What causes constipation and hard stools. How to relieve constipation at home. When should you see a doctor for constipation. What are the effects of constipation in children and babies. How does aging affect bowel movements. Can medications cause constipation. What role does diet play in preventing hard stools.

Understanding Constipation and Hard Stools

Constipation and hard stools are common digestive issues that affect millions of people worldwide. These conditions occur when stools pass through the colon too slowly, allowing the large intestine to absorb excess water. This results in dry, hard stools that are difficult to pass. Approximately 16% of adults and one-third of individuals over 60 experience symptoms of constipation.

Hard stools can be caused by various factors, including lifestyle choices, medications, and underlying medical conditions. While occasional constipation is generally not a cause for concern, chronic constipation may indicate a more serious health issue and should be addressed by a healthcare professional.

How does the digestive system contribute to hard stools?

The large intestine, or colon, plays a crucial role in the formation of stools. As food passes through the digestive tract, the colon absorbs water from the waste material. When digestion slows down, the colon has more time to absorb water, resulting in harder, drier stools. This process can lead to constipation and discomfort during bowel movements.

What are the common symptoms of constipation?

• Hard, lumpy stools
• Abdominal bloating and pain
• Difficulty passing stools
• Straining during bowel movements
• Pain or bleeding when passing stools
• Incomplete bowel movements
• Fewer than three bowel movements per week

Common Causes of Constipation and Hard Stools

Understanding the underlying causes of constipation is essential for effective treatment and prevention. Several factors can contribute to the development of hard stools and constipation:

How does aging affect bowel movements?

As we age, our bodies undergo various changes that can impact digestive health. A 2021 review found that reduced physical activity and polypharmacy (taking multiple medications) are the most common causes of constipation in older adults. Additionally, pelvic floor dysfunction can lead to delayed colonic transit and hard stools in elderly individuals.

What role does diet play in preventing hard stools?

Diet is a crucial factor in maintaining healthy bowel movements. Insufficient fiber intake, particularly from fruits and vegetables, can lead to constipation. Fiber promotes food movement through the digestive tract and absorbs water to soften stools. Conversely, food sensitivities and excessive consumption of sugary foods may contribute to constipation.

How does dehydration affect stool consistency?

Adequate hydration is essential for maintaining soft stools. When the body is dehydrated, the intestines and colon absorb more water from the stool to compensate. This process results in hard, lumpy stools that are difficult to pass. Ensuring proper fluid intake is crucial for preventing constipation.

Can lack of physical activity cause constipation?

Physical inactivity can significantly impact digestive health. Insufficient movement affects blood supply to the gut, leading to slower food transit through the digestive tract. Regular exercise and physical activity can help stimulate bowel movements and prevent constipation.

Constipation During Pregnancy and Postpartum

Many women experience changes in bowel habits during pregnancy and after childbirth. Hormonal fluctuations and physical changes in a woman’s body, such as increased pelvic floor pressure, can contribute to constipation. It’s essential for pregnant and postpartum women to maintain a healthy diet, stay hydrated, and engage in safe physical activities to promote regular bowel movements.

How can pregnant women manage constipation?

Pregnant women can manage constipation by increasing their fiber intake, drinking plenty of water, and engaging in light exercise as approved by their healthcare provider. In some cases, prenatal vitamins containing iron may contribute to constipation, and a healthcare professional may recommend alternatives or additional supplements to alleviate symptoms.

Constipation in Children and Babies

Constipation can affect individuals of all ages, including children and infants. In young children, toilet training anxiety and changes in routine can lead to constipation. Some children may develop a tendency to retain their bowel movements, resulting in hard, painful stools.

How can parents help children overcome constipation?

Parents can help children overcome constipation by:

• Encouraging a fiber-rich diet
• Ensuring adequate hydration
• Promoting regular physical activity
• Creating a positive and supportive toilet training environment
• Establishing consistent bathroom routines
• Consulting a pediatrician for persistent issues

Medical Conditions Associated with Constipation

Several medical conditions can contribute to chronic constipation and hard stools. Understanding these underlying causes is crucial for proper diagnosis and treatment.

Which chronic conditions can cause constipation?

Chronic medical conditions that may lead to constipation include:

• Irritable Bowel Syndrome (IBS)
• Diabetes
• Hypothyroidism
• Alzheimer’s disease
• Parkinson’s disease
• Certain types of cancer

Individuals with these conditions should work closely with their healthcare providers to manage constipation symptoms and develop appropriate treatment plans.

Medications and Constipation

Certain medications can slow digestion and contribute to constipation. It’s important to be aware of potential side effects and discuss concerns with a healthcare provider.

Which medications commonly cause constipation?

Medications that may lead to constipation include:

• Antidepressants, particularly tricyclic antidepressants
• Some pain relievers, especially opioids
• Iron supplements
• Calcium channel blockers
• Antacids containing aluminum or calcium
• Anticonvulsants
• Diuretics

A 2021 study found that taking multiple pain medications significantly increases the risk of drug-induced constipation. Patients undergoing radiation therapy, particularly pelvic radiation, may also experience constipation during and after treatment.

