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

Understanding Hard Stools and Constipation

Hard stools and constipation 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 excessive water. As a result, the stools become hard, dry, and difficult to pass. Approximately 16% of adults and one-third of individuals over 60 experience symptoms of constipation.

Hard stools can be attributed to various factors, including lifestyle choices, medications, and certain medical conditions. While occasional hard stools are generally not a cause for concern, chronic constipation may indicate an underlying health issue that requires medical attention.

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

The Bristol stool chart is a valuable tool for assessing stool consistency and identifying potential digestive issues. By comparing the shape and consistency of their stools to the chart, individuals can better understand their bowel health and recognize when to seek medical advice.

Common Causes of Hard Stools and Constipation

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

Age-Related Changes

As people age, their digestive system undergoes various changes that can impact bowel function. 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 the elderly population.

Dietary Factors

Diet plays a significant role 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. Moreover, food sensitivities and excessive consumption of sugary foods may contribute to constipation.

Dehydration

Inadequate water intake is a major cause of constipation. The intestines and colon absorb water from stools to maintain the body’s hydration levels. When there’s insufficient water available, stools become hard and lumpy, making them difficult to pass.

Lack of Physical Activity

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

Pregnancy and Childbirth

Many women experience hard stools during pregnancy or following childbirth. This can be attributed to fluctuating hormone levels and other physiological changes, such as increased pelvic floor pressure. Pregnant women should consult their healthcare providers for safe and effective ways to manage constipation.

Psychological Factors

Anxiety and trauma can contribute to constipation, especially in children. Some young children may develop anxiety about toilet training, particularly if their caregivers become impatient or frustrated. This can lead to a tendency to retain bowel movements until they become painful to pass. Similarly, changes in bathroom routines, such as starting school, can cause children to avoid defecating, resulting in hard stools and potential fecal incontinence.

Medical Conditions

Various medical conditions can cause chronic constipation, including:

• Irritable Bowel Syndrome (IBS)
• Diabetes
• Hypothyroidism
• Alzheimer’s disease
• Parkinson’s disease
• Cancer

Medications

Certain medications can slow digestion and contribute to constipation. These include:

• Antidepressants, particularly tricyclic antidepressants
• Some pain relievers
• Medications used in radiation therapy

A 2021 study found that taking multiple pain medications significantly increases the risk of drug-induced constipation. Additionally, a 2017 study revealed that almost half of the patients receiving pelvic radiation experienced constipation during treatment and up to 10 days after treatment.

Effective Remedies for Hard Stools and Constipation

Fortunately, numerous remedies can help alleviate hard stools and constipation. Here are some effective strategies:

Lifestyle Modifications

1. Increase fiber intake: Consume more fruits, vegetables, whole grains, and legumes to promote regular bowel movements.
2. Stay hydrated: Drink plenty of water throughout the day to soften stools and facilitate their passage.
3. Exercise regularly: Engage in physical activity to stimulate bowel function and improve overall digestive health.
4. Establish a regular toilet routine: Set aside time each day for bowel movements to train your body.

Natural Remedies

• Probiotic supplements: These beneficial bacteria can help improve gut health and regularity.
• Herbal teas: Certain herbal teas, such as peppermint or ginger, may help stimulate digestion.
• Abdominal massage: Gently massaging the abdomen can help stimulate bowel movements.

Over-the-Counter Treatments

Various over-the-counter medications can provide relief from constipation:

• Bulk-forming laxatives: These products absorb water and create softer, bulkier stools.
• Osmotic laxatives: These draw water into the intestines to soften stools and promote bowel movements.
• Stool softeners: These products help moisten and soften hard stools for easier passage.
• Stimulant laxatives: These medications stimulate intestinal contractions to promote bowel movements.

It’s important to use these medications as directed and consult a healthcare professional if symptoms persist or worsen.

