Families Bowel problems Spotting the signs of constipation in children Signs of constipation in children include: Avoiding emptying the bowels Some children avoid going to the toilet to do a poo. This is called stool withholding. Your child might cross their legs, sit on the back of their heels, clench their buttocks and generally be fidgety to resist the need to poo. The poo gets bigger and harder the longer the child holds it in. Eventually, when they absolutely have to go, it is very painful and difficult to pass. Your child might start withholding stools for several reasons: they’ve had a bad and possibly painful pooing experience before they might have a sore bottom or anal fissure (a tear in the anal canal) which makes pooing very painful they might not want to use unfamiliar or unclean toilets and prefer to hold on until they get home. Crying when pooing A child who cries when they poo might be trying to pass a large, hard poo. Straining and forcing out a large poo can cause anal fissures, which can make pooing even more painful. Pooing in pants / soiling Severe constipation can cause faecal impaction – when a very big poo or build-up of poo gets stuck in the rectum, the lowest part of the bowel. Faecal impaction causes the rectum to stretch and the sensation of needing the toilet is reduced. When stretched, the rectum becomes floppy, making it more difficult to pass a large poo. Impaction can lead to faecal soiling or overflow, where small bits of poo break off into the child’s pants or soft, sometimes runny poo leaks around the large blocked mass in the rectum. Soiling is often mistaken by parents for diarrhoea. A child who soils shouldn’t be seen as lazy; they have no control over it, can’t feel it and often don’t smell it either. Other signs of constipation to look out for: pooing less than four times a week or more than three times a day regular and foul-smelling wind foul-smelling poo a painful tummy or bottom a distended (i.e. swollen or bloated) tummy hard poo or runny poo (without associated vomiting) poor appetite lack of energy unhappy, angry or irritable mood day or night time wetting urinary tract infection Download the Bristol Stool Form Scale to identify whether your child is constipated. The ideal poo is Type 4 on the scale – a soft, smooth, sausage shape.