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How does the bowel work? 

  • The food we eat gets mashed around in the stomach and turns into a soupy mixture.

  • This moves into the small bowel, where all the nutrients (the good stuff) are taken out to be used by the body to keep us healthy.

  • As it travels along the large bowel, water is absorbed and the poo turns into a smooth sausage shape ready to be passed.

  • The poo in the large bowel moves along every time the gut muscles squeeze.

  • When the poo reaches the rectum, the rectum stretches and that sends a message to the brain saying we need a poo.

What can go wrong? 

  • If we don’t respond to this message, the poo just stays there.

  • The gut muscles keep squeezing so more poo arrives, as poo builds up in the large bowel more water is absorbed, and the poo becomes harder and gets stuck.

  • Messages are only sent to the brain when the rectum stretches. If it stays stretched, you won’t get a new message telling you need a poo.

  • Very soon you have got a poo traffic jam, also known as constipation.

Constipation is very common in children, if affects 1 in 3 children, even babies. Don’t wait for it to get better by itself. TAKE ACTION!

ERIC

How can you tell if a child is constipated? 

  • Children should pass soft poo every day, or at least every other day.

  • Passing types 1 - 3 means poo is sitting in a traffic jam.

  • Pooing fewer than 4 times a week also means poo is in a traffic jam.

  • Pooing more than 3 times a day can be a sign that the bowel is full, and is leaking out a bit at a time.

  • Soiling - it might be hard bits, soft stuff or even liquid bypassing the traffic jam, called overflow. The child won’t have any control over this.

  • Big poos, or lots of poo all at once.

  • Tummy ache or pain when they poo.

  • Distended/swollen tummy. 

  • Really smelly poo/wind, or bad breath.

  • They might not feel like eating, or even feel sick.
  • The full bowel might press on the bladder and cause frequent small wees/urgency/day or night time wetting/Urinary tract infections. 

HAVING JUST TWO OF THESE SYMPTOMS MEANS CONSTIPATION! 

How to treat constipation: 

  • Keep a Poo Diary for 2 weeks: what it looks like, how much, where it goes.

  • See your GP: Take the poo diary and tell them all your child’s symptoms.

  • The GP should examine your child and ask questions to find out if the constipation could be caused by an underlying condition.

  • The GP should prescribe a macrogol laxative like Movicol, Laxido or CosmoCol which softens poo and helps move it along (as per NICE Guidelines). 

Taking laxatives: 

  • The macrogol must be mixed with the right amount of water first, but then other food/drink can be added – read: How to prepare macrogol laxatives.

  • Most children start with disimpaction – this means taking lots of medicine to clear out the backlog of poo – read: A Parent’s Guide to Disimpaction.

  • When the bowel is clear they will need to keep taking a smaller dose each day to keep their poo soft and moving along.

  • Your child might need to stay on laxatives for a long time, but don’t worry, laxatives won’t hurt them. However, in the long term, undertreating constipation will.

Getting the poo in the loo
Child on toilet blowing bubbles

  • Get there at the right time - 20 to 30 minutes after meals and before bed.

  • Sit in the right way - feet flat and firmly supported on a box or stool, knees above hips.

  • Secure sitting position - they might need a children’s toilet seat.

  • RELAX to let the poo out. So keep toys, games and books beside the toilet.

TRY TO MAKE EACH TOILET SIT ‘ACTIVE’ BY ALTERNATING
PLAY ACTIVITIES AND EXERCISES:

  • Massaging the tummy in clockwise circles, and rocking forwards and backwards on the toilet can really help.

  • Laugh/cough/blow to help push down with the tummy muscles.

  • Make it a fun time! Look at ERIC’s Toileting Reward Chart for more ideas to motivate your child. A 10 - 15 minute toilet sit should be long enough.

Promoting a healthy bowel: 

  • Encourage your child to drink 6 - 8 water based drinks every day.

  • Include fruit and vegetables in their diet.

  • Exercise and move around!

More info: 

ERIC’s Guide to Children’s Bowel Problems
Pooper Highway animation
Flowchart – Constipation (part of our Children's Continence Pathway).
Helpline Podcasts about constipation