When to Seek Medical Attention for Constipation

While occasional constipation is generally not a cause for concern, certain symptoms warrant medical attention:

• Severe abdominal pain
• Blood in the stool
• Unexplained weight loss
• Persistent constipation lasting more than three weeks
• Alternating bouts of constipation and diarrhea
• Constipation accompanied by fever or vomiting

If you experience any of these symptoms, it’s crucial to consult a healthcare professional for proper evaluation and treatment.

Constipation in Children and Babies: Special Considerations

Constipation in children and babies requires special attention and care. Young children may experience anxiety or trauma related to toilet training, leading to a tendency to hold in bowel movements. This can result in hard stools that are painful to pass and may even cause fecal incontinence.

Tips for Managing Constipation in Children

1. Encourage a fiber-rich diet with plenty of fruits, vegetables, and whole grains.
2. Ensure adequate hydration by offering water and other healthy fluids throughout the day.
3. Promote regular physical activity to stimulate bowel movements.
4. Create a positive and stress-free environment for toilet training.
5. Establish a consistent bathroom routine to help regulate bowel movements.

For babies, constipation can be a common concern, especially when transitioning to solid foods. If you suspect your baby is constipated, consult your pediatrician for appropriate guidance and treatment options.

The Impact of Aging on Bowel Health

As individuals age, their digestive system undergoes various changes that can affect bowel function. Understanding these age-related changes is crucial for maintaining digestive health in older adults.

Factors Contributing to Constipation in Older Adults

• Decreased muscle tone in the digestive tract
• Reduced physical activity levels
• Medications that may cause constipation as a side effect
• Chronic health conditions affecting digestive function
• Dietary changes and reduced fluid intake

To maintain healthy bowel function in older adults, it’s essential to focus on maintaining a balanced diet, staying physically active, and addressing any underlying health issues that may contribute to constipation.

The Role of Medications in Causing Constipation

Many medications can contribute to constipation as a side effect. Understanding which medications may cause this issue is crucial for managing digestive health effectively.

Common Medications Associated with Constipation

• Opioid pain relievers
• Antidepressants, particularly tricyclic antidepressants
• Antacids containing aluminum or calcium
• Iron supplements
• Certain blood pressure medications
• Antihistamines
• Antispasmodics

If you suspect that your medication is causing constipation, consult your healthcare provider. They may be able to adjust your dosage, switch to an alternative medication, or recommend strategies to manage this side effect effectively.

Preventing Hard Stools and Maintaining Digestive Health

Prevention is key when it comes to maintaining healthy bowel function and avoiding hard stools. By incorporating the following strategies into your daily routine, you can promote regular bowel movements and overall digestive health:

Dietary Considerations

1. Consume a high-fiber diet rich in fruits, vegetables, whole grains, and legumes.
2. Stay well-hydrated by drinking plenty of water throughout the day.
3. Limit intake of processed foods, which are often low in fiber and high in unhealthy fats.
4. Consider incorporating probiotic-rich foods or supplements to support gut health.

Lifestyle Habits

• Engage in regular physical activity to stimulate bowel function.
• Establish a consistent bathroom routine to train your body.
• Manage stress through relaxation techniques, as stress can impact digestive health.
• Avoid holding in bowel movements when you feel the urge to go.

By implementing these preventive measures, you can reduce the likelihood of experiencing hard stools and constipation, promoting overall digestive wellness and quality of life.

Understanding the causes, remedies, and prevention strategies for hard stools and constipation is essential for maintaining optimal digestive health. By paying attention to your body’s signals, making informed lifestyle choices, and seeking medical attention when necessary, you can effectively manage these common digestive issues and enjoy improved overall well-being.

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.