Home Remedies and Lifestyle Changes for Constipation Relief

Many individuals can find relief from constipation and hard stools through simple home remedies and lifestyle modifications. These strategies can help promote regular bowel movements and improve overall digestive health.

How can you naturally relieve constipation at home?

Natural remedies for constipation include:

1. Increasing fiber intake through fruits, vegetables, and whole grains
2. Staying well-hydrated by drinking plenty of water throughout the day
3. Engaging in regular physical activity, such as walking or swimming
4. Establishing a consistent bathroom routine
5. Using a footstool to elevate the feet during bowel movements
6. Trying gentle abdominal massage to stimulate bowel movements
7. Consuming probiotic-rich foods or supplements to support gut health

Are over-the-counter laxatives safe for treating constipation?

Over-the-counter laxatives can be effective for occasional constipation relief. However, it’s important to use them as directed and not rely on them for long-term treatment. Common types of laxatives include:

• Bulk-forming laxatives (e.g., psyllium)
• Stool softeners
• Osmotic laxatives
• Stimulant laxatives

Consult a healthcare provider before using laxatives regularly, as overuse can lead to dependency and other health issues.

When to Seek Medical Attention for Constipation

While occasional constipation is common, persistent or severe symptoms may require medical attention. It’s important to recognize when to consult a healthcare professional for proper diagnosis and treatment.

When should you see a doctor for constipation?

Consider seeking medical attention if you experience:

• Constipation lasting more than three weeks
• Severe abdominal pain
• Blood in the stool
• Unexplained weight loss
• Persistent changes in bowel habits
• Constipation alternating with diarrhea
• Symptoms that don’t improve with home remedies

A healthcare provider can perform a thorough evaluation, identify underlying causes, and recommend appropriate treatment options.

Constipation and hard stools are common digestive issues that can significantly impact quality of life. By understanding the causes, implementing lifestyle changes, and seeking medical attention when necessary, individuals can effectively manage these conditions and maintain optimal digestive health. Remember that everyone’s digestive system is unique, and what works for one person may not work for another. Patience and persistence in finding the right combination of diet, hydration, exercise, and potential medical interventions are key to achieving regular, comfortable bowel movements.

Causes, remedies, and when to see a doctor

Hard stools are a common occurrence. They occur when stools pass through the colon too slowly, allowing the colon time to absorb too much water. The stools then become hard and dry.

Hard stools are common, and most people experience them occasionally. Around 16 out of 100 adults and roughly one-third of adults ages 60 years and older have symptoms of constipation.

Hard stools may be attributable to lifestyle factors, such as a person’s diet or activity levels or the medications they take. Hard stools may also occur due to certain medical conditions, such as irritable bowel syndrome (IBS) and diabetes. In most cases, people can use home remedies to help soften the stool and ease constipation.

This article explains what causes hard stool, how to treat constipation, and when to speak with a doctor. We also provide information on the effects of hard stools in children and babies.

The large intestine, or “colon,” absorbs water from the food that passes through it during digestion. When food moves too slowly through the colon, the colon can absorb too much water from the stool. This results in stools that are hard, dry, and difficult to pass.

Most healthy people have a bowel movement between three times a day and three times a week. When the body digests food inefficiently, a person’s typical bowel movement pattern may slow down. This can result in hard stool that is difficult to pass. The longer the stool remains inside the colon, the harder it may become.

Some symptoms of constipation include:

• hard, lumpy stool
• abdominal bloating
• abdominal pain
• feeling the need for a bowel movement but being unable to pass one
• straining to have a bowel movement
• pain when passing stool
• bleeding when passing stool
• being unable to pass an entire bowel movement
• having fewer than three bowel movements per week

The Bristol stool chart can help people identify problems with bowel movements by comparing the shape and consistency of their stool:

Various issues can slow down digestion and harden the stool.

Some of the most common causes include:

• Aging: As a person ages, changes in the body can cause constipation. A 2021 review found that the most common causes of constipation in older adults are reduced physical activity and taking multiple medications. Another study of older individuals found that delayed movement in the colon and hard stools could be due to pelvic floor dysfunction.
• Diet: If a person does not consume enough fiber, such as fruits and vegetables, it may lead to constipation. This is because fiber promotes the movement of food through the digestive tract and absorbs water to soften stool. Food sensitivities and a high intake of sugary foods may also cause constipation.
• Dehydration: Inadequate water intake (dehydration) is also a major cause of constipation. The intestines and colon absorb water from the stool to hydrate the body. If there is insufficient water available, stools will become hard and lumpy.
• Lack of physical activity: Lack of physical movement affects blood supply to the gut, leading to slower movement of food through the digestive tract.
• Pregnancy and childbirth: Some women may experience hard stools during pregnancy or following childbirth. This can be due to fluctuating hormone levels and other changes in a woman’s body, such as increased pelvic floor pressure. Learn more about constipation during pregnancy here.
• Toilet training anxiety: Some young children get anxious about toilet training, especially if their parents or caregivers become cross or impatient. They may develop a tendency to retain their bowel movements until they become too painful to pass.
• Anxiety and trauma: Children sometimes avoid pooping because of anxiety, trauma, or a change in their bathroom routine, such as when they start a school term. This avoidance can cause hard stools that are difficult for the child to pass. Children who become very constipated may experience fecal incontinence.
• Irritable bowel syndrome (IBS): This chronic condition may cause alternating bouts of constipation and diarrhea.
• Chronic medical conditions: Many medical conditions may cause chronic constipation, including:
  • diabetes
  • hypothyroidism
  • Alzheimer’s disease
  • Parkinson’s disease
  • cancer
• Medications: Certain medications may slow digestion, such as:
  • Antidepressants: Tricyclic antidepressants can disrupt normal functioning of the digestive tract.
  • Some pain relievers: A 2021 study found that taking multiple pain medications is a significant risk factor for drug-induced constipation.
  • Radiation therapy: A 2017 study found that almost half of people receiving pelvic radiation experienced constipation during treatment and up to 10 days after treatment.

Numerous remedies may help with hard stool and constipation, including:

• Taking laxative medications: Various constipation medications may help with passing a hard stool, including:
  • Osmotic laxatives: These laxatives draw water into the colon, which helps to soften stool. Polyethylene glycol is a first-line osmotic laxative for constipation in adults and children. Lactulose is another common option.
  • Emolient laxatives or “stool softeners”: These medications help draw water into the stool, making it softer and easier to pass. Stool softeners are safe for most people, including pregnant women and older adults.
  • Bulk-forming laxatives: These laxatives increase the weight of stools, thus stimulating the bowels and making the stools easier to pass. An example is methylcellulose (Citrucel).
• Making dietary changes: A diet that is high in fiber can make stools easier to pass. Fruits and vegetables are examples of foods that are rich in fiber.
• Drinking plenty of water: Drinking more water can help soften the stool.
• Receiving an enema: An enema involves inserting liquid or gas into the rectum in order to empty the bowels or administer medication. Enemas add water to the stool and can stimulate the impulse to poop.
• Taking supplements: Some people may find that magnesium supplements help relieve their constipation. A 2019 study found that magnesium supplements improved participants’ stools based on the following measures:
  • the Bristol stool form scale
  • colonic transit time
  • spontaneous bowel movement

Many babies and children experience hard stools. The pain of passing the stool may cause a child to avoid having a bowel movement, which can make the problem worse.

Severe, chronic constipation in a child or baby can cause a partial intestinal blockage. The blockage can cause pain, which may lead to fecal incontinence. It may also impair a child’s ability to detect when they need to use the bathroom.

Parents and caregivers should talk with a doctor before giving a child constipation medication. Some of these drugs contain ingredients that may not be safe for children and babies.

While waiting to speak with a doctor, the following practices may help:

• Making regular bathroom visits: Taking the child to the bathroom at regular intervals should help encourage them to poop.
• Offering positive reinforcement: Allowing the child to do something fun while sitting on the toilet can help the child view toileting as a positive experience. This may alleviate any anxiety they have about toileting.
• Avoiding punishments: People should avoid getting angry or punishing a child for toileting accidents. Constipation is not the child’s fault, and scolding the child will only increase their anxiety about toileting, potentially making constipation worse.
• Ensuring good hydration: People should offer the child plenty of water and avoid giving them sugary snacks and fruit juices.
• Offering fruit: Giving a child fruit can help soften bowel movements. Prunes are a particularly good option as they are high in fiber. People should avoid giving bananas, as they can cause or worsen constipation. Learn more about prunes and prune juice as a remedy for constipation.
• Encouraging movement: Babies may have a bowel movement if parents or caregivers move their legs in a bicycle motion. Find out about more home remedies for constipation in babies here.

Not having regular, soft bowel movements and not receiving any treatment for constipation may lead to complications, including:

• Hemorrhoids: These are large, swollen veins in the rectum and anus.
• Rectal bleeding: This refers to blood coming from the anus, usually due to hemorrhoids and straining too hard.
• Fecal impaction: This is a collection of dried, hard stools in the rectum or anus that is impossible to pass naturally.
• Anal fissures: Hard stool passing through the anus may cause small tears in its lining.
• Rectal prolapse: Rectal prolapse is a condition in which part of the rectum detaches and protrudes into the anus. It can occur due to repeated straining while pooping.
• Pelvic floor damage: Prolonged straining can weaken and damage the pelvic floor muscles.

Occasional constipation is common and does not necessarily indicate an underlying health issue. However, a person should speak with a doctor if they experience any of the following:

• hard stools that last longer than a week or are a recurring problem
• hard stools that cause bleeding or pain
• hard stools that develop after starting a new medication

A parent or caregiver should also notify a doctor if a child cannot pass stool for several days or if the child seems very distressed as a result of hard stools.

