Constipation (kahn-sti-PAY-shun) is common. Children with constipation have stools (poops) that are hard, dry, and difficult or painful to get out. Constipation can be treated.

You may worry your child is constipated if he or she doesn't have a bowel movement* (BM) every day. But every child is different. Most children have BMs 1 or 2 times a day. Others may go 2 to 3 days or longer between BMs.

Signs of Constipation

• Hard or painful stools

• Many days between bowel movements

• Bleeding from the child's bottom where stool comes out

• Stomachaches, cramping, nausea*

• Brownish wet spots in the underwear (See “What Is Encopresis?” on the second page of this handout.)

Call the Doctor If…

• Your child doesn't have a BM at least every 2 to 3 days.

• Passing a stool hurts your child.

What to Do for Constipation

Treatment is based on your child's age and how bad the problem is. Usually no special tests are needed.

Constipation can get worse if it isn't treated. The longer stool stays inside the body, the larger and drier it gets. Then it hurts to pass it. This starts a cycle. The child becomes afraid to have a BM, and holds it in even more.

What Causes Constipation?

What your child eats and doesn't eat.

Not getting enough fiber or liquid can make your child constipated.

Holding back, or “withholding,” stool.

Your child may not want to have a BM for different reasons:

• Your child may try not to go because it hurts to pass a hard stool. (Diaper rashes can make this worse.)

• Children aged 2 to 5 years may want to show they can decide things for themselves. Holding back their stools may be their way of taking control. This is why it is best not to push children into toilet-training.

• Sometimes children don't want to stop playing to go to the bathroom.

• Older children may hold back their stools when away from home (like camp or school). They may be afraid of or not like using public toilets.

How to Prevent Constipation

• Encourage your child to drink lots of water and eat more high-fiber foods.

• Hold off on toilet-training until your child shows interest.

• Help your child set a toilet routine. Pick a regular time to remind your child to sit on the toilet daily (like after breakfast.) Put something under your child's feet to press on. This makes it easier to push BMs out.

• Encourage your child to play and be active.

What Is Encopresis?

Sometimes a child with bad constipation has BMs that look like diarrhea*. When a child holds back stools, the stools build up and get bigger. They may get so big that the rectum* stretches. Then the child may not feel the urge to go to the bathroom. The stool gets too big to pass without an enema, laxative, or other treatment.

Sometimes only liquid stool can come out, and leaks onto the underwear.

This is called encopresis (en-koh-PREE-sis). Talk with your child's doctor about treatment. It can get better, but it takes months.

Getting Enough Fiber