Families Bowel problems Bowel problems: FAQs 1. How often should my child do a poo? Every child’s pooing pattern is different. Some children will poo twice a day whilst others will go only every other day. Ideally, children should have a bowel movement once a day. If a child has been constipated before, they should definitely aim to poo once a day. A child is considered to be constipated if they poo less than four times a week. Pooing more than three times a day isn’t right either. If your child’s stools are watery, it could be diarrhoea, but it could also be overflow poo caused by constipation. 2. At what age can constipation start? Constipation can start at any age. Even babies can get constipated, including those who are breastfed (read our factsheet on breastfed babies and constipation). Never wait for constipation to get better by itself – the longer it’s left untreated, the longer it’ll take to get better. 3. Do children just grow out of constipation as they get older? No. If left untreated, chronic constipation doesn’t go away or get better on its own as the child grows up. Children who have been constipated are likely to get blocked up again in the future and may still need the help of laxatives as adults. Parents and carers should keep a close eye on how often their child is pooing and what the poo looks like. This will help alert them to the early warning signs of constipation and if they need further treatment. 4. Is constipation caused by a bad diet? Constipation isn’t always linked to diet. It can be a result of a child passing a painful poo and then withholding their stools through fear of a repeat experience, or not drinking enough fluids. An underlying physical reason and some medications can also cause constipation. In some cases, however, children become constipated without any known cause (this is known as 'idiopathic constipation'). Constipation is a treatable medical condition, but encouraging your child to have a well-balanced, fibre-rich diet, get plenty of exercise and drink well (6-8 glasses of water-based fluid a day) will all help to keep poo soft and on the move (have a look at our information on how to prevent constipation). 5. My 6 year-old daughter regularly has small bits of dry poo in her pants. Is she just being lazy? It sounds like your daughter is constipated and the dry bits of poo in her pants are ‘overflow’ poo which have broken away from a blockage of hard poo in her rectum (called an impaction). The longer impacted poo stays stuck in the bowel, the harder it gets to push out. The overstretched rectum stops sending messages to the brain telling your daughter that she needs to do a poo. She can’t feel the poo breaking away into her pants and doesn’t have any control over this happening. So she’s definitely not being deliberately difficult or lazy! It’s important that your daughter is seen by a doctor as soon as possible so they can assess her for constipation and prescribe laxatives to clear the blockage and stop her soiling. 6. Surely my son can’t be constipated because he’s doing lots of very soft and runny poos? Soiling is fresh, runny overflow poo which leaks round a hard poo blockage (called an impaction) in the rectum. Faecal soiling is often mistaken for diarrhoea. Take your son to the doctor as soon as possible. They will assess him for constipation and, if necessary, prescribe medicine to clear out the poo blockage following the NICE guidelines on constipation in children and young people. 7. My son, who has recurring constipation and often soils his pants, starts school in September. What will the school do to help? It’s important to let the school nurse and the teaching staff know that your son suffers from constipation and soiling before he starts school. Schools must not discriminate against or disadvantage children with medical conditions, and this includes continence difficulties. So they can't deny a place to a child who may still be in nappies because of soiling or delayed toilet training. As the Department for Education's statutory guidance on supporting pupils at school with medical conditions states, it is not acceptable for schools to: prevent pupils from drinking, eating or taking toilet or other breaks whenever they need to in order to manage their medical condition effectively; require parents, or otherwise make them feel obliged, to attend school to administer medication or provide medical support to their child, including with toileting issues. No parent should have to give up working because the school is failing to support their child’s medical needs; prevent children from participating, or create unnecessary barriers to children participating in any aspect of school life, including school trips, e.g. by requiring parents to accompany the child. You should speak to the school about setting up an Individual Health Care Plan (IHCP) to manage your son’s constipation. The IHCP will set out a proactive toileting programme which focuses on getting him to do a poo in the toilet rather than dealing with soiling accidents. It’s not enough for your son simply to be given regular access to the toilet – young children with constipation need to be supervised when going to the loo. The IHCP should also ensure your son’s constipation and soiling is managed discretely and sensitively so that it doesn’t become apparent to other children. Our Right to Go campaign aims to improve support for children with continence problems in schools. Visit the campaign page for more information on setting up an IHCP and on getting your son's school to support him. 8. My GP prescribed a laxative for my daughter which has made her soiling