Constipation means either going to the toilet less often than usual to empty the bowels, or passing hard or painful stools. Every child is different and there is a large range of normal bowel habit, it is a change from what is normal for your child that suggests a problem. Regular soiling may indicate that there is severe constipation with some blockage of stool in the lower part of the gut, this is known as impaction.
You will be asked questions about your child’s diet, bowel habit and general health. Your child’s growth will also be reviewed. Most of the time, tests are not needed
Usually there is no particular disease or illness causing the constipation and it is known as idiopathic constipation. These are the things that could be causing the constipation or making it worse.
Stool withholding is a common problem seen in toddlers. This is when toddlers try to hold onto their stool instead of passing it. It is one of the greatest risk factors for developing constipation. This usually occurs around the time of potty training, when the child has discovered they can withhold. It may also occur at nursery age or at school age when the child does not/cannot/will not access the toilets. Often the child has experienced pain on passing a stool, then because of the pain they hold onto their stool in order to avoid the pain. By holding onto their stool, the constipation becomes worse. Once they do finally pass the stool, it is usually hard, wide and large which leads to discomfort and reinforces their desire to continue to withhold.
Idiopathic constipation that has lasted for more than a few days is usually treated with laxatives.
Laxatives are normally continued for several weeks after the constipation has eased and a regular bowel habit has been established. The duration of treatment may be several months.
Don’t stop the laxatives abruptly, it is better to gradually reduce the dose depending on the consistency and frequency of the stools.
Laxatives used for children are divided into two types;
It is essential to mix Macrogol laxatives with the correct amount of water or it will not work.
Paediatric sachets should be mixed with at least 63mls water PER SACHET
Adult sachets should be mixed with at least 125mls water PER SACHET
As the macrogol water is not absorbed, it can’t be included in the child’s daily fluid requirement
1. Empty the sachet of Macrogol powder into a cup.
2. First add the right amount of cold water.
3. Stir until the powder has dissolved and the water is clear.
The resultant liquid can be mixed with anything your child likes, to encourage them to drink it, e.g. squash, juice, hot chocolate, milk.
If your child does not like the taste, try mixing the macrogol earlier and chill it in the fridge - it will last 6 hours (Laxido) or 24 hours (Movicol)
Do not mix the powder straight into the milk, juice or flavoured drink – it needs to ‘bind’ with the water first.
1. Boil fresh water
2. Pour water into bottle
3. Cool boiled water in fridge
4. Empty the sachet of Macrogol powder into a cup.
5. Add 63ml of cooled boiled water
6. Stir until the powder has dissolved and the water is clear.
7. Prepare formula according to the manufacturer’s instructions using water which is at least 70°C
8. Add sufficient formula to macrogol water to flavour it and mix well.
DO NOT add macrogol water to the baby’s whole feed in case they don’t finish it
Impaction is very bad constipation where poo can build up in the abdomen and become immobile in the intestines. The child may pass very small stools every few days or have very infrequent bowel movements. They may have ‘leaks’ of stools causing soiling, where poo has bypassed other hard poo, out of the child’s control (overflow).
Disimpaction means giving laxatives in sufficiently large quantities to ‘clear out’ all accumulated poo. If you give a standard dose of laxative it is likely to soften the poo but not stimulate the bowel to empty fully.
On day 1 take two paediatric sachets, then follow the table below (you may have to turn your phone or tablet sideways to view the full table) until the stools have become loose and watery for at least 24 hours.
| Day | 1 | 2 | 3 | 4 | 5 | 6+ |
|---|---|---|---|---|---|---|
| Sachets* | 2 | 4 | 4 | 6 | 6 | 8 |
| Water to Mix (ml) | 125 | 250 | 250 | 375 | 375 | 500 |
On day 1 take four paediatric sachets, then follow the table below (you may have to turn your phone or tablet sideways to view the full table) until the stools have become loose and watery for at least 24 hours.
| Day | 1 | 2 | 3 | 4 | 5 | 6+ |
|---|---|---|---|---|---|---|
| Sachets* | 4 | 6 | 8 | 10 | 12 | 12 |
| Water to Mix (ml) | 250 | 375 | 500 | 625 | 750 | 750 |
Children over 12 years should be treated with an adult preparation – the macrogol is exactly the same but there is twice as much in the sachet. (you may have to turn your phone or tablet sideways to view the full table).
| Day | 1 | 2 | 3 | 4 | 5 | 6+ |
|---|---|---|---|---|---|---|
| Sachets* | 4 | 6 | 8 | 8 | 8 | 8 |
| Water to Mix (ml) | 500 | 750 | 1000 | 1000 | 1000 | 1000 |
* Number of sachets per day, taken over a 12 hour period
When your child’s poo has the appearance of brown bitty water (type 7 on the stool chart) on at least one occasion, the disimpaction regime can be stopped. It is normal for this to take 7 to 14 days. Laxative treatment does need to continue to prevent recurrence of constipation, and the allow the stretched bowel to regain its tone. If it takes longer than 14 days, make an appointment to see your child’s GP.
Your child should be given a maintenance dose of their laxative after disimpaction. The dose should be adjusted to ensure your child poos at least one soft poo every day. You will therefore need to monitor their poos and increase/decrease laxative doses accordingly. Your child may need to stay on laxatives for many months or even years. You will know if they need less laxatives – check their poo and
decrease the dose if it is too sloppy.
| Age | Quantity |
|---|---|
| 1 -5 years | ½ - 3 sachets/day |
| 5-12 years | 1-4 sachets/day |
| Over 12 years | 1-2 adult sachets/day |
Once disimpaction is achieved, reduce the number of sachets to a maintenance dose. This will be half the disimpaction dose, taken over a 12 hour period, up to a maximum of 4 paediatric sachets per day. Over time, it should be possible to reduce the maintenance dose, aiming for type 3-4 stools, but be aware this can take months to achieve. It is likely that is the sachets are stopped too soon that constipation may return and we would advise continuing a maintenance dose for at least 6 months.
ERIC, The Children's Bowel & Bladder Charity, is a UK charity for families affected by bedwetting, daytime wetting, constipation and soiling.
The charity Bladder & Bowel UK has produced a range of booklets and leaflets covering bladder and bowel problems in children.