In addition to adjusting diet and taking medication for children’s constipation, bowel training is crucial!

Author: Wu Jie, Chief Physician, National Children's Medical Center, Beijing Children's Hospital, Capital Medical University

Reviewer: Yang Yunsheng, Chief Physician, PLA General Hospital

According to current statistics, nearly 10% of children will suffer from constipation, which is very common among children.

Constipation generally means that the number of bowel movements per week is less than three times; the stool characteristics change, the stool pieces are larger and drier, and some are spherical like sheep dung balls; defecation is difficult and cannot be defecate for a long time, or defecation is accompanied by pain, and the child needs medication and posture to assist defecation. The above are all manifestations of constipation. Some children will have fecal incontinence because the dry and coarse stools cause the rectum to expand, leaving a gap between the rectum and the large pieces of feces, and sometimes intestinal fluid will flow out of the gap.

Figure 1 Original copyright image, no permission to reprint

1. Why are children prone to constipation?

The average age of onset of constipation in children is around two years old, which is a relatively early age.

For children under three years old, the digestive system is not yet fully developed, and the colon and anus are not motile enough, which leads to difficulty in defecation. This is a physiological factor.

The second is genetic factors. If there is a family history of constipation, for example, if mom and dad were always constipated when they were young and had difficulty defecating, the child’s chances of constipation will increase.

Third, it is related to diet. Children only eat meat and eat less vegetables, fruits and other foods containing fiber. In addition, some children do not like to drink water, lack of exercise, and gastrointestinal motility is slow.

Fourth, sleep is irregular and disordered; the mood is particularly irritable or depressed, and there are mental and psychological problems, which are often accompanied by constipation.

Constipation first makes children feel uncomfortable. Every bowel movement is a painful process for children, which can cause children to fear bowel movements, become anxious, lose concentration, and even induce psychological problems. In addition, long-term constipation may cause abdominal distension, abdominal pain, poor appetite, and affect growth and development. Therefore, children's constipation should be taken seriously and should not be allowed to become a chronic disease.

Children with constipation first need to adjust their diet, supplement with enough fiber and water, and improve their lifestyle. If constipation persists or even worsens after lifestyle adjustments, medication is needed.

2. What are the medicines for treating constipation in children?

The main treatment for constipation in children is osmotic laxatives, such as polyethylene glycol and lactulose. These drugs can increase the moisture in the stool, soften the stool and stimulate defecation, and are the preferred drugs.

There are also some bulk laxatives, such as wheat bran, which are not absorbed by the body but can increase the water content in the stool. Children who do not get enough fiber or whose constipation is relatively mild and of short duration can choose bulk laxatives first, and their symptoms can be relieved after supplementation.

Stubborn constipation can easily cause feces to become impacted in the rectum and unable to be discharged. Stool softeners can help solve the problem, such as enema, but long-term use is not recommended and can only be used occasionally in emergency situations.

For acute constipation, such as after the use of antibiotics, which leads to intestinal flora disorder and constipation, you can try using some probiotic preparations.

Bowel training can establish good bowel habits for children and maintain the therapeutic effect of constipation. Otherwise, constipation may recur once the medication is stopped. Generally, children aged 2-3 years old can cooperate with bowel training.

3. How to train your child to have a bowel movement?

First of all, the time and frequency of training. Generally, you should train 1-2 times a day. Gastrointestinal motility is faster half an hour to an hour after a meal, and it is easier to establish defecation. For example, you can choose to do defecation training half an hour to an hour after breakfast. If time does not allow, you can also choose to do training half an hour to an hour after dinner. As long as it is fixed in a certain time period, regular and fixed-point training can help children establish a defecation reflex.

Figure 2 Original copyright image, no permission to reprint

It is recommended that defecation training should not exceed 10 minutes per training session to avoid causing disgust in children, which will not be worth the effort. If the child successfully defecates, give the child some rewards and praise in time to establish a virtuous cycle.

The second is the choice of toilet. I hope that the child will sit on his own potty to defecate, with the correct defecation posture, such as the knees higher than the buttocks, the body slightly leaning forward, and the feet touching the ground, so that the child can use strength when defecating.

Third, parents should train their children during the defecation process, such as holding their breath after exhaling, and exercising the ability of the anus and rectum to coordinate defecation.