Chronic, untreated constipation may lead to complications, so it is important that a person receives prompt treatment for hard stools.

Hard stools occur when food passes too slowly through the colon. They can be painful and unpleasant for adults and children alike. In children, hard stools may also lead to fecal incontinence and delay toilet training.

Infrequent hard stools are usually just an inconvenience. People who experience this symptom from time to time may find it beneficial to drink more water, eat more fruit and fiber, and perform more exercise.

When hard stools become a chronic problem, it is important to see a doctor. The right treatment can quickly resolve the issue and may prevent serious complications.

Treatments, causes, when to seek help

Many people occasionally find that their poop is large and difficult to pass. There are many possible causes, including some underlying medical issues.

Various treatments and lifestyle adjustments may help a person pass stool that feels stuck, and prevent the issue from happening again.

In this article, we look at possible causes of large stools that are difficult to pass. We also discuss the treatment options and explain when to see a doctor.

There are many possible causes of large, painful, and hard-to-pass stools. They include:

Constipation

Constipation can cause stools that are hard to pass. The National Institute of Diabetes and Digestive and Kidney Diseases note that constipation is a common condition, affecting about 16 out of 100 adults in the United States. Among those aged 60 years and over, it affects 33 out of 100 people.

Possible causes of constipation include:

• older age
• lack of fiber in the diet
• travel
• ignoring the need to have a bowel movement
• dehydration
• lack of physical activity
• changes in diet or eating habits

The symptoms of constipation may include:

• fewer than three bowel movements in a week
• hard, dry, or lumpy stools
• difficulty passing a stool or pain on doing so
• the feeling of an incomplete bowel movement

Fecal impaction

Fecal impaction is a condition in which the body is unable to move a large, dry, hard stool through the colon or rectum.

Causes of fecal impaction can include:

• overuse of laxatives
• some types of pain medication
• lack of physical activity over an extended period
• dietary changes
• untreated constipation

The symptoms can include:

• inability to pass a stool
• stomach or back pain
• difficulty urinating
• nausea
• vomiting
• diarrhea that leaks out
• changes in breathing or heartbeat

Fecal impaction can be dangerous without treatment, so a person should seek medical help straight away if they have symptoms of fecal impaction.

Bowel obstruction

A bowel obstruction is a severe condition in which an obstruction in the intestines blocks the normal digestion process. As a result, it can be difficult or impossible to move stools through to the rectum.

Possible causes of a bowel obstruction include:

• foreign objects in the intestines
• abnormal twists or growths of the intestines
• inflammatory bowel disease
• a tumor
• scarring after surgery or infection
• a hernia

The symptoms can include:

• severe stomach pain or cramping
• vomiting
• a swollen or full-feeling stomach
• constipation
• inability to pass gas
• loud sounds coming from the stomach

A bowel obstruction is an emergency, and a person will need medical help immediately.

Hypothyroidism

In people with hypothyroidism, the thyroid is unable to produce enough of the thyroid hormones, which affects many bodily functions.

Hypothyroidism can cause constipation. Other symptoms may include:

• fatigue
• dry skin and hair
• being unable to tolerate the cold
• depression
• unexplained weight gain

Hypothyroidism is more common in females and those over the age of 60 years.

Irritable bowel syndrome (IBS)

IBS is a digestive issue that causes abdominal discomfort and frequent changes in bowel movements.

The symptoms may include:

• stomach pain
• constipation
• diarrhea
• bloating
• gas
• mucus in the stool
• headaches
• nausea
• fatigue

There is no clear cause of IBS, but triggers can include:

• stress
• certain foods or drinks
• bacterial infection or overgrowth in the gut
• mental health disorders

Encopresis

Encopresis refers to children over 4 years of age being unable to control their bowel movements. Long-term constipation usually causes encopresis. The symptoms include:

• soiling of clothing or defecating on the floor
• painful, hard-to-pass stools
• large stools that may clog the toilet
• leaking of liquid stools

Pregnancy

Constipation can be a common symptom in pregnancy, when it can be due to:

• changing hormones affecting the digestive system
• the developing baby pressing down on the intestines
• reduced physical activity
• dietary changes

People may experience:

• hard, lumpy stools
• the feeling of an incomplete bowel movement
• straining
• infrequent bowel movements

Medications

Certain medications and supplements can cause hard-to-pass stools, including:

• antiacids with aluminum and calcium
• antiseizure medications
• calcium channel blockers
• diuretics
• iron supplements
• Parkinson’s disease medications
• narcotics
• medications to treat muscle spasms
• some antidepressants

People may be able to treat large, hard-to-pass stools by making adjustments to their daily routine, such as:

• increasing fiber intake by eating more fruits, vegetables, whole grains, legumes, and nuts
• increasing water intake
• avoiding low fiber foods, such as processed and fast foods
• doing more physical activity
• allowing time to have a bowel movement at a regular time of the day
• eating meals at regular times and chewing thoroughly
• responding to any urge to go to the toilet
• avoiding straining or sitting on the toilet for too long

Learn more about natural remedies for constipation.

