Stomach pains are common in kids, with constipation being one of the more common causes and one of the first things that parents and pediatricians think of as being to blame.
Still, since there are many other things that can cause stomach pains, it is important to learn about constipation symptoms to see if your child really has constipation or if something else causing his pain.
What Is Constipation?
Constipation is usually defined as having fewer than two or three bowel movements a week, or having hard or painful bowel movements, even if the child has bowel movements every day.
In most children, constipation is caused by having a diet that is low in fiber or high in fat, or by not drinking enough liquids. Constipation can also be caused by not getting enough exercise, as a side effect of some medications, and in children who hold their stools and avoid having bowel movements regularly.
Constipation Symptoms
Constipation symptoms are usually fairly straightforward. They can be a little more confusing in an older child, when a parent will likely be much less aware of how often their child is having bowel movements.
Depending on the child's age, constipation symptoms and signs can include:
- having fewer than two or three bowel movements a week
- straining while having a bowel movement
- not wanting to have a bowel movements because of fear of the pain it might cause (stool withholding), which makes the constipation worse
- abdominal pain, bloating, and cramps, which is often relieved by having a bowel movement
- having very large bowel movements that are painful, that can occasionally stop up the toilet, or that are like hard little balls, which would be a sign of constipation even if the child had these types of bowel movements each day
- feeling like you still need to have a bowel movement, even though you just had one (incomplete evacuation)
- rectal pain
- excessive gas
- bright red blood on the outside of hard stools or when your child wipes after a bowel movement, which can be caused by a large bowel movement causing an anal fissure
Keep in mind that some younger children, especially infants and toddlers before they are potty trained, may appear to strain when they have a bowel movement. If they are having soft stools, then they likely aren't constipated.
Severe Constipation
Parents are usually well aware of routine constipation symptoms.
Severe or chronic constipation symptoms can be more confusing. These children can often have encopresis, with the involuntary leakage of small amounts of soft or watery stools into their underwear.
Encopresis is usually caused by having a large, hard stool that is impacted in the rectum, leading to stool that has to pass around it and eventually leaks out of the dilated rectum without the child being aware that it is happening. If the parent is unaware of the constipation, they may think that the leakage is the main issue and go to their pediatrician complaining that the child is having diarrhea, when he actually has the opposite problem.
Other complications of severe constipation can include:
Sources:
Integrative approaches to childhood constipation and encopresis. Culbert TP - Pediatr Clin North Am - 01-DEC-2007; 54(6): 927-47
Kliegman: Nelson Textbook of Pediatrics, 18th ed.