worse. Should she stop taking it? No. If a child is chronically constipated and has impacted poo they will need to be given increasing doses of medicine (most commonly a macrogol laxative to soften stools, possibly with the addition of a stimulant laxative to work on the pushing action of the bowel muscles) over a period of 5-7 days to clear the blockage. Laxative treatment will result in some soiling but this is a natural part of the clear-out process, which is called 'disimpaction'. Many parents worry that the laxatives make the soiling problem worse, but it’s important that your daughter continues with the disimpaction. Stopping the medication too soon can result in the constipation recurring. A lower, ‘maintenance dose' of the medicine is taken once the impaction has been cleared to ensure the poo remains soft and easy to pass. Your daughter may have to take regular laxatives for several months or even longer. See our information on laxative treatment for more guidance. 9. My daughter doesn't drink very much and I'm finding it really difficult to get her to take the laxatives she's been prescribed. She hates the taste. What can I do? Children are more likely to accept their treatment if they understand why they need it, so try reading the children's section of our website with your daughter and some books on poo (available in our shop). Reward her for having her 'poo medicine' and increasing the amount she drinks each day. Some other tips: Make up the amount she needs and keep it in the fridge (it will keep all day). Some children find it easier to drink if it's cold and mixed with a sharp tasting juice such as lime or lemon. Once mixed with the right amount of water first, the medicine can be mixed with milk, vegetable juice, soup or anything else your daughter likes to drink. Stronger flavours hide it best. Offer her a straw to drink it through - this can make it more fun for young children. Drinking through a straw also bypasses some of our taste buds! Try a flavoured laxative such as Movicol Chocolate or orange, lemon or lime CosmoCol. If your daughter still won't drink it, ask your GP what other laxative options there are. See our factsheet on how to prepare macrogol laxatives. 10. I’m worried my son is going to become reliant on laxatives and his bowels will never get back to normal! There’s no evidence or medical research to suggest that laxatives damage the bowel or make it ‘lazy.’ By keeping his poo soft and on the move with effective laxative treatment, his overstretched bowel should go back to its normal size and your son should then be able to poo normally. Laxatives are seen as being a very safe treatment and some children will need to continue taking them into adulthood in a similar way that asthmatic children need an inhaler long-term. Any concerns about laxatives and their side effects should be discussed with a health professional. 11. We’ve tried several different laxative treatments and our daughter is still constipated. What can we do now? First check that you’re using the laxative treatment correctly (see our factsheet on how to prepare macrogol laxatives) and that your daughter has a good toilet routine in place. She may need to be cleared out ('disimpacted') first (see our factsheet 'A Parent's Guide to Disimpaction') so that the right maintenance dose is easier to find, or be given a combination of laxatives - one to keep the poo soft and another to work on the pushing action of her bowel muscles. If your daughter still isn't responding to treatment, as per the NICE Quality Standards, ask your GP to refer her to your local continence clinic for an assessment by a specialist continence nurse. The continence nurse may discover an underlying cause that hasn’t yet been identified (for example Hirschsprung’s disease, anorectal malformation, a spinal cord abnormality, or cystic fibrosis). Visit the Bladder and Bowel UK website for lots of downloadable resources for managing constipation in children who have underlying health conditions. 12. My 7 year-old son still wets the bed most nights and I’ve been told constipation could be the cause. Is this right? Yes, the bladder can also be affected by constipation. When the bowel gets overloaded with poo, it stretches and pushes against the bladder. This pushing distorts the bladder and makes it difficult to empty properly. Leftover wee in the bladder can cause urinary tract infections (UTIs). The squashing of the bladder also reduces the storage space for urine and can cause the sensation of needing to wee frequently and urgently. Both these can lead to daytime and nighttime wetting problems. See our information on how to deal with daytime wetting and bedwetting. 13. My son has autism and is also constipated. Our GP has said it's because of his additional needs and there's nothing we can do. Research shows that children on the autistic spectrum are more prone to constipation and tummy problems, but it should be treated in exactly the same way as a child without additional needs. For help with the behavioural side of toileting and children on the autistic spectrum call the ERIC helpline for information and signposting to other organisations who can help. 14. We’re finding it incredibly difficult to deal with our son’s constipation. Where can I get help and support? You can contact the ERIC helpline. Our advisors are on hand to talk to you about any concerns or problems you have. Childhood constipation is very common and there are many other parents dealing with it. Lots of parents find it useful to share their experience with others in a similar position, talk to them by joining our online community on HealthUnlocked.