If people do not find these changes effective, or they have severe or additional symptoms, they may need medical treatment. Depending on the underlying cause, treatment may involve:

• laxatives, stool softeners, or fiber supplements
• prescription medication to encourage bowel movements
• biofeedback therapy to retrain the muscles responsible for bowel movements
• an enema, which is an injection of fluid or gas into the rectum to release stools
• changing an existing medication if this is a potential cause
• the manual removal of stools, if necessary
• surgery, for example, to repair the colon or treat a rectal prolapse
• therapy and positive toilet training techniques for children with encopresis
• following a specific treatment plan, for conditions such as IBS

If dietary changes are not effective during pregnancy, a person can talk with their healthcare team about which treatment options are safe.

People should see their doctor if they have symptoms of fecal impaction. Treatments may include:

• enemas or suppositories to soften the stool
• the manual removal of the stool from the rectum
• laxatives and increased water and fiber intake for prevention

It is advisable to see a doctor if at-home treatments are not effective or a person has any of the following symptoms:

• constant stomach pain
• inability to make a bowel movement, but there is leaking of liquid stool
• being unable to control bowel movements
• oily or greasy stools that are difficult to flush
• hard, black stools
• blood in stools
• bleeding from the rectum
• being unable to pass gas
• vomiting
• fever
• unintentional weight loss
• lower back pain

People should seek immediate medical attention if they have symptoms of fecal impaction or intestinal obstruction.

People may be able to treat large, hard-to-pass stools by making dietary changes and other simple lifestyle adjustments.

In some cases, hard-to-pass stools can cause serious complications if a person does not get treatment. If a medical condition is causing uncomfortable bowel movements, treating or managing the condition may help relieve the symptoms.

Large, hard-to-pass poop can be uncomfortable, but this issue may resolve with simple changes, such as increasing fiber intake, doing more physical activity, and drinking more water.

If home remedies are not effective, it is best to see a doctor for further treatment advice to prevent any complications.

Intestinal constipation: causes, treatment, diet

Every person faced the problem of constipation at least once in his life. If difficulties with bowel movements are observed regularly, then the pathology has acquired a chronic form. In chronic constipation, bowel movements occur less than 3 times a week. At the same time, the chair itself is rare and hard. A constipated person spends more time on the toilet than usual. In the process of defecation, the straining time increases.

Causes of constipation

Intestinal constipation can occur for various reasons.

The first cluster of causes is associated with congenital or acquired pathologies of the large intestine:

• anal fissures
• polyps
• internal and external hemorrhoids
• tumors
• megarectum
• megadolichosigma
• atresia

The second type of causes of constipation include concomitant diseases of the digestive, endocrine and genitourinary systems.

There are also a number of causes of unknown origin, due to which the motility of the rectum and colon is impaired.

Functional constipation can be caused by malnutrition. Eating low in dietary fiber, as well as taking certain medications (diuretics, antidepressants, iron supplements, antacids, anticholinergics) interfere with bowel movements.

A few more causes of chronic constipation:

• wrong way of life
• “knocked down” day and night mode
• lack of physical activity
• low fluid intake (body dehydration)
• “inert” colon syndrome (slow movement of feces)

Special mention should be made of constipation during pregnancy – due to the internal pressure of the fetus, there may be a delay in bowel movements.

Treatment of constipation

People who have problems with bowel movements often ask themselves the question: what to do with constipation? The treatment of constipation, including chronic constipation, is aimed at eliminating the primary pathology that resulted in the problem, as well as changing lifestyle, diet, working conditions, etc.

For the treatment of constipation, a proctologist or gastroenterologist should be consulted. Frequent constipation can be a sign of serious diseases of the stomach and intestines, so we do not recommend self-medication: it would be wiser to make an appointment with a trusted specialist.

Qualified doctors of the Naedine Clinic will conduct a complete examination of the gastrointestinal tract, establish the root cause of the problem and choose the appropriate method of treatment.

Medications are widely used in the treatment of constipation. The type of medication, dose and duration of administration are calculated individually for each patient.

Diet for constipation

Doctor prescribes a special diet for constipation . It is necessary to eat foods rich in fiber daily, for example:

• wheat, oatmeal, pearl barley, buckwheat cereals
• vegetables (carrots, beets, marrows)
• wholemeal bread
• bran
• fruits and berries, including dried fruits (figs, prunes, dates, dried apricots, bananas, non-sour apples)
• vegetable and fruit juices
• fermented milk products (kefir, curdled milk, acidophilus)
• olive, sunflower, linseed, corn oil

Food should be taken 4 times a day. The amount of fluid consumed for constipation should be at least 1.5 liters per day.

The patient must “learn” to go to the toilet to empty his bowels in the morning. With the right treatment regimen, the patient will be able to walk “in a big way” every 1-2 days.

