Constipation in children

Very common, frequently mismanaged, and soiling is almost always overflow rather than deliberate.

What it is

Constipation affects around 1 in 3 children at some point. Most cases are functional, meaning no underlying disease.

It usually starts with one painful poo. The child then withholds to avoid repeating it, the stool gets harder, the next one hurts more, and a cycle establishes itself within weeks.

The part that causes the most unfair blame is soiling. A child with chronic constipation develops a stretched rectum full of hard stool, and softer stool leaks around it. The child cannot feel it coming and cannot control it. It looks like laziness or defiance, and it is neither.

Under-treatment is the norm. Laxatives are prescribed at too low a dose, for too short a time, and stopped as soon as things improve, which is exactly when the cycle restarts.

Signs you might notice

Fewer than three poos a week, or large, hard, painful stools.

Straining, crying, or hiding to poo. Standing on tiptoes, crossing legs, or holding on to furniture, which is withholding, not straining.

Soiling, streaks in pants, or a smell the child does not notice.

Tummy pain, poor appetite, and irritability.

Blood on wiping from a small tear.

Red flags: constipation from birth, delayed passing of meconium, ribbon-like stools, weight loss, or abnormalities of the lower back.

How it can affect day-to-day life

Families are frequently told to add more fruit and fibre, which alone does not clear an established impaction and delays effective treatment.

Disimpaction requires a high, escalating dose of macrogol over several days, and it usually gets worse before it gets better. Parents who are not warned about that stop the treatment.

Maintenance then needs to continue for months, often longer than the constipation lasted, and tapered slowly.

School toilets are a substantial and under-recognised factor. Many children avoid them entirely.

Supporting someone well

Treat properly: disimpaction with an escalating macrogol dose, then maintenance for months, tapered slowly. Do not stop as soon as things improve.

Expect it to get messier before it improves during disimpaction, and plan for it.

Never blame or punish for soiling. The child genuinely cannot feel it.

Establish an unhurried toilet routine, after meals, with a footstool so the knees are above the hips.

Talk to the school about toilet access and privacy.

Keep fluids up, and treat diet as supportive rather than curative.

See constipation for the adult and care-setting picture.

Where to get help

A GP or health visitor can prescribe and should follow the NICE pathway.

ERIC, the children's bowel and bladder charity, run a helpline on 0808 169 9949 and are outstanding on this.

Red flags, or constipation from birth, need paediatric assessment.