Constipation in children – treatment in BaltMedna Vasilyevsky Island

Main causes of constipation in children

• The main cause of constipation in babies over 18 months old is the reluctance to go to the toilet for one reason or another. For example, “toddlers” (children from 1 to 3 years old) may “play too hard” or lack the patience to sit on the potty.
• School-aged children do not want to go to the public toilet at school because it may be too dirty or because there is not enough intimacy.
• If the act of defecation was (for some reason) painful, or going to the toilet left psychological trauma, then the child may also refuse to go to the toilet, and, after a while, learn to ignore, and then not at all perceive the urge to defecate. Feces linger in the rectum, accumulate there. The continued absorption of water makes it even harder, which causes the bowel movement to become even more painful, the child “refuses” to have a bowel movement – a vicious cycle occurs.
• Diet, of course, has an effect on the presence of constipation. Children who eat a balanced and varied diet are less likely to suffer from constipation.
• Teenagers and toddlers who eat a lot of sweets may also have stool problems.
• Various stressful situations in children (illnesses with high fever, prolonged bed rest, insufficient food intake, dehydration) can also lead to stool retention.
• Some medicines, including cold medicines, can also cause stool retention.

There are a number of chronic diseases that cause constipation, but this issue must be resolved together with the attending physician, and we will not discuss it here.

Treatment

First of all, parents must understand that there is NO ONE’S FAULT in the fact that the child suffers from constipation: NOT THEM, NOR THE CHILD! You can not show the child any negative emotions or negative attitudes about this.

If there was no stool for a long time, then treatment begins with the release of the large intestine (enema or laxative, or both, as prescribed by the attending physician).

After the bowel is cleared, it is very important to continue the treatment, the purpose of which is to teach the child that bowel emptying should occur regularly. Mineral oils (vaseline, paraffin) are used for this. they are not absorbed in the body, various laxatives (as prescribed by a doctor), all kinds of encouragement for the child for a “successful” visit to the toilet, a full, varied diet, adequate fluid intake.

Treatment of chronic constipation is long, at least 7 months, sometimes even a year. Patience and consistency in treatment almost always guarantee success.

Additional information about constipation in young children (under one year old)

My baby has constipation. Is it constipation?

Constipation is infrequent, painful, hard stools. Normal bowel function indicates good health in a child of any age. In the first months of a child’s life, parents are especially attentive and painful about the frequency of bowel movements in their baby. On average, babies in the first weeks of life have 4 bowel movements per day with a gradual decrease in their number with age. Often it seems to parents that their child poops too infrequently, and they believe that their child has constipation that requires immediate attention.

But, in fact, in babies, especially those who are breastfed, true constipation is rare. Breast milk is so well digested that babies can have a bowel movement once a week, or even once every 2 weeks. If the stool is soft or mushy, then there is no constipation, even if defecation, according to the parents, is rare. The same is true for formula-fed babies. The fact that the baby is pushing and groaning during bowel movements does not at all mean that he has constipation, provided that the stool is soft or mushy. Remember also that the iron found in all iron-fortified formulas does not cause constipation.

A few words about when to see a doctor

If you note that the baby rarely poops and, at the same time, every act of defecation is painful for him, and the child constantly cries during defecation,
feces are hard, like raw smoked sausage or resemble “sheep feces”, if you see blood in the feces, then all this is a reason to show the child to the doctor.

A little more about constipation in children

A short episode of constipation in children is common and usually lasts only a few days. Proper diet and adequate fluid intake is sufficient in most cases. However, some children develop chronic constipation (persistent and severe). Regularly soiled laundry (often mistaken for diarrhea) can mean that a child has chronic constipation. As a rule, long-term use of laxatives is necessary to treat constipation.

What is constipation?

Constipation in children is called:

• Difficult defecation or defecation that requires considerable effort
• Pain during defecation
• Stool less frequent than usual

Note: There is a large normal frequency range. One to three bowel movements per day is considered normal. A chair less than once every two days – may be constipation. However, it can still be normal if the child does not strain too much during bowel movements, does not experience pain, has soft and formed stools.

It is useful to divide constipation in children into two broad categories

• Mild and/or temporary constipation that lasts only a few days. This is a very common situation that can recur from time to time.
• Chronic (persistent and severe) constipation. It occurs much less frequently. Its treatment differs from the more frequent – mild, temporary constipation. Details – further.

What are the causes of constipation in children?

Food and drink

Food and drink are common causes of constipation in children, they do not eat enough foods containing dietary fiber, fiber (the coarse part of the food that is not digested and remains in the intestine), they drink little. Feces become hard, dry, and difficult to defecate when the intestines are low in fiber and fluid.