Sign up for a consultation with a proctologist at the Naedine Clinic by phone (8332) 32-7777 or through the online appointment form on our website!

What should I do if my child has constipation?

Parents often ask: Is daily but hard stool constipation? A rare, but not bringing discomfort – a variant of the norm? Many parents face this problem: up to 30% [1] of children are familiar with constipation. We will discuss this important topic in more detail with children’s gastroenterologist Nikitin Artem Vyacheslavovich and pediatrician Miroshchenko Oksana Alexandrovna.

Normal stool frequency

There is no single norm for all children: the frequency of stool depends on age, diet and the presence of diseases or intolerances. For example, up to two years of age, bowel movements can occur from three times a day to once every few days, and children older than two go to the toilet, on average, once a day.

Stool frequency is not the only indicator for diagnosis. The child can regularly go to the toilet once a day, while the stool will be hard: this is also considered constipation.

Constipation classification

Constipation is a violation of bowel movements, in which it is impossible to completely empty the intestines.

Depending on the reasons, they are:

• primary – due to congenital or acquired anomalies of the colon;
• secondary – as a result of diseases, such as Crohn’s disease, or side effects from drugs;
• idiopathic – due to impaired motility of the colon, which arose for unknown reasons.

According to the nature of the course, constipation is divided into:

• acute when there is no bowel movement for several days;
• chronic, when symptoms persist for several months.

Causes

In 95% of cases, constipation is not associated [2] with diseases or malformations. The most common causes of constipation in children are malnutrition, food intolerances, and psychological factors. Read more about the causes – from common to rare.

No defecation skill

Not all babies are born with the ability to empty their bowels. At first, there may be no coordination between the pelvic floor muscles and the anal sphincters. Therefore, when signals are sent to the brain that it is time to empty, the baby blushes, screams and cries. When the baby still manages to go to the toilet, he calms down.

This condition is called infantile dyschezia. It occurs in children in the first months of life and usually resolves by six months. It is impossible to influence dyschezia, but it is important to exclude other diseases, so it is better to consult a doctor at the first symptoms.

Adaptation to complementary foods

When complementary foods are introduced, the gastrointestinal tract is forced to adapt to new types of food. Because of this, constipation may occur, but, as a rule, they pass after a few days.

Food intolerance

In the first year of life, a baby may develop an allergy to cow’s milk protein or celiac disease – gluten intolerance. Constipation is one of the symptoms of intolerance.

Errors in nutrition

Part of constipation occurs due to malnutrition, for example, the diet is high in carbohydrates and low in fiber or almost no water. In this case, it is enough to add more vegetables and fruits to the menu and the stool will return to normal.

A mother with a nine-month-old girl once came to our clinic. The child could not go to the toilet for three days. We found out that the diet is low in fiber and made recommendations. Immediately after the visit to the clinic, the mother fed the baby with a lot of vegetables, and on the same day she managed to go to the toilet.

Psychological factor

Stress can act as a trigger and break the chair. For example, once a child felt pain during a bowel movement and now he is afraid that this will happen again. Out of fear, he holds back his stool and starts a vicious cycle: the longer he endures, the harder the feces become, which means the more painful bowel movements.

Another common example. At first, the child is uncomfortable going to the toilet in kindergarten, so he endures home. The feces thicken, defecation becomes painful, and the kindergartener begins to consciously avoid it.

It is necessary to treat such constipation not only with a gastroenterologist or pediatrician, but also with a psychologist.

I will give an example from practice. The boy went to first grade and around this time he began to have abdominal pain and loose stools five to seven times a day. For several months, the pediatrician and gastroenterologist at the place of residence tried to treat the child, and then they were sent to the hospital with a diagnosis of colitis. This is a prolonged inflammation of the colon or rectum.

We examined the boy: the left half of the abdomen turned out to be dense, like a gas cylinder. The sigmoid colon was clogged with fecal stones – an accumulation of hardened feces. And loose stools arose due to the fact that feces could not freely pass through the intestines and tried to seep along the edges. This confused the doctors, because it looked like the symptoms of colitis.

The patient was able to be helped conservatively: siphon enemas – repeatedly injected with a lot of fluid, and rectal stimulants, such as microenemas or glycerin.

Postinfectious constipation

After a viral illness, irritable bowel syndrome may begin with diarrhea or, conversely, constipation. This condition will pass on its own, but it is important to adhere to the regimen and principles of a healthy diet:

• include plenty of fiber in the diet: legumes, vegetables, fruits, whole grains and bran;
• eat less convenience foods, dairy and meat products;
• drink plenty of fluids;
• exercise regularly;
• do not ignore the urge to defecate;
• try to go to the toilet regularly and on schedule.

Diseases and developmental anomalies

In 5% of cases, constipation in children occurs [3] due to diseases or pathologies of the intestinal structure. For example, due to Hirschsprung’s disease – a congenital deficiency of the nerve plexuses of the colon wall. In children with this disease, peristalsis is weakened or absent, so feces pass through the intestines with a delay, and the affected sections of the intestine expand. The disease is amenable only to surgical treatment – resection of the affected area of ​​the intestine.

