Over time, constipation can worsen, so it's important for parents to be on the lookout for warning signs. These include behaviours such as straining while passing stool or clenching buttock muscles which indicate efforts to withhold bowel movements. Other symptoms include stomach pain and cramping, urinary leakage which can be caused by build-up of stools pressing against the bladder, or stool in the underwear caused by stool building up and leaking.3
What causes constipation?4
- A lack of fibre can cause constipation, as fibre helps to keep stools soft, easing bowel movements.
- Some types of medicine can contribute towards constipation. Parents seeking a doctor's advice for their child's constipation should inform the doctor of any medication their child might be taking.
- Withholding bowel movements causes stool to be pushed back into the rectum or anus, the lowermost part of the digestive tract. This causes muscles in the rectum and lower colon to stretch and become less effective. Meanwhile, the colon continues to absorb water from the stool, and it becomes hard, dry and difficult to pass. Children may withhold bowel movements for many reasons, from being stressed about toilet training to not wanting to interrupt their playtime, or because they are afraid of experiencing a painful bowel movements.
- Medical conditions such as diabetes can disrupt the body's regular process.
- Functional constipation occurs in children during three periods: during a significant dietary transition such as the introduction of solid foods; when they are being toilet trained and learning to control their bowel movements; when they start school and avoid using the bathroom at school for bowel movements.
Managing and preventing constipation
Parents can help to keep their child's tummy healthy and reduce the risk of constipation by making some changes in their child's diet and behaviour.
- Introduce fibre into their daily diet. The Malaysian Dietary Guidelines for Children and Adolescents recommends two servings each of fruits and vegetables daily for children below the age of seven.5 Good high-fibre options include prunes, raisins, peas, beans, broccoli, leafy vegetables and whole grain cereals.6
- Give them plenty of water, especially when they are active or unwell. Children aged 2-3 years should drink up to two glasses per day while children four years and above require 6-8 glasses.5
- Encourage children to use the toilet regularly, such as after meals.4
- Try to include prebiotics and probiotics in their diet – prebiotics such as galactooligosaccharides (GOS) and fructooligosaccharides (FOS) help support the growth of healthy bacteria in the gut, known as probiotics7, which in turn help support healthy gut functions.8
If these measures don't help, or if the constipation gets worse, it's important to seek a doctor's advice.
Overall, children need to be reminded to use the toilet regularly but remember that toilet training can be stressful for children and worsen constipation so it's important to make it part of a positive routine rather than a forced experience.