Conscious retention of stool

Consciously holding a stool is a common cause. This means that the child feels the urge to defecate, but resists. This is a common circumstance. You may notice this in a child by squeezing their legs, sitting on their heels, or other similar activities that help suppress the feeling of having a bowel movement. This increases the bulk of the stool and makes it harder to pass later.

There are a number of reasons why children may struggle to hold a chair:

• Previous bowel movements may have been difficult and painful. Therefore, the child tries to delay defecation, afraid to experience it again.
• The child may feel pain in the anus, or there may be a fissure (anal fissure) – this is the consequences of the passage of a previous bulky fecal lump. Then the child expects pain during bowel movements. Because of this, the child may try to suppress the urge to go to the toilet.
• The child may have a dislike for an unfamiliar or smelly bathroom, such as at school or on vacation. The child may want to “temporarily turn off” bowel movements until he gets home.
• Emotional problems may play a role in some children.

Medical reasons (diseases)

Medical causes are a rare cause of constipation.

• Various diseases can cause constipation. For example, thyroid disease, as well as some intestinal disorders. One of the constipation factors can be an allergy to cow’s milk. If constipation is a symptom of an illness, then other symptoms are usually present because it is highly unlikely that this will be the only manifestation of the illness.
• Some medicines can cause constipation as a side effect.

How can I prevent constipation in a child?

Eating foods with a lot of fiber and a lot of water contributes to an increase in the volume of the stool, but at the same time the stool becomes soft. The intestines are easily emptied. Regular physical exercise also promotes free bowel movements.

Dietary fiber (fiber)

Check with your health care provider for a list of high-fiber foods if you’re not sure you know it yourself. Some examples are: fruits, vegetables, cereals, wholemeal bread. Changing the diet to increase fiber content is often “easier said than done” as many children do not eat well. However, making some changes is better than doing nothing at all.

Try products like:

• Jacket potatoes with baked beans or vegetable soup with bread
• Dried apricots or raisins for dessert.
• Cereal or other high fiber cereals for breakfast.
• Providing fruit with every meal.
• It may not be wise to let the child take candy until he has eaten the fruit.
• Another tip when children don’t want to eat foods high in dietary fiber is to add dried bran to yogurt. Yogurt will soften the unpleasant aftertaste of dry bran.

Drinks

Encourage children to drink a lot. However, some children have a habit of only drinking juice, soda, or milk to quench their thirst. They can satisfy their appetite and therefore eat little food containing a large amount of fiber. Try to limit these types of drinks. Give water as the main drink. However, some fruit juices that contain fructose or sorbitol have a laxative effect (such as prunes, pears, or apple juice). This can be helpful at times when the stool becomes harder than usual and you suspect constipation may soon develop.

Some other tips that can help

• Try to get your child used to a certain time to go to the toilet. After breakfast, before school or kindergarten, often the best option. Try and allow enough time so that he doesn’t feel rushed.
• Some kind of reward system is sometimes helpful for young children who are prone to holding stool. For example, a small treat after every successful trip to the bathroom. However, try not to make a toilet problem a tragedy. The goal is for the situation to be normal and unstressed – a matter of life.

Mild/temporary constipation in children and its treatment

Most episodes of constipation in children last only a few days. Many children strain to “squeeze out” a bulky or hard stool. It does not really matter, the consistency of the feces will soon return to normal. The treatment of temporary constipation is the same as the prevention of constipation. That is, a high fiber diet, plenty of fluids, and possibly fruit juice that contains fructose or sorbitol. In some cases, your doctor may recommend a laxative for several days.

In an episode of mild constipation, the functions of the lower intestines (rectum) are not affected. Thus, you can stop laxative treatment as soon as the stool becomes easy to pass again. It could be in a few days. This is in contrast to chronic constipation (see below), where rectal function changes and laxatives are used in long courses.