Another cause of constipation is the lengthening of the sigmoid colon. For some, this structural feature does not affect bowel function, while for others it causes problems with defecation. In such a situation, add foods with a laxative effect and fiber to the diet and exercise.

Less common are anomalies in the development of the anus or anal canal, for example, atresia – the absence of the anus and the infection of the rectum.

Sometimes constipation occurs due to adhesions after surgical interventions on the rectum and anal canal. And sometimes because of a complication of another disease.

A 13-year-old boy was admitted to a Moscow hospital, who, in terms of height and weight, looked like a junior schoolboy. For 8 years of his life he suffered from constipation: he went to the toilet every three to four days. In the clinic he was treated with suppositories and laxatives, but he was never referred to a proctologist. Our colleague from the hospital was the first to examine a teenager’s rectum. It turned out that the boy has Crohn’s disease – a serious disease that provokes an inflammatory process, the appearance of ulcers and scars on the intestinal mucosa and leads to a delay in physical and sexual development. With Crohn’s disease, a complication can develop – stenosis (narrowing) of the anal canal, due to which constipation occurs. The boy managed to be helped: he was prescribed treatment and achieved remission. Now, fortunately, nothing bothers him.

Symptoms

Constipation has several diagnostic criteria [4]. The main symptoms of constipation in children:

• reduced frequency of bowel movements;
• incomplete bowel movement;
• dense “sheep” feces in separate fragments;
• painful bowel movements.

But in order to make a diagnosis, it is not enough for a doctor to know about the symptoms. He must examine the patient and question him and his parents. This helps to get the full picture.

Errors in the treatment of constipation

We will not give examples of all the absurd methods of diagnosis and treatment, we will only warn about the most popular ones.

Do not donate stool for coprogram

This is an uninformative and subjective study: what you eat is what you get. In addition, the coprogram includes many studies, for example, for the presence of mucus, leukocytes and parasites. When a doctor prescribes tests for everything at once, most likely he does not know what he is looking for. According to modern clinical guidelines, the doctor should prescribe targeted studies.

Feces for dysbacteriosis are also not needed

When checking feces for dysbacteriosis, laboratory assistants analyze only 20 types of bacteria, and there are about 1000 of them in the intestine. Moreover, they are unique: each person has a different intestinal microbiota – the composition of all the microorganisms that live in it. It depends on the type of nutrition, on the way of birth, on the type of feeding and other factors. Therefore, there is no general norm for the population – the ideal number of lactobacilli and staphylococci in the intestine.

Buy fruits instead of prebiotics

Continuing the topic of dysbacteriosis, we will give you advice: do not waste money on prebiotics and probiotics. Research on their effect on constipation has not yet been completed. And while the best prebiotic is fiber – vegetables and fruits.

In recent years, lactobacilli have often been prescribed for problems with stools. There are some studies confirming the effectiveness of this treatment, but it is too early to draw conclusions: the method is still being studied.

Do not give your child prokinetics, antacids and enzymes

Doctors often prescribe prokinetics, antacids, and enzymes. However, their usefulness is highly questionable. For example, the appointment of an aluminum phosphate antacid, due to the composition of the drug, can aggravate constipation, and magnesium-containing antacids can only be taken from 6 years of age.

When prescribing prokinetics – drugs that increase the motility of the gastrointestinal tract, you need to clearly understand the nature of constipation. If problems arose against the background of adhesive disease after surgery, the appointment of the prokinetic “Trimebutin” may be justified.

Enzyme therapy also has clear indications for the appointment, in some cases, uncontrolled and unreasonable intake of enzymes can increase constipation.

When to see a doctor

Acute constipation that is left untreated for three months develops into chronic constipation and may recur for the rest of your life. Therefore, if you notice alarming symptoms, take your child to the doctor.

Here are the red flags that require expert advice:

• Constipation occurred not once, but recurs periodically.
• Along with the difficulty of defecation, you notice a lag in physical development.
• Nausea and vomiting or abdominal pain occur in parallel with constipation.
• Blood in stool. It can talk about an anal fissure, a polyp, or a rupture of blood vessels.
• It is scary and painful to go to the toilet.
• Neoplasms appeared on the buttocks, for example, boils or fistulas.

If you can’t quickly make an appointment with a doctor, and the child cannot go to the toilet on his own, you can give him a microclyster. But only if there is no blood.

Remember that microenemas are not a cure, and if constipation episodes recur, see your doctor.

