Why Pediatric Constipation Is A Serious Issue
Constipation in children is a common problem. Despite being considered by many a relatively benign condition, childhood constipation has been shown to be associated with a significantly decreased quality of life for the child. The day-to-day struggle caused by constipation can often be emotionally devastating, and can also have an impact on the overall health and well-being of affected children and their families.
According to 2009 research published in ‘The Journal of Pediatrics’, the burden of illness in children suffering from constipation, and the costs associated with this condition, are roughly of the same magnitude as those for asthma and attention deficit- hyperactivity disorder (ADHD).
What is constipation?
A child is said to be constipated when they have very hard stools, and fewer bowel movements than they normally do. Constipation is often defined as having fewer than three bowel movements a week. However, healthcare experts explain that the number of bowel movements may be different for each child, depending on their age, diet and overall health. So, one could have a bowel movement a day and still be a bit constipated. Conversely, having a stool every other day may not constitute constipation. But a change in what is normal for your child may mean there is a problem.
What’s normal?
Understanding what’s normal, depending on your child’s age, may help you to decide if it’s time to seek help. According to Mayo Clinic, here’s how normal bowel habits break down by age:
Newborns: Expect four soft bowel movements daily
First 3 months for children who are breastfed: Expect three soft bowel movements daily.
First 3 months for children who are formula-fed: Expect two to three soft bowel movements daily.
6 months–1 year: Expect two bowel movements daily.
1–3 years: Expect one to two bowel movements daily.
4 years and older: Expect one bowel movement daily.
It can be common for a breastfed infant to have as many as one bowel movement after each feeding to as little as one bowel movement every five to seven days.
Signs and symptoms of constipation in children
There are, however, multiple clues to look for to determine if your child is constipated.
Some of the typical signs and symptoms are as follows:
- Having bowel movements that are difficult or painful to push out.
- Passing stool that is hard and sometimes large.
- Frequent abdominal pain, cramping.
- Encopresis (bowel accidents and soiling).
- Bleeding with bowel movements.
- Itchy or painful anus including hemorrhoids.
- Smearing and staining of stool on underwear.
- Irritable and disagreeable moods.
- Gets full quickly when eating.
- Increased flatulence.
- Intermittent diarrhoea and hard stools.
- Recurrent attacks of nausea and vomiting.
- Urinary frequency and urgency.
- Urinary tract infections, bedwetting, urinary accidents and difficulty starting a stream.
Healthcare experts believe that severe constipation in a newborn should be evaluated by a physician. Infants and toddlers that exhibit constipation may continue to have problems after potty training.
Causes of constipation & Holding
Constipation is classified into two general categories based on whether or not there is an underlying medical or ‘organic’ cause. The vast majority of childhood constipation is not due to medical causes, but instead, caused by ‘holding’ and incorrect diet. However, children with severe and chronic constipation from holding can develop other significant medical issues. Constipation is a result of several physical and psychological issues working together.
If your child’s constipation is not due to an underlying medical cause, you need to look at their diet, their potty training, and their attitude towards bowel movements. As infants change their diet from breast milk to formula or formula to cow’s milk, they tend to develop harder and larger stools. This can result in painful or difficult bowel movements. Diaper rashes can also make wiping after having a bowel movement more painful. Even very young children can then associate passing stool with pain and discomfort.
The same is true with toddlers. As their diet changes further to solid foods, they can
develop stools that are hard or painful to pass. They too will hold to avoid this discomfort. Inconsistent, incomplete, or difficult potty-training experiences
can lead to fear, confusion, obstinate behavior, tantrums or confusion, which then can lead to constipation. Anal tears or fissures and bleeding can occur adding to the pain, fear and distress.
Children may also avoid passing stools because they’re too busy playing. Toddlers are also aware that their parents will change their diaper if it is dirty. This means an interruption of their fun activities, so they try to hold to avoid a diaper change. However, holding will only add to the risk of constipation.
Older children can develop bowel problems due to all the above reasons, but they are also more active as they attend school. They avoid using the restroom for various reasons: Could be because they’re embarrassed, the toilets are dirty, or they don’t want to make time for it or they can’t go when they want to. When stool is withheld in the colon and rectum, it hardens due to water absorption, causing the rectum to stretch and hold more stool. This results in decreased rectal sensations. When they do go, it is urgent and they may have an accident and soil their underpants if they don’t reach the bathroom quickly enough, which the parents sometimes misinterpret as diarrhoea. In an attempt to avoid having an accident, they tighten their bottom muscles (sphincters). Over time, these muscles become stronger and harder to relax with each bowel movement. The child then runs the risk of not letting the entire bowel movement out, leaving more stools to accumulate and cause more problems.
Why is it important to treat constipation?
Chronic unaddressed constipation results in much more than a child not being able to ‘go’. It can lead to several complications:
- About 10% of children with constipation have recurrent urinary tract infections. According to a 2015 study published in the ‘World Journal of Methodology’, correcting constipation has been shown to decrease in the incidence of recurrent UTIs in children.
- Treating constipation can reduce episodes of incontinence in children. Constipation often leads to dysfunction of the bladder, causing incontinence, urgency of urination, increased frequency or a sensation of having to urinate when there is little or no urine.
- Improve the child’s vesicoureteral reflux. Here, the urine moves backward from the bladder to the kidneys. This can cause urinary tract infections (UTI) and, less commonly, kidney damage.
- Treating constipation can decrease a child’s stool accidents and stool leaking. Often stool accidents, also known as encopresis, is actually a sign of constipation.
- Treating constipation can also lead to better mental wellbeing of the child. It will improve mood and save the child from guilt, shame and anxiety due to bowel or bladder accidents.
