child. If emotional issues persist, speak to a health visitor or therapist.

Prevention

Childhood constipation cannot always be prevented, but you can lower the risk. A balanced diet with enough water and fibre, regular physical activity, and a relaxed toilet routine go a long way. Teach your child to respond to the urge to poo, especially when they start school or daycare.

Complications

If left untreated

• Severe, chronic constipation can lead to a swollen belly, pain, and a 'blockage' that may need hospital treatment.
• Soiling (leakage of liquid poo) – this happens when hard poo blocks the rectum and liquid poo leaks around it. It can cause social embarrassment and affect confidence.
• Anal fissures – small painful tears in the skin around the bottom, which can bleed and cause more pain when doing a poo.
• In very rare cases, a bowel obstruction (a complete blockage) or a tear in the bowel (perforation) can occur – these are emergencies.

Long-term outlook

The outlook for children with constipation is very good. With proper dietary changes, lifestyle adjustments, and sometimes short-term medicine, most children develop regular, comfortable bowel movements. Even long-term constipation can be resolved with patience and consistent care. It is rarely a sign of a serious condition, and most children grow out of it. With support, children can overcome this problem and enjoy good digestive health.

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