Chronic constipation, or infrequent and/or hard bowel movements that last more than a few days, can be a frustrating and uncomfortable problem. Sometimes it can also lead to soiling of the underwear, something called encopresis. There are many things that can cause chronic constipation; some children are simply more prone to constipation, but even children who usually have normal bowel movements can develop chronic constipation after an illness, during toilet training, when they have a fissure or other skin condition around the anus, or when there is a life change (such as starting a new school).

There are also medical conditions, such as hypothyroidism, that can cause chronic constipation. So if there isn't a clear explanation for your child's constipation, if your child is having other symptoms such as frequent abdominal pain, fever, low energy, or vomiting -- or if the constipation has been going on for a long period of time (more than a month or two), you should call your doctor before using this guide. Remember that this guide is not meant to take the place of a visit to your doctor's office.

The treatment of chronic constipation involves clearing the bowel of the large amount of hard stool, preventing the return of constipation, and teaching normal bowel habits. This may involve medications in addition to changes in diet and toileting behavior.

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The first step in treating constipation is to "clean out" any stool that has built up in the intestines (bowels).

When a child has not pooped for several days, stool collects in the lower bowel (rectum). This causes the bowel wall to become stretched out. This feeling of the bowel being stretched is what normally makes us realize we have to go to the bathroom.

However, if the child isn't pooping regularly and the bowel wall stays stretched for a long time, it loses its normal muscle tone and feeling. Then it becomes harder and harder to pass the enlarging amount of stool, creating an unhealthy cycle.

In order to treat constipation, we must break this cycle.

The first step: emptying the rectum

If your child has not had a bowel movement for quite some time, medications are often needed to help empty the rectum. Most children can be managed with medications given by mouth (reviewed at the end of this tool), but some need suppositories or enemas which are put directly into the rectum. Which medications are recommended will depend on your child's age, how long your child has been constipated, and how much stool has built up in the rectum. In rare cases, children need to be admitted to the hospital to have this done.

Your doctor will help you figure out the best way to empty your child's rectum.

The next step: preventing stool build-up

Once the rectum has been emptied, your child must try to prevent the stool from building up again. This usually is done by making changes in your child's diet, developing regular toilet habits, and if necessary, taking some medications.

Let’s start with changes you can make in your child’s diet.

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The things that your child eats and drinks affect the bowel movements. Remember that we eat food to get energy and nutrition. What is left over after going through the stomach and intestines becomes a bowel movement.

Let's start with juice.

Does your child drink juice?

Yes, my child drinks some juice.

No, my child does not drink any juice.

In general, it is not good for children to drink too much juice because it is high in sugar and calories, which can cause cavities and unnecessary weight gain. However, children with constipation should drink some juice every day. The fruit sugars (sorbitol) in juice help to make your child's stools softer and more frequent. In fact, when toddlers drink too much juice, they often get diarrhea (lots of soft stools).

Prune, pear and apple juice are the best (in that order) for helping to soften stools. Encourage your child to drink four to eight ounces of these juices every day.

What about milk?

Good. The fruit sugars (sorbitol) in juice help to make your child's stools softer and more frequent. In fact, when toddlers drink too much juice, they often get diarrhea (lots of soft stools).

However, some juices work better than others at treating constipation. Prune, pear and apple juice are the best (in that order) for helping to soften stools. Encourage your child to drink four to eight ounces of these juices every day.

Remember that it is not good for children to drink too much juice because it is high in sugar and calories, which can cause cavities and unnecessary weight gain.

What about milk?

How much milk does your child drink each day?

My child drinks more than 16 ounces of milk each day.

My child drinks 16 ounces or less of milk each day.

Most children need only 16 ounces of milk or two servings of other dairy products each day to get enough important nutrients.

What about water?

Too much milk, especially whole milk, can be constipating. Children older than the age of two should drink low-fat or non-fat milk (which is usually less constipating than whole milk) and generally do not need more than 16 ounces of milk per day.

What about water?

How much water does your child drink?

My child drinks lots of water.

My child drinks some water.

My child rarely drinks water.

Children need to drink a lot during the day. Water keeps us well-hydrated without any excess calories or sugar and helps keep stools soft. Drinking too much juice, soda, or milk every day will give your child more calories than he or she needs and may lead to dangerous weight gain. Drinking too much juice or soda can cause cavities, too.

What about bread?

That's good. Perhaps you could encourage your child to drink more. Aim for three or four glasses of water a day.

Water keeps us well-hydrated without any excess calories or sugar and helps keep stools soft.

What about bread?

Excellent! Water keeps us well-hydrated without any excess calories or sugar and helps keep stools soft. Aim for three or four glasses each day.

What about bread?

What kind of bread does your child eat?

My child eats whole wheat bread.

My child eats white bread.

Most children will eat whole wheat bread. Try it! Whole wheat bread has more fiber (about three times as much as white bread) and natural nutrients. Make sure the label says 100 percent whole wheat. Other "wheat breads" have lots of processed, lower fiber white flour in them. Look for whole wheat pasta as well.

What about rice?

Excellent! Whole wheat bread has more fiber (about three times as much as white bread) and natural nutrients. Make sure the label says 100 percent whole wheat. Other "wheat breads" have lots of processed, lower fiber white flour in them. Look for whole wheat pasta as well.

What about rice?

What kind of rice does your child eat?

My child eats brown rice.

My child eats white rice.

My child doesn't eat rice.

Remember that it takes many tries before a child likes any food. If your child is constipated, it is best to avoid white rice and offer brown rice instead.

What about cereals?

White rice is much lower in fiber than brown rice, and eating too much of it can cause constipation. If your child is constipated, it is best to offer brown rice instead.

What about cereals?

That's great! Brown rice is unprocessed and has more than twice the fiber as white rice.

