What Happens When Kids Don’t Poop?

Everybody poops. But some of us get constipated, a problem that impacts people of all ages, including children. In fact, constipation in children is common: One in four will experience it.

And though constipation may be fleeting in most kids, some develop chronic problems that need medical attention.

“Functional constipation is common in children and can be a great source of distress to our patients and families,” says Nicole Baron, PNP, of the Pediatric Gastrointestinal Motility Center at Columbia. “Adults may have a good understanding of their regular bowel movement pattern and when to get concerned if variations persist. It’s more challenging but so important to identify and understand in children.”

We asked Baron about times when constipation is more common, behaviors to watch for, treatment, and when to seek medical attention. Here’s what she said.

What is constipation?

Constipation means difficulty pooping or pooping infrequently.

Healthy frequency varies: “normal” can range from three times a day to four bowel movements a week. Most people have one bowel movement a day.

What causes constipation in kids?

There are two main types of constipation:

• Organic: When there is an underlying medical condition such as celiac disease, thyroid dysfunction, or an underlying neurological problem
• Functional: When people have hard, infrequent bowel movements that are difficult to pass and there’s no identifiable anatomic abnormality or disease process. Most children have this type.

Diet and lifestyle contribute to constipation. You may see constipation in infants and toddlers who are changing their diet, like when transitioning to solid food or cow’s milk, or in older children who eat little fiber or don’t drink enough water.

Children who watch a lot of TV or play video games for extended periods, or do not get enough exercise can get constipated. Physical activity aids in digestion.

Some medications can contribute to constipation.

Changes in routine and stressful events can also contribute to the development of functional constipation—toilet training, starting school, an illness, or changes to family dynamics such as the birth of a sibling or parental separation.

Children may be scared to use bathrooms in unfamiliar or public settings (school, camp, movie theater), which can trigger withholding behaviors.

What are the signs of constipation in kids?

Watch for:

• Two bowel movements or less per week
• Painful or hard bowel movements (more than once or twice): If it hurts to go, children may try to hold it in (withholding)
• Unusually large bowel movements
• Staining underwear or poop accidents in underwear. When there’s hard stool lodged in the bowel, liquid stool may seep around the impaction, something children can’t control
• Withholding behavior: posturing, dancing around, holding onto the furniture when needs to go

Why is constipation bad for your health?

When children do not poop regularly, it can become hard and dry, making it difficult and painful to pass. Hard stools can result in anal fissures (small tears in the skin around the anus), fecal impaction (a large mass of dry stool stuck in the rectum), or encopresis (involuntary soiling of underwear). Children may also experience abdominal pain, decreased appetite, nausea, or vomiting.

What should you do at home if a child cannot poop?

If you think a child is experiencing constipation, first identify all recent changes in diet, routine, or stressors. An increase in fruits, vegetables, whole grains, and water can be enough to reverse constipation.

Start a toilet-sitting routine

If you think a child is withholding, a toilet-sitting routine can change the behavior and prevent constipation. Set up a routine where the child sits on the toilet for 5-10 minutes 2-3 times daily. After mealtime is ideal because eating helps movement in the digestive tract and can aid in the passage of bowel movements.

Celebrate with the child the act of sitting on the toilet. If there is poop, that is great, but the goal is to increase the child’s comfort with the toilet, and poop will often follow.

Proper sitting position is important. Some children (and adults, too) benefit from having a stepstool under their feet to raise the knees higher than the hips. This allows smoother and more effective evacuation of feces and can decrease straining.

When should you see a doctor if a child cannot poop?

• Two-week history of decrease in bowel movements (two or fewer per week)
• Blood in stool
• Abdominal distention or swelling of the belly
• Abdominal pain
• Pain with the passage of bowel movement
• Vomiting in the setting of decreased bowel movement frequency
• Change in appetite, weight loss
• Accidents in underwear/ fecal soiling
• A portion of the intestine coming out of the anus (prolapse)

Is it safe for children to use laxatives?

Yes. But only if used appropriately, with medical guidance, in addition to dietary and behavioral changes.

Parents and caregivers often have concerns about children using laxatives because they worry about side effects and becoming dependent on the medication. But like all medications, when used properly, as directed by the child’s health care provider, laxatives can improve bowel movement frequency, consistency, and decrease withholding behavior. These changes prevent long-term problems associated with constipation.

What do you wish everyone knew about constipation and kids?

Constipation is treatable, but finding the best treatment for a child may take some time. Ongoing communication and collaboration with the child, parent or caregiver, and health care provider is important so that treatments can be adjusted when needed and constipation improves.