Children: Constipation and Hydration – Causes and barriers

Let’s look at the science first. The food we eat goes through our stomach, into our small intestines where lots of the nutrients are absorbed, then into our large intestines (or colon) where most of the water is absorbed. After all these processes, you are finally left with stool. In the simplest terms, the less we drink, the harder and drier our stools are.

So why does this matter more in children than adults? Well, as adults we have far more control over when we push stool out, and we accept that sometimes this can come with a bit of discomfort or pain. For a child, the pain of doing a poo is scary. They don’t understand it and they don’t like it. Therefore – like many learned habits at that age – they shy away from anything that causes discomfort and pain. This leads to a fear of going to the toilet, which leads to a vicious circle: more constipation, which, in turn, brings more discomfort.

If keeping well-hydrated helps make the stools softer and more comfortable to push out, constipation and the complex behavioural patterns that build around children's toilet habits can hopefully be avoided.

Laxatives are medications that help loosen stool and increase the frequency of bowel movements. They fit into two categories: stimulants and osmotics. Stimulant laxatives like senna encourage the bowel to contract and push stool through the body. They are more commonly prescribed to adults than children.

An osmotic laxative such as Movicol or lactulose suit children better. These work to soften stool by keeping it hydrated. Imagine the stool is a sponge: usually the colon's job is to reabsorb water from stool back into the body, making it drier and firmer. But the osmotic laxative prevents this, keeping the stool like a big squishy sponge, passing easily through the digestive system to the rectum and softly out the other end.

It requires children to drink plenty of water to aid this process, and needs to be taken for a few days to see results. This medication is widely used and considered very safe. Some children require daily osmotic laxatives for an extended period of months to years to support normal bowel movements as they grow up.

Fibre is very important in helping and preventing constipation. It acts to bulk up the stool, helping your body move it through the intestines. Foods high in fibre include fruits, vegetables, cereals and wholemeal bread. Including these in a child’s diet can sometimes be tricky, but two easy tricks are blending extra vegetables into sauces or soups, and using dried fruit such as raisins or prunes as snacks.

Children need time to do a poo, and a space free of interruptions or feeling pressured. Getting in the right position can help. The squatting position, where the knees are above the hips, makes squeezing a poo out just a bit easier. You could try sitting them on the loo with their feet on a stool or upturned bowl.

The key to this, in my opinion, is availability. Children often get distracted with the wonderful things in the world around them, so it's easy for them to forget to drink. Keeping a cup or glass filled with water nearby will dramatically increase the chance of them drinking small amounts throughout the day. Schools have become much better at allowing children to have water in lessons, but as school makes up such a large part of their week, make sure that your child is in a position to drink through the day.

Laxatives can be difficult to get down children. Flavoured versions dissolved in water do entice children, but it is still hard for parents. Offering juice can be a good way to disguise the flavour, but the best advice is to try to stay relaxed. Your child will read your cues, so if you are anxious and desperate to get them to take it, they will feel the pressure and become reluctant. Give it time, and your patience will be rewarded with success. But as a Paediatrician, I am well aware that this is easier said than done!

• Written by Dr Tom Maggs, General Manager at Healthwords and Paediatrician