What is Chronic Constipation?
Many kids will experience occasional bouts of constipation during their childhood. Chronic constipation is a slightly different, yet much more challenging condition to treat. Because chronic constipation can lead to long-term discomfort and loss of bowel control, it can be very stressful for both parents and kids.
Nationwide Children’s has a team of experts and specialized outpatient clinics dedicated to providing children with the right combination of behavioral, medical and nutritional therapies they need to successfully overcome chronic constipation.
How the Bowel Works
To understand how chronic constipation develops, it’s helpful to know how the gastrointestinal tract works.
When a person starts eating, the stomach sends the colon signals to get ready to have a BM. This is called the gastrocolic reflex. The signals take about 30 minutes to an hour to go into full effect, which is why many people will use the bathroom shortly after finishing a meal. As food leaves the stomach, it is digested in the intestines and ultimately collects in the rectum as stool. The rectum signals the brain that it is time find a bathroom, but an involuntary muscle holds the waste in until a person voluntarily relaxes the muscles in the anus to allow the waste out.
It may sound simple, but the muscles must coordinate and receive the right “instructions” to keep the system going. These muscles don’t begin working together until the age of 3 or 4 – exactly when most parents and kids attempt potty training.
What are the Symptoms of Chronic Constipation?
Symptoms of regular constipation include:
- having less than 3 bowel movements per week
- hard stools
- incomplete evacuation
- the inability to pass stool
Chronic constipation occurs when these difficulties persist for several weeks or months. Children with chronic constipation complain of pain while having a bowel movement (BM) and of feeling like their bowels are blocked or that they can’t completely empty their bowels.
What Causes Chronic Constipation?
Chronic constipation can be caused by many factors, but one common trigger is when a child decides to hold in their bowel movements. Children do this for any number of reasons ranging from a preference for diapers, to not wanting to interrupt play, to simply being uncomfortable with using a restroom outside their home.
If a child continues to ignore the body’s cues to go, their waste becomes hard and the rectum fills with stool and stretches. This has two consequences. Hard stool is painful to pass, and the child becomes more reluctant to go – setting up a vicious cycle. Over time, as the rectum stretches, the child won’t feel the urge to go. The stool can build up until the child is no longer able hold it in, resulting in overflow incontinence, where leakage or accidents occur.
Children with behavioral issues like attention deficit hyperactivity disorder (ADHD) or developmental delays like autism can be at risk for developing chronic constipation. Chronic constipation can be further aggravated by a diet low in fluids or fiber.
Diagnosing Chronic Constipation
In order to get the right treatment for chronic constipation, the GI team will first determine the cause of the constipation. The team may conduct motility studies to track how the child’s digestive system is functioning as well as evaluate toileting behaviors. If there are no underlying medical or anatomical causes of constipation, the GI team may refer the child to be treated at one of Nationwide Children’s outpatient bowel management clinics.
The Bowel Management Clinic: Changing Behaviors
Nationwide Children’s Bowel Management Clinics offer a streamlined, comprehensive treatment approach using both behavioral and medical interventions. There are clinics located on the main downtown campus and in Westerville. The Westerville clinic was created specifically for children with cognitive delays and is staffed by a nurse practitioner (NP) and pediatric psychologist from the Child Development Center.
Once a child has been examined and referred by a GI , the first step is to start the child off with clean bowel. This may be achieved by using X-rays or other procedures to ensure the bowel is empty. The clinic’s NP and psychologist coordinate to develop an individualized plan to address all aspects of the child’s constipation. This plan may include guidelines for modifying:
- Behavior. The team will establish a schedule of “go” times based around the gastrocolic reflex to help train children to recognize their body’s cues. The staff also helps parents set up a reward system to reinforce new toileting habits.
- Nutrition. Dietitians at the clinic know how to work around the picky eating habits of kids, and have recipes and suggestions for increasing dietary fiber.
- Medicine. The team will determine if the child could benefit from over-the-counter or prescription therapies that change the consistency of stool or relax the rectal muscles. The team works closely with families to identify alternatives for kids who don’t like swallowing pills or have sensory issues.
Most children are seen every 4 to 6 weeks for about 3 to 4 months by an NP and psychologist who check progress and adjust the plan as needed. Children of toilet training age generally see results after following a plan for 4 months. School age kids typically require six months to one year. The very best results are seen with kids who attend follow up appointments and follow the prescribed regimen.
If medical therapy is not effective, then motility studies may be indicated to assess how the child’s anus and colon are functioning.
For more information
We require that you consult with your pediatrician before bringing your child to a gastroenterology specialist at Nationwide Children’s. Your child must have a referral and diagnosis from a gastroenterologist before they can attend the Bowel Management Clinic. Please call (614) 722-3450 for more information.