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Pediatrics - Constipation 

Introduction
Constipation refers to a change and decrease in bowel movements.  Constipation can be very uncomfortable but is rarely linked to a serious medical condition.  It can cause hard stools that are difficult and painful to pass.  A poor diet, poor bowel habits, physical inactivity, and older age are common factors associated with constipation.  Constipation is treated with dietary changes, lifestyle changes, and in some cases, medications.

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Anatomy
Your child's body absorbs nutrients and removes waste products via the digestive system.  Whenever your child eats and drinks, food travels through your child's digestive system for processing. As water from the waste product is absorbed, the product becomes more solid and forms a stool or feces.  It is eventually eliminated from your child's body when he or she has a bowel movement.
 
After food is swallowed, it moves through the esophagus and into the stomach.  Chemicals in your child's stomach break down the food into a liquid form.  The processed liquid travels from your child's stomach to your child's small intestine.  The small intestine breaks down the liquid even further so that your child's body can absorb the nutrients from the food. The remaining waste products from the small intestine travel to the large intestine.
 
The large intestine, also called the large bowel, is a tube that is about 5 feet long and 3 or 4 inches around.  The first part of the large intestine is the colon.  The large intestine is divided into sections, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, and anus.  The appendix is located on the cecum, but it does not serve a purpose in the digestive process. 
 
The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine.  As the colon absorbs water from the waste product, the product becomes more solid and forms a stool.  The large intestine moves the stool through the large intestine into the sigmoid colon, where it may be stored before being traveling to the rectum.  The rectum is the final 6-inch section of the large intestine.  No significant nutrient absorption occurs in the rectum or anal canal.  From the rectum, the stool moves through the anal canal.  It passes out of your body through the anus when your child has a bowel movement.

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Causes
Constipation refers to a change and decrease in bowel movements.  Stools become hard because they contain less water than usual.  This makes the stools difficult and painful to pass.  A poor diet, poor bowel habits, physical inactivity, older age, and certain diseases or medical conditions can cause constipation.  Diets that are high in fats, refined sugar, and low in fiber can cause constipation.  Not drinking enough water can contribute to constipation.
 
Poor bowel habits are associated with constipation.  For healthy bowels, your child should go to the bathroom when he or she feels the urge to have a bowel movement.  Holding a bowel movement can lead to progressive constipation.  This may occur in people who are apprehensive about using public restrooms or in children that are resisting toilet training.
 
Certain medical conditions including irritable bowel syndrome, intestinal obstruction, pregnancy, thyroid conditions, and neurological disorders can cause constipation.  It can occur as a side effect of some medications.  It can also occur as a consequence of laxative abuse.

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Symptoms
Constipation can be very uncomfortable because of changes in your child's stools and bowel habits.  Your child's bowel movements may occur more infrequently than usual.  It may be difficult for your child to start a bowel movement.  Your child's stools may become hard and take a long time to pass.  Passing a stool may be difficult and painful.  Constipation can lead to hemorrhoids or rectal prolapse.  Rectal prolapse is a condition that occurs when part of the intestinal lining comes out through the rectum.
 
You should contact your doctor if your child experiences rectal prolapse, blood in his or her stool, very thin stools, unexplained weight loss, or severe pain, which may be symptoms of other medical conditions.  Your child should receive immediate emergency medical attention for symptoms of an intestinal blockage including a sudden inability to pass gas or stools, abdominal pain, and vomiting.

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Diagnosis
Your doctor can diagnose constipation by reviewing your child's medical history and asking you questions about your child's bowel movements.  You should tell your doctor about your child's symptoms and risk factors.  Your doctor will conduct a physical examination and test your child's stools and blood.  Your child's thyroid functioning may also be assessed, as hypothyroidism can contribute to constipation. 
 
Your doctor may refer your child to a gastroenterologist for special tests.  A gastroenterologist is a doctor that specializes in digestive tract conditions.  Additional tests may be ordered to help determine the cause of your constipation and to rule out other conditions with similar symptoms, such as an intestinal blockage. 
 
Your doctor will examine your child's abdomen to feel for growths or enlarged organs.  Your doctor may also perform a digital rectal examination.  An X-ray of your child's abdomen may reveal an intestinal obstruction or other problems.  An X-ray simply requires that your child remain motionless while a camera takes a picture.  In some cases, doctors may order additional imaging tests such as a sigmoidoscopy or a colonoscopy.
 
A flexible sigmoidoscopy is used to view the rectum and part of the colon.  A sigmoidscope is a thin tube with a light and viewing instrument.  It is about two feet long.  The sigmoidscope is placed in the colon, through the anus.  This test can be uncomfortable, but should not be painful.
 
A colonoscopy is used to view the entire colon.  A colonscope is similar to a sigmoidscope, but it is much longer.  A tissue sample or biopsy may also be taken with the colonscope.  A colonoscopy can be uncomfortable, and your child will receive medication to relax him or her prior to the test.
 
A virtual colonoscopy is a newer way to view the colon with a computed tomography (CT) scan.  A CT scan takes a series of images to compose a detailed picture.  A virtual colonoscopy involves filling the colon with air and then taking the CT scans.  The CT images construct a visual depiction of the interior of the colon.  The colon can also be viewed with a barium enema with air contrast test.  For this test, the barium, a chalky substance, and air are used to fill and expand the colon.  Next, X-rays are taken.  These tests can be uncomfortable.  Any abnormal results are followed up with a colonoscopy.

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Treatment
Your doctor will first treat any underlying medical condition that is contributing to your child's constipation.  A dietary component is always a part of the treatment plan.  Recommendations usually include eating more foods that are high in fiber and drinking plenty of water and fruit juices.  It is also important that your child gets plenty of regular exercise.  Additionally, your child should go to the bathroom as soon as he or she feels the need to have a bowel movement.

Initially, doctors may recommend some medications.  Your doctor may prescribe bulk-forming agents, stool softeners, or laxatives.  You should discuss long-term medication options with your doctor, if necessary.  Over-the-counter laxatives are not recommended for long-term use.

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Am I at Risk

Is My Child at Risk?

Certain factors can lead to constipation.  They include eating a poor diet, physical inactivity, older age, certain medical conditions, and some medications.  You should tell your doctor about your child's risk factors and discuss your concerns.  There may be changes you can make to eliminate selected risk factors.

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Complications
Your child should receive immediate emergency medical attention for symptoms of an intestinal blockage including a sudden inability to pass gas or stools, abdominal pain, and vomiting.  You should contact your doctor if your child experiences blood in his or her stool, very thin stools, unexplained weight loss, or severe pain, which may be symptoms of other medical conditions.  Constipation can lead to hemorrhoids or rectal prolapse.  Rectal prolapse is a condition that occurs when part of the intestinal lining comes out through the rectum.

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Advancements
There are several steps your child can take to prevent constipation.  It is helpful to eat a diet that is high in fiber including fresh fruits, vegetables, and whole grains.  It is important to drink plenty of water and fruit juices.  Your child should exercise regularly.  Your child should establish healthy bowel habits.  Your child should go to the bathroom when he or she feels the need to void. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.