Chronic (persistent and severe) constipation

Chronic constipation in children is a severe and prolonged episode. It most often develops in children aged 2 to 4 years, but it also occurs in older and younger children.

Symptoms and features of chronic constipation include:

• Recurring situations in which the child has difficulty or difficulty emptying bowels.
• Child regularly soils linen with very soft stools or mucus-like faeces. This is often regarded by parents as diarrhea.
• The child may become irritable, eat little, feel unwell, experience abdominal pain from time to time, and be generally in a bad mood.
• The clinician can often feel the terminal intestines filled with hard, lumpy stool on palpation of the abdomen.

Next, we will try to explain how chronic constipation can develop and its symptoms. In particular, why soiled laundry is a symptom of chronic constipation.

The picture is very clear and does not require translation. On the left is a normally functioning rectum. On the right – overstretched with a dense fecal lump (shown in dark gray) rectum. Stretched (gaping) anus, leakage of the liquid component of feces (shown in light gray) – around a dense fecal lump.

• As a rule, feces accumulate in the lower part of the large intestine.
• As stools accumulate, they begin to pass into the rectum (the last part of the intestine), which expands. This sends signals along the nerves to the brain saying “you need to go to the toilet.”
• When relaxing the anus on the toilet, it takes a little effort to “squeeze out” the feces.
• If the child ignores the signal, restrains, then the feces remain in the rectum.
• Gradually, a large dense fecal lump forms in the intestine.
• The rectum then dilates and enlarges much more than usual.
• This contributes to the formation of a fecal blockage, in which dense feces “get stuck” in the rectum.
• If the rectum remains overdistended for a long time, the normal sensations of the urge to defecate are weakened. In addition, the “power” of the rectum falls (it becomes “lazy”).
• Additional portions of feces approach the fecal lump in the rectum.
• The lowest part of the stool lies just above the anus. Some of these “fresh” portions liquefy and flow out of the anus. This stains the child’s underwear and bedding. In addition, some of the soft stools, liquid stools from the overlying sections of the large intestine can “go around” around the fecal lump. It also oozes from the anus and may be mistaken for diarrhea. The child in no way (!) Can control this leakage and contamination of linen.
• If the fecal blockage is eventually completely expelled (via an enema), it quickly refills with hard stools due to the fact that the walls of the rectum are distended and weakened.

Treatment of chronic constipation in children?

High fiber diet and plenty of fluids

This is described above, but, as a rule, in addition to this, the appointment of laxatives is required.

Laxatives

Laxatives are usually prescribed if a child develops chronic constipation. Their first goal is to empty the rectum, to resolve the fecal blockage. This can usually be done fairly quickly with just an adequate dose of a strong laxative. Sometimes laxative suppositories or cleansing enemas are needed to resolve a stool blockage. After emptying the rectum, it is important to continue taking laxatives as directed by your doctor. This may be necessary for several months, and sometimes even up to two years.

When a child takes laxatives every day, the following happens:

• The child goes to the toilet more often and has regular stools. Since he goes to the toilet more often, the stool becomes smaller and softer. Thus, the feces will be allocated more easily. The child will be freed from the fear of going to the toilet in a big, hard, painful lump.
• The overdistension of the rectum decreases, and it can gradually return to normal size, functions are restored properly.
• Constipation is unlikely to recur.

If laxatives are discontinued prematurely, the fecal blockage is likely to recur again in the weakened rectal ampulla, which has not had enough time to return to normal size and regain strength.

There are different types of laxatives, which include:

• Substances that increase the volume of stool. This, for example, bran. They make the chair soft, but voluminous.
• Stool softeners. These substances thin and soften the stool. For example, docusate sodium (which also has a weak stimulant effect).
• Osmotic laxatives. For example, lactulose and polyethylene glycol. These substances retain fluid in the large intestine by osmosis (reduce the absorption of fluid into the blood from the lumen of the colon).
• Stimulant laxatives. For example, senna or docusate sodium. They act on the muscles in the intestinal wall and “squeeze” less than usual.

