Constipation and Soiling in Children
Constipation
Children with constipation have bowel movements that are large, hard, dry, and painful to pass. These stools may occur every day or the child may not have a bowel movement for a few days. Children may refuse to go to the toilet or may hold the stool back and try not to pass the stool.
Other symptoms include:
- Stomachaches
- Cramps
- Nausea
- Vomiting
- Bloating
- Cranky behavior
- Not hungry
- Flushing or pallor
- Weight loss
Some children may have rectal tears (fissures) that are painful and may bleed. Some children with constipation may wet the bed at night. Urinary tract infections may occur since the stool presses on the urinary tract and can block normal urine flow.
It can be normal to have a stool every few days rather than daily. Having soft and painless stools every few days, without other symptoms, is likely not a problem.
Soiling (Encopresis)
Soiling occurs when a child has stool smears in his or her underwear. It is often linked with constipation. Children with soiling may have bowel movements on the toilet but also leak liquid, diarrhea-like stool into their clothes. Some children do not stool in the toilet at all.
Other symptoms of soiling include:
- The child may hide soiled clothing or refuse to change soiled clothing.
- He may not feel the soiling occur.
- He may get used to the odor and not notice it.
- Other children may tease the child. This may lead to embarrassment, the child not wanting to go to school, fighting, and other problems.
Causes
Constipation often begins when a child holds back a bowel movement. This may happen because the stools are hard and painful to pass. It can also happen if the child does not have enough privacy when using the bathroom. Fear of pain or embarrassment can make a child try not to have a bowel movement. Stool that is held back fills up the bowel (colon) and stretches it out of its normal shape. Stool held in the colon dries out as the colon absorbs water from it. The longer the stool is there, the larger and harder it becomes making bowel movements even more painful. This starts a vicious cycle. In the normal colon, muscles try to push stool out. Nerves tell the child that a stool needs to come out. The stretched-out flabby colon muscles in a constipated child cannot push. Hard stool gets stuck. Stretched nerves become less sensitive, so the child may no longer realize that he needs to have a bowel movement. Soiling is caused by liquid stool leaking around the hard stool in the colon.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 05/20/2013
Copyright © 05/20/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5747
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