What about cereals?

Does your child eat cereal for breakfast?

Yes, my child eats cereal for breakfast.

No, my child doesn't eat cereal for breakfast.

Cereal is a great source of fiber. Perhaps you could try different varieties.

Other breakfast foods can get fiber into their diet. Other higher fiber breakfast foods include oatmeal, whole wheat toast, whole wheat English muffins, bran muffins and whole grain waffles.

Crackers are grains, too.

Choose cereals that are made from whole grains and that are high in fiber. Some good choices include oatmeal, shredded wheat, bran flakes, raisin bran, bran chex, and whole wheat flakes.

Crackers are grains, too.

Does your child eat crackers?

Yes, my child eats crackers.

No, my child doesn't eat crackers.

Crackers can be a good source of fiber. Look for whole grain, high fiber varieties, such as Triscuits or Wheat Thins.

Other higher fiber snack foods include graham crackers, fig or dried fruit cookies, and whole wheat pretzels. Older children can also eat unbuttered popcorn.

What about fruits?

Excellent! Crackers can be a good source of fiber. Look for whole grain, high fiber varieties, such as Triscuits or Wheat Thins.

Other higher fiber snack foods include graham crackers, fig or dried fruit cookies, and whole wheat pretzels. Older children can also eat unbuttered popcorn.

What about fruits?

Fruits have lots of fiber and water.

Does your child eat at least 2-3 servings of fruit each day?

Yes, my child eats at least 2-3 servings of fruit each day.

No, my child doesn't eat much fruit.

Remember, children need to try things ten or more times before they like them.

Some fruits seem to help with constipation more than others. Dried fruits, such as prunes, raisins, and apricots will help. Fresh or canned fruits that help with constipation include pears, peaches, plums, prunes, apricots, and oranges.

Avoid bananas, as they can make constipation worse.

How about vegetables?

That's great! Some fruits seem to help with constipation more than others. Dried fruits, such as prunes, raisins, and apricots will help. Fresh or canned fruits that help with constipation include pears, peaches, plums, prunes, apricots, and oranges.

Try to limit their consumption of bananas, as they can make constipation worse.

How about vegetables?

Vegetables are high in fiber, too.

Is your child eating two to three servings of vegetables every day?

My child eats at least two to three servings of vegetables every day.

My child doesn't eat many vegetables.

Many children (and adults, too) do not get enough vegetables.

Fresh vegetables are great. Try not to overcook them. Salads are good, too. It is fine to use salad dressing if that helps your children eat more vegetables.

Remember to never serve raw vegetables to children under age three, as they can cause choking.

Along with diet, regular toilet habits are important, too.

That's great!

Fresh vegetables are great. Try not to overcook them. Salads are good, too. It is fine to use salad dressing if that helps your children eat more vegetables.

Remember to never serve raw vegetables to children under age three, as they can cause choking.

What about regular toilet habits?

Your child needs to learn to have a bowel movement every day.

Does your child have a regular time for sitting on the toilet?

Yes, my child has a regular time.

No, my child does not have a regular time.

To help your child learn to have a bowel movement every day, it is important to have regular toilet habits. Encourage your child to sit for five to ten minutes after meals. (People often have the urge to go to the bathroom shortly after eating.) You can use a calendar with stickers to keep track of sitting time and stools.

What about exercise?

That's great.

To help your child learn to have a bowel movement every day, it is important to have regular toilet habits. Encourage your child to sit for five to ten minutes after meals. (We often have the urge to go to the bathroom shortly after eating.) You can use a calendar with stickers to keep track of sitting time and stools.

What about exercise?

Getting your child moving may help to get the bowels moving, too. Encourage your child to get regular exercise. Walk to school, ride bikes, play soccer or basketball. Limit television, computer and video game time to one hour per day in younger children and two hours for older kids.

In addition to the recommendations above, some medications may be necessary.

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Following a non-constipating, fiber and fluid-rich diet, having regular toilet habits, and getting plenty of exercise are enough to manage constipation for some children. However, many children need some type of medication to help treat their constipation until their colon has returned to normal.

Your child's doctor may recommend one or more of the following medications to treat the constipation and prevent it from happening again.

With any medication, make sure you follow the dosage directions exactly. If you are not sure how much to give your child, call your doctor.

Click here for information on mineral oil.

Click here for information on milk of magnesia.

Click here for information on lactulose or sorbitol.

Click here for information on polyethylene glycol (Miralax).

Click here for information on senna and bisadocyl.

Mineral oil helps to soften the stool and make it easier to come out. It does not have any taste and usually is mixed in with other foods. Some children do not like the way it feels (texture). Mineral oil should never be given to children younger than one year of age or children with swallowing difficulties or reflux, unless directed by a doctor, because it can damage the lungs if it is inhaled while drinking.

Click here for information on milk of magnesia.

Click here for information on lactulose or sorbitol.

Click here for information on polyethylene glycol (Miralax).

Click here for information on senna and bisadocyl.

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Milk of magnesia (magnesium hydroxide) is a laxative, meaning that it makes a child want to have a bowel movement. It is generally well-tolerated by children. Review the dose carefully with your doctor, as giving too much can cause serious problems.

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Click here for information on polyethylene glycol (Miralax).

Click here for information on senna and bisadocyl.

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Lactulose and sorbitol are nonabsorbable carbohydrates (large sugars) that act as laxatives to promote bowel movements. They are very sweet. If the dose is too high for your child, they can cause excess gas (flatulence), belly (abdominal) cramps, and diaper rash. Call your doctor if any of these symptoms occur.

Click here for information on mineral oil.

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Click here for information on polyethylene glycol (Miralax).

Click here for information on senna and bisadocyl.

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Polyethylene glycol