Your doctor will usually advise you to use laxatives. However, it is quite common to need two laxatives at the same time for several months if one drug does not give the desired effect. For example, an osmotic laxative plus a stimulant. Over time, the dose is gradually reduced and the drug is canceled. It is important to continue treatment for as long as the doctor advises. Chronic constipation often recurs if treatment is stopped too soon.

Constipation: causes, symptoms and treatment recommendations.

Dr. Peter

The cause of constipation is usually easily remedied – eating problems, fluid deficiency, inactivity. However, sometimes constipation is only a symptom of serious pathologies.

The frequency of bowel movements varies with age and lifestyle. Some people have a bowel movement every day, others need to empty their bowels every other day or 34 times a week. According to experts, when it comes to the frequency of bowel movements, a frequency of three times a day to three times a week is considered normal.

Doctors usually talk about constipation, when the bowels are less than three times a week, it is necessary to make efforts to pass the stool, it is hard and lumpy due to the fact that it stays in the intestines longer.

In practice, however, this definition is not always correct. Even daily stools, if they are very hard and can only pass with great tension and pain, are also considered constipation.

Constipation: causes

The most important forms or causes of constipation are:

• Temporary or situational constipation. Many people get constipated in certain situations, such as when they have a fever, while working shifts, or when they are bedridden. Unfamiliar food while traveling can also temporarily cause constipation.

• Chronic habitual constipation is caused by bowel dysfunction. The reasons are not clearly understood. Possible triggers include insufficient fluid intake, a low-fiber diet, lack of exercise, and frequent suppression of the urge to defecate (for example, due to lack of time).

In people with irritable bowel syndrome, constipation alternates with diarrhea (diarrhea). The reasons for this are not yet known. However, experts have put forward various hypotheses. For example, impaired intestinal peristalsis (intestinal peristalsis), increased permeability of the intestinal mucosa, increased immune activity in the intestinal mucosa, and serotonin imbalance are suspected. Disturbed gut flora, stress, and gastrointestinal infections can also contribute to the development of irritable bowel syndrome.

Sometimes constipation is caused by medication. For example, iron, calcium, and aluminum supplements for heartburn and antidepressants can make the intestines sluggish. Anticholinergics (eg, for irritable bladder and urinary incontinence, Parkinson’s disease, asthma), opiates (strong painkillers or codeine for coughs), and high blood pressure medications are also possible triggers for constipation.

Sometimes a lack of potassium (hypokalemia) is to blame for constipation. This can develop, for example, if you take laxatives too often. In addition, other salt imbalances such as excess calcium (hypercalcemia) can also cause digestive problems.

Various bowel diseases can lead to problems and pain during bowel movements. These include, for example, intestinal diverticula, intestinal polyps, anal fissures and abscesses, painful hemorrhoids, chronic inflammatory bowel disease, Crohn’s disease, rectal prolapse and colon cancer.

In some cases, constipation is caused by nervous disorders. This may be due to diabetes, Parkinson’s disease or multiple sclerosis.

Constipation can also be the result of a hormonal imbalance, such as an underactive thyroid gland (hypothyroidism), diabetes, an overactive parathyroid gland (hyperthyroidism), or during pregnancy.

Constipation: symptoms

Most people experience occasional constipation: occasional sluggish bowel movements, for example due to too little movement, too little drinking and a diet low in fiber. Lifestyle changes quickly restore normal bowel function.

Chronic constipation is less common but more difficult to treat and causes great discomfort. Experts speak of chronic constipation when there is a subjectively unsatisfactory bowel movement for at least three months and this is accompanied by two of the following key symptoms:

• strong straining;

• lumpy or hard stools;

• subjective sensation of incomplete defecation;

• Hand defecation aid;

• less than three bowel movements per week.

Constipation is often accompanied by bloating and discomfort. Flatulence, a feeling of pressure, and abdominal pain may also occur. Some sufferers also report headaches, fatigue, exhaustion, and loss of appetite.

Why constipation is dangerous

Constipation is not a disease, but a symptom – a sign that something is wrong in the body. This cause is usually relatively harmless (lack of exercise, low-fiber diet, etc.), but sometimes there is a serious illness behind it.