Diagnostic methods

In addition to collecting an anamnesis, the doctor may use other diagnostic methods:

• examination of the patient;
• palpation of the abdomen to detect or rule out bloating, spasms, enlargement of the sigmoid colon;
• digital rectal examination. The doctor evaluates the condition and filling of the rectum, the tone of the sphincter and the integrity of the mucosa;
• Abdominal ultrasound. Shows signs of inflammatory processes, anomalies in the structure of the digestive tract, suspicious neoplasms;
• radiography. Shows signs of intestinal obstruction.
• analyzes. For example, blood biochemistry;
• sigmoidoscopy or colonoscopy: to exclude organic pathology and intestinal tumors.

Methods of treatment

The doctor prescribes the treatment of constipation in children after he has found the cause. First of all, you need to remove this trigger. If it is stress, take the child to a psychotherapist, if food intolerance, remove irritating food from the diet.

Help for a child with constipation can be provided by:

• laxatives – increase intestinal peristalsis;
• antispasmodics that relax smooth muscles and facilitate bowel movements. Also relieve pain in the intestines;
• rectal suppositories with glycerin soften feces;
• microclysters soften the feces and remove them from the rectum.

Prevention

My colleagues and I notice an unhealthy trend: patients are ready to be treated, but not prevented. Many people find it easier to take a course of pills than to change their lifestyle. But medicines are a temporary tool that makes it possible to change the daily routine and nutrition. Most stool problems, if they are not associated with developmental abnormalities or other diseases, can be overcome without medication. We’ll tell you exactly how.

Adjust the diet

The first rule is to drink plenty of fluids, preferably clean drinking water or mineral water [5]. Usually, Donat Mg water with a high magnesium content or Zajechitska bitter water is prescribed at the rate of 8 ml per 1 kg per day. Drink three times a day 20 minutes before meals.

The second rule is to consume a lot of fiber – 50% of the daily diet. A diet for constipation in children should be based on vegetables, fruits and greens.

The third is to limit the foods that hold the chair together. For example, rice and semolina.

Exercise regularly

Physical activity for at least four weeks helps in 50% of cases of constipation [6]. Choose activities to do with your child. For example, simple exercises for the muscles of the pelvic floor: rolling, goose step. Or any outdoor games that the child likes. The main thing is regularity.

Go to the toilet at the same time

It is important to train your bowels to empty them at the same time. Best of all – 15-45 minutes after breakfast.

It is advisable to accustom the baby to the regimen from an early age. But if it didn’t work before, try now. Teach him in a playful way: read fairy tales, for example, about poop travels or give a game to develop fine motor skills for 10-15 minutes.

Place a small table with toys next to the potty or toilet. It is important that these toys are only in the toilet. Then the baby will form a connection:

to play with these toys, I have to go to the toilet and poop. So he will have an interest in the toilet, and over time, the habit of visiting him at the same time can be fixed.

Do not put pressure on the child

In this case, you do not need to sit on the toilet until the victorious. Failed in 15 minutes – try again after lunch. Do not force the child to push and by all means empty the intestines. The anal sphincter can be overstressed, causing a fissure, and the psychological pressure will cause stress and fear of the toilet.

If the baby is used to the diaper and is afraid to go to the potty, put him on the potty in the diaper: so the addiction will be gradual. Or buy a musical pot: it plays a tune when something hits the bottom.

Teach correct posture

The most comfortable position for defecation is squatting [7]. This makes it easier for the stool to move down to the anus. On the toilet, the desired position can be adopted using the footrest.

It is important that the child is comfortable to sit and does not have to tuck his legs under him or hold his hands on the rim of the toilet.

Perform biofeedback therapy

Use the biofeedback mechanism (BFB), a modern technique that teaches the patient to control the muscles of the pelvic floor [8]. A sensor connected to a computer is placed in the rectum. A game is broadcast on the screen and in order to perform an action in it, for example, jump over a fence, the child must strain his muscles.

Biofeedback therapy well relieves spasm of the rectum or sigmoid colon and helps strengthen the muscles of the pelvic floor. Unfortunately, the method is not yet widely used. To use it, see your doctor.

Conclusions

• With proper prevention, most constipation can be managed. But prevention is a long, meticulous, methodical process that does not tolerate slack. There must be a system.
• Do not look for magic pills that will help in a few days. Without involving parents in the problem, the problem will not be solved.
• Make your child’s diet varied. A diet with a small amount of allowed foods is a temporary measure with clear indications. On an ongoing basis, on the contrary, you need to eat as varied as possible.
• Do not be afraid to give microclysters as an emergency. The main thing is that they do not become part of the daily routine. If the doctor has prescribed a course of laxatives, follow the dosage: it is selected individually and at first it may be higher than recommended in the instructions.
• Don’t take your child’s constipation as a temporary problem. Functional disorders accompany us through life.
• Persistent constipation in a child may be a symptom of another disease, so be sure to consult a doctor.

Sources:

1. S. Rajindrajith, Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management, 2011

2. MR Good, Patient education: Constipation in infants and children (Beyond the Basics), 2021

3. Constipation // Mayo Clinic

4. Rome IV criteria for the diagnosis of functional constipation in children, UpToDate

5. Eating, Diet, & Nutrition for Constipation // NIDDK, 2018

6. th.