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Constipation in children

How do doctors diagnose constipation in children?

Your doctor will ask you questions and examine your child to make sure your child has constipation and to find out what might be causing it.

Getting details about symptoms

Your doctor might ask these questions to find out if your child has constipation and how bad it is.

Source:
Arce DA, Ermocilla CA, Costa H.
Evaluation of constipation.
American Family Physician. 2002; 65: 2283-2290.

Source:
Nelson R, Wagget J, Lennard-Jones JE.
Constipation and megacolon in children and adults.
In: Misiewicz JJ, Pounder FR, Venables CW (editors). Diseases of the Gut and Pancreas. 2nd edition. Blackwell Science.

Source:
Baker SS, Liptak GS, Colletti RB, et al.
Constipation in infants and children: evaluation and treatment: a medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition.
Journal of Pediatric Gastroenterology and Nutrition. 1999; 29: 612-626.

How often does your child usually pass a stool? Has this changed recently?
What do the stools look like? Are they big or small, hard or soft, formed or loose? What color are they?
How hard is it for your child to pass a stool? Does your child strain? And how long does it usually take?
Does your child say it hurts? Do they get upset?
Does your child put off going to the bathroom?
Does your child get a stomach ache in between bowel movements? Does it ease up after your child has gone to the bathroom?
When did the constipation begin?
Is there any blood on the toilet paper or in your child's stools?
Does your child always have symptoms, or do they come and go?
Is your child less hungry than usual?
Is your child losing weight? Do they have a

fever
If you have a fever, your body temperature is above 98.6 degrees Fahrenheit (37 degrees Celsius). With a fever you often get other symptoms, such as shivering, headache or sweating. A fever is usually caused by an infection.

fever or vomiting?
If your child is toilet-trained, does your child ever leak very soft or liquid stools into their underwear?

Figuring out what's causing the constipation

Your doctor will also try to work out what's causing your child's constipation. They may ask these questions.

Source:
Arce DA, Ermocilla CA, Costa H.
Evaluation of constipation.
American Family Physician. 2002; 65: 2283-2290.

Do other members of your family have constipation? (It can run in families.)
What's your child's diet like? (Not getting enough water and

fiber
Fiber is all the parts of your diet that your body can't absorb. This is why foods that are high in fiber make you have more bowel movements. When your body can't absorb something, it leaves your body in your stools. Foods high in fiber include wholemeal bread and cereals, root vegetables and fruits.

fiber may cause constipation.)
Has your child's daily routine changed? For example, have they started a new school or been on vacation? (Changes like this can trigger the problem.)
Is your child taking any medications, herbal remedies or vitamins?
What's your child's behavior like? (Holding in stools may be a way to get attention.)

Your doctor may also ask you questions that you find upsetting, such as whether your child might have been abused. This is just to check all possible causes of your child's problem. Try to answer as best you can and not worry about it.

To get even more information, your doctor may ask you to write down what your child eats and how often they pass a stool.

Examining your child

Your doctor may look at your child's bottom to see if it's red or cracked and to check for signs of leaking stool.

Source:
Gold DM, Levine J, Weinstein TA, et al.
Frequency of digital rectal examination in children with chronic constipation.
Archives of Pediatrics and Adolescent Medicine. 1999; 153: 377-379.

⁴

Source:
Lake AM.
Chronic abdominal pain in childhood: diagnosis and management.
American Family Physician. 1999; 59: 1823-1830.

⁵

Your doctor may also put a finger inside your child's

anus
The anus, which is at the end of the rectum, is where a stool leaves your body when you go to the bathroom. Part of the anus is a muscle that helps you hold in the stool until you are on the toilet.

anus to check:

Source:
Gold DM, Levine J, Weinstein TA, et al.
Frequency of digital rectal examination in children with chronic constipation.
Archives of Pediatrics and Adolescent Medicine. 1999; 153: 377-379.

⁴

Source:
Lake AM.
Chronic abdominal pain in childhood: diagnosis and management.
American Family Physician. 1999; 59: 1823-1830.

⁵

If the muscles that let out stools are working properly
If your child's

rectum
The rectum is the last six to eight inches of the large intestine, ending with the anus (where you empty your bowels).

rectum feels normal inside
If there's a little or a lot of stool in your child's bowel, and how soft or hard it is.

Making the diagnosis

After talking to you and examining your child, there's a good chance your doctor will be able to tell if your child has constipation and what's causing it. Your child probably won't need any tests.

But your doctor may suggest tests if:

They aren't sure your child has constipation
Your child has serious symptoms (fever, vomiting or weight loss)
They think a medical condition could be causing your child's constipation.

To learn more, see Tests for constipation in children.

Sources for the information on this page:

Arce DA, Ermocilla CA, Costa H.Evaluation of constipation.American Family Physician. 2002; 65: 2283-2290.

Nelson R, Wagget J, Lennard-Jones JE.Constipation and megacolon in children and adults.In: Misiewicz JJ, Pounder FR, Venables CW (editors). Diseases of the Gut and Pancreas. 2nd edition. Blackwell Science.

Baker SS, Liptak GS, Colletti RB, et al.Constipation in infants and children: evaluation and treatment: a medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition.Journal of Pediatric Gastroenterology and Nutrition. 1999; 29: 612-626.

Gold DM, Levine J, Weinstein TA, et al.Frequency of digital rectal examination in children with chronic constipation.Archives of Pediatrics and Adolescent Medicine. 1999; 153: 377-379.

Lake AM.Chronic abdominal pain in childhood: diagnosis and management.American Family Physician. 1999; 59: 1823-1830.

This information was last updated on May 12, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.

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