Diagnosis of constipation

In order to get to the bottom of the cause, the doctor will first talk in detail with the patient in order to collect his medical history (anamnesis). Important to clarify:

1. How often do you have a bowel movement?

2. What color and consistency is the chair?

3. Do you feel pain when you have a bowel movement?

4. How long have you had problems and pain with bowel movements?

5. Do you have any other complaints (eg back pain, nausea)?

6. Are you taking any medication? If so, which ones?

7. Do you have any underlying disease (diabetes mellitus, glandular hypofunction, irritable bowel syndrome, diverticulosis, Parkinson’s disease, etc. )?

The doctor can often determine the cause of constipation (eg lack of fluids, stress, shift work) from information provided by the patient himself. In addition, the doctor can use various tests and examinations to find out if any disease can be the cause of hardening of the stool. Therefore, he will conduct a medical examination. Especially in the case of chronic constipation, he will also examine the patient’s anus and check with a finger the underlying tension of the anal sphincter.

Additionally assigned:

• Blood test: A blood test can, for example, indicate diabetes, hypothyroidism or an electrolyte imbalance.

• Colonoscopy: This test is particularly useful for suspected intestinal diverticula, intestinal polyps, bowel cancer, and irritable bowel syndrome.

• Ultrasound: Abdominal ultrasonography is useful if diverticulosis, diverticulitis, or Crohn’s disease is suspected. Ultrasound of the thyroid gland can clarify the suspicion of hypothyroidism.

• Stool examination: If there is blood in the stool, this could be Crohn’s disease or diverticulitis, for example. Colon polyps and colon cancer are also possible causes.

In the case of persistent chronic constipation, additional examinations and tests may be required.

How to treat constipation

Laxatives to prevent constipation should only be used if lifestyle changes (eg, exercise, stress reduction), fiber intake, and use of other home remedies have not had any effect even after a month.

There are various types of laxatives, some of which are available over the counter (eg Glauber’s salt, lactulose, castor oil).

• Osmotically active laxatives bind water in the intestines, making stools moist and slippery. Examples are Glauber’s salt, Epsom salt, lactulose, sorbitol and macrogol.

• Laxative hydragogics provide more water to the intestines. These include bisacodyl, sodium picosulfate, and anthraquinones (eg, in senna leaves, buckthorn bark).

• Stool softeners mix with food debris in the intestines and act as a lubricant (eg paraffin oil).

• Gas-producing laxatives (sodium bicarbonate) release gas (carbon dioxide) in the intestines, which increases stool volume and increases pressure on the intestinal wall – this stimulates further transport of stool and the defecation reflex.

• Prokinetics promote intestinal peristalsis (intestinal motility). Thus, the remains are transported faster towards the exit (anus).

Many laxatives are taken by mouth, for example as tablets, drops or syrup. Others are injected directly through the anus into the intestines, either as suppositories or as an enema/mini-enema. With the latter, a small amount of liquid is injected into the intestine, such as a solution of salt or sugar. The laxative effect when using this small enema is quite fast.

Talk to your doctor or pharmacist about which laxative is best for you. Use this exactly as recommended by your doctor or pharmacist, or as directed on the package insert. Because when used incorrectly (too high a dose and/or taken too long), laxatives can have serious side effects, including fluid and salt loss.

Prevention of constipation

With the right diet and lifestyle, you can easily eliminate or even prevent constipation. Help:

• High-fiber diet: Eat plenty of fruits, vegetables, and whole grains.

• Eat calmly, chew thoroughly: Digestion begins in the mouth, chew every bite thoroughly.

• Drink enough water: experts recommend drinking two liters a day (eg water, mineral water, tea).

• Get moving: constipation is associated with lack of exercise.

• Calm bowel movements: take enough time to go to the toilet.

• Regular toilet visits: For example, always go to the toilet in the morning after breakfast and sit for ten minutes even if nothing is happening. Often the body gradually gets used to it and then uses this time to defecate.