Intro
Constipation is one of the most common causes of abdominal pain in children — and one of the most frequently missed.
Children may still pass stools regularly and still be constipated. Pain, nausea, poor appetite, and even vomiting can result from stool retention.
Key Points
- Constipation can cause chronic or recurrent abdominal pain
- Children may hide or deny stool problems
- Soiling does not rule constipation out — it often confirms it
- Treatment usually requires weeks to months, not days
- Untreated constipation increases anxiety and pain cycles
Signs Parents Often Miss
- Large or painful bowel motions
- Avoidance of toileting or “withholding”
- Soiling or “skid marks” in underwear
- Abdominal bloating or a “full” belly
- Poor appetite or early fullness
- Pain that improves after passing stool or gas
Why Constipation Hurts
When stool accumulates:
- The bowel stretches and loses sensitivity
- Normal urge signals weaken
- Liquid stool may leak around hard stool (soiling)
- Pain becomes chronic and unpredictable
This creates a self-reinforcing loop:
pain → withholding → stool retention → more pain
The Constipation Cycle (Why it becomes chronic)
Many children with constipation aren’t “lazy” or “not trying.” They’re avoiding pain.
Common triggers:
- A single painful bowel motion
- Fear of using toilets at school
- Busy routines that reduce toilet time
- Low fluid intake during school days
Over time:
- The rectum stretches
- The urge to go becomes weaker
- Stools become larger and harder
- Accidents and embarrassment increase stress
This is why constipation often needs a longer plan, not a quick fix.
Treatment Basics (General Guidance)
Always follow clinician advice — this is educational, not prescriptive.
A typical approach includes:
- Stool softeners (often needed for longer than parents expect)
- Adequate fluids
- Regular toilet routines (often after meals)
- Fibre introduced gradually (too much too fast can worsen cramps/gas)
- Avoid punishment or pressure (it worsens withholding)
A simple routine that helps many families
- Sit on the toilet 5 minutes after meals
- Feet supported (small stool/box)
- Calm environment (no shame, no threats)
- Track frequency + stool consistency (even brief notes help)
When to Seek Review
Seek medical review if:
- Pain persists despite constipation support
- Weight loss, poor appetite over time, or poor growth
- Persistent vomiting or dehydration
- Blood in stool with significant pain
- Severe abdominal distension
- Constipation starting in infancy
- Recurrent soiling that isn’t improving
When to seek urgent care
Go to urgent care / ED if there is:
- Severe or rapidly worsening belly swelling
- Persistent vomiting with inability to keep fluids down
- Child is unusually drowsy, faint, or very unwell
- Severe abdominal pain that is worsening (especially if localised)
Decision Tree (Constipation vs “Something Else”)
flowchart TD
A[Child has abdominal pain] --> B{Any red flags?<br/>Persistent vomiting, severe distension,<br/>blood + significant pain,<br/>very unwell, dehydration}
B -->|Yes| R[Urgent medical review]
B -->|No| C{Constipation clues?<br/>Painful/large stools,<br/>withholding, soiling,<br/>bloating, pain improves after stool}
C -->|Yes| D[Constipation pathway<br/>Hydration + routine + clinician plan]
C -->|No| E{Pain progressing or localising?}
E -->|Yes| F[Same-day review<br/>Consider appendicitis/UTI/other]
E -->|No| G[Monitor + reassess<br/>Return if worsening]