The gut microbiota and constipation
Trillions of bacteria reside in the gut in what is known collectively as the gut microbiota. Enough of good bacteria is important for the child’s health. The good bacteria help the immune system, making it ready to fight unwelcome invaders like bad bacteria and toxins. To achieve a healthy balance, the good bacteria need to outnumber the bad with ten to one. The microbiota contributes to:
- Enforced gut barrier
- Improved digestion
- Improved gut motility
- Development of the immune system.
If, for some reason, the bad bacteria start to exceed it may lead to an imbalance in the digestive system, called dysbiosis. Dysbiosis may cause problems like diarrhoea, constipation, bloating, temporary stomach pain and leaky gut. Probiotics can help to restore the balance, thereby restoring normal bowel function and increasing stool frequency in children.
The role of diet
In many cases, constipation in children can be prevented or corrected through dietary and behavioural changes.
- Some great sources of fibre in a child’s diet are whole grains, like whole wheat bread and pasta, oatmeal, and bran flake cereals, legumes, such as lentils, black beans, kidney beans, soybeans, and chickpeas, nuts, such as almonds, peanuts, and pecans, fruits, such as berries, apples with the skin on, oranges, and pears, vegetables, such as carrots, broccoli, green peas, and collard greens. According to a 2010 study in the ‘Journal of Clinical Nursing’, primary school children who don’t like eating fruit and vegetables are 13 times more likely to develop functional constipation than children who do.
- Adequate fluid intake can soften the stools so the child can pass them easily. Water and other liquids, such as naturally sweetened fruit and vegetable juices and clear soups, to help the fibre work better.
- Drinking enough water and other liquids is also a good way to avoid dehydration. Drinking less than 400ml of fluid a day also significantly increases the risk of constipation. Staying hydrated is good for the child’s overall health and can help them avoid getting constipated.
How probiotics help
Probiotics are live microorganisms that confer a health benefit on the host when administered in adequate amounts. Probiotics not only improve their digestive functions but also help support their weaker immune functions. Multiple studies indicate that probiotics relieve constipation in children. According to a 2017 study in the journal ‘Frontiers in Cellular and Infection Microbiology’, a review of 6 studies found that taking probiotics for 3–12 weeks increased stool frequency in children with constipation. Another report, published in the International Journal of Pediatrics in 2014, observes that a 4-week study in 48 children linked probiotic supplements to improved frequency and consistency of bowel movements. A 2007 study that appears in the BMC Nutrition Journal notes that a mixture of probiotics has positive effects on symptoms of constipation in children.
Here is how probiotics work to restore your child’s gut microbiome and alleviate constipation:
- Intestinal microorganisms perform many important functions, one of which is participation in metabolic processes, e.g., in the production of short-chain fatty acids—SCFAs. These acids represent the main carbon flow from the diet to the host microbiome. Maintaining intestinal balance is necessary to maintain normal health and prevent many diseases.
- Increased bile salt metabolism by strains of friendly bacteria in the gut stimulates peristalsis (muscle contractions that move food through the digestive tract) as there is an increased level of deconjugated bile salts which can stimulate colonic motility (regulating the frequency and consistency of stools).
- Friendly bacteria may also increase intestinal fermentation and there by enhance colonic peristalsis, which decreases transit time in functional constipation.
- A 2014 study, published in the ‘International Journal of Pediatrics’, showed that probiotics were significantly effective in improving the stool frequency and consistency. There is a significant decrease in fecal incontinence and abdominal pain and increasing body weight in previously constipated children.
Conclusion
Between 1% to 30% children suffer from constipation worldwide. There are multiple factors that are involved in managing children’s constipation. Probiotics are live bacteria that are proven to benefit children’s healthy by restoring the bacteria balance in the body and thereby easing problems like constipation. They are usually consumed as food supplements.
Sources:
https://www.sciencedaily.com/releases/2008/11/081126122319.htm
https://www.hopkinsmedicine.org/health/conditions-and-diseases/constipation-in-children
https://www.chadkids.org/urology/bowel-management
https://www.choc.org/programs-services/gastroenterology/constipation/
World J Methodol. 2015 Jun 26; 5(2): 13–19. Published online 2015 Jun 26. doi: 10.5662/wjm.v5.i2.13
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482817/
https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/eating-diet-nutrition
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291444/
Frances KY Wong, Moon Fai Chan, Susan Chow, Katherine Chang, Loretta Chung, Wai-man Lee, Rance Lee. What accounts for hospital readmission? Journal of Clinical Nursing, 2010; 19 (23-24): 3334 DOI: 10.1111/j.1365-2702.2010.03366.x
https://www.healthline.com/nutrition/probiotics-for-constipation#constipation-relief
Front Cell Infect Microbiol. 2017; 7: 153.
Published online 2017 Apr 28. doi: 10.3389/fcimb.2017.00153
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408016/
Int J Pediatr. 2014;2014:937212. doi: 10.1155/2014/937212. Epub 2014 Apr 9.
Sadeghzadeh M, Rabieefar A, Khoshnevisasl P, Mousavinasab N, Eftekhari K. The effect of probiotics on childhood constipation: a randomized controlled double blind clinical trial. Int J Pediatr. 2014;2014:937212. doi: 10.1155/2014/937212. Epub 2014 Apr 9. PMID: 24812563; PMCID: PMC4000641.
https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-6-17
Bekkali, NLH., Bongers, M.E., Van den Berg, M.M. et al. The role of a probiotics mixture in the treatment of childhood constipation: a pilot study. Nutr J 6, 17 (2007). https://doi.org/10.1186/1475-2891-6-17
