Is This Really Constipation? It’s Not Always What You Think

Child feeling sick

If you ask most parents what are the symptoms of a child with constipation, most will say crying while trying to go to the bathroom, avoiding going to the potty, and hard, dry stools that finally are passed. Sometimes constipation does not present itself that way.

There are several other different signs and symptoms that a child may be suffering that can come from long-standing constipation. Some of these signs and symptoms are:

  • Bed-wetting (after the child has been fully potty trained)
  • Loose, watery stools
  • Nausea, vomiting, complaining of stomach ache and exhibiting stomach flu like signs
  • Urinary tract infections
  • Lethargy and fatigue; wanting to take naps and not play
  • Loss of appetite
  • Being picky about food
  • Does not want to leave the house or other familiar places
  • Hiding in private areas of the house more than usual
  • Becoming combative and irritable

If your child’s bowel movements have not been regular and they are exhibiting one or more the above, your child may have constipation.

Bed-wetting

Enuresis is another term for “bed-wetting” (wetting at night during or around sleep) or “accidents” (wetting during the day), especially after the child is potty-trained.  This can be disconcerting especially after the child has achieved full dryness and potty-training during daytime and nighttime.  How does this happen?  When the child has a large, impacted stool sitting in their lower abdomen, there is constant pressure that is felt whether they express it or not.  They know any movement or bearing down, as in urination, can cause that stool to pass. Avoiding the pain, their body not only withholds the stool but now also “holds-in” the urine.  The bladder then overflows and with a combination of lack of space in the lower abdomen, the urine will flow out uncontrollably - causing an “accident.”

Loose, Watery Stools

Another term for loose, watery stools is diarrhea and it can also occur in constipated children.  How is this possible? This starts as one or more episodes of constipation. The child remembers the experience and most of the time will not or cannot communicate it to the parent or caregiver. Instead, the child will innately withhold stool or avoid defecating. When this occurs, even more water is absorbed from the stool and new intestinal contents into the body. As a result, the stool becomes hard and impacted, causing more obstruction and difficulty passing the stool. The stool remains there for days and there is new fecal matter that needs to be eliminated.  Sometimes, the liquid stool leaks around an impacted stool mass, resulting in staining of the underwear. This is an involuntary action that can be misinterpreted by parents as a fecal accident not related to constipation. Another term for this is encopresis which is having a fecal accident after achieving full potty training.

Nausea, vomiting, complaining of stomach ache

Constipation can look like the symptoms of the stomach flu. Nausea, vomiting, complaints of stomach pain and also diarrhea and soiling are signs and symptoms that both conditions share.  Constipation will not come with a fever and stomach flu sometimes accompanies a fever.  Lack of appetite is also a sign of both.  These symptoms should be considered especially in children that are not able to express exactly how they are feeling such as toddlers and the child must be evaluated by a health care professional to make sure that an infection is ruled out.

Urinary Tract Infections

Urinary Tract Infections (UTIs) can also be a sign of constipation.  As explained in the “Bed-Wetting” section above, when children have large, impacted stools sitting in their lower abdomen, there is constant pressure that is felt whether they express it or not.  They know that bearing down, as in urination, can cause that stool to pass. Avoiding the pain, their body not only withholds the stool but now also “holds-in” the urine. When a child withholds the urine for a prolonged and repeated basis, the child is prone to developing urinary tract infections. To make matters worse, if the child is uncontrollably soiling due to passing loose fecal matter around the impacted stool, that also contributes to the child developing urinary tract infections.

Changes in Behavior

  • Other behavioral changes listed above can also be signs in a child suffering with constipation:
  • Lethargy and fatigue; wanting to take naps and not play
  • Loss of appetite
  • Being picky about food
  • Does not want to leave the house or other familiar places
  • Hiding in private areas of the house more than usual
  • Becoming combative and irritable

Again, these are mostly seen in children who are unable to express the exact pains and feelings they are expressing, namely toddlers and infants.  It is important to note that all of these are also signs of the conditions that mimic constipation: bedwetting/enuresis, stomach flu, urinary tract infections and other pediatric conditions. 

If you see the signs described above, the child has not had a normal bowel movement in 24 -36 hours and the child does not have fever, you can try increasing the child’s hydration with water and/or prune or pear juice.  If a normal bowel movement is still not passed, Pedia-lax® products such as the chewable tablets or liquid stool softener can be used as directed. If the problem and symptoms persist or worsen within a 24-hour period, you must contact the doctor.

As always, it is always the best practice to consult your child’s pediatrician to make sure a thorough and comprehensive medical exam is conducted and all serious medical conditions are ruled out.