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| |    Causes of Constipation by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. Most constipation is what doctors call "functional," meaning that we can't find anything wrong with the colon itself, but for some reason it doesn't function properly. There is also a long list of relatively rare medical causes of constipation, including a condition called Hirschprung's, in which a segment of the colon develops without the ability to squeeze the stool along properly. The point is, if your child has serious constipation that doesn't go away with simple changes in diet and behavior, it's important that you involve a doctor in his care to make certain that there isn't an underlying medical condition that needs treatment. Constipation in infants Constipation can start during infancy, during the preschool period, or later in childhood. In infancy, the main symptom of constipation is not the infrequency of passing stools, but rather the consistency of the stool. A baby's BMs should be mushy or soft; if they're hard like pebbles, it's constipation. Some healthy breastfed babies will go several days between BMs--others will only go several hours!--but in either case, the stool that comes out should be soft. Minor bouts of constipation are fairly common in infancy, probably because it takes a while for babies to learn to digest different foods. More serious constipation needs to be evaluated medically, since there are some conditions and rare diseases that cause constipation that should not be missed. How preschoolers develop it In preschoolers, constipation often develops after a painful bowel movement. The child may have a minor illness that temporarily lowers her fluid intake. The result is a hard, painful stool. Once the child learns that going to the bathroom hurts, she tries to hold the stool in. The more she succeeds, the harder the stool is when it finally passes, and the more she resolves never to let that happen again. Stool withholding can also come about when parents try to compel a strong-willed child to put his stool in the toilet before he is comfortable doing that. Rather than give in to these parental demands, the child decides to keep the stool for himself. The end result--a painful stool and the beginning of constipation--is the same. Add full school days to the mix Severe constipation in school-age children often has been present for a long time (two or three years on average, according to one study). It may have started during preschool and simply continued under its own momentum. Constipation can also arise for the first time in school-age children in response to discomfort using the bathroom at school. (You may be able to remember how unappealing school bathrooms can be: missing stall doors, wet seats, etc.) Even if the bathroom isn't off-putting, some children just need to sit for longer before they can have a BM. If there isn't time at school, they hold it and eventually can become constipated. The thing to remember is that constipation develops over time and tends to get worse unless parents and children work hard to combat it. By the time a child has encopresis, whatever originally caused the constipation is likely to be ancient history. Regardless of the cause (assuming rare diseases have been ruled out), treatment is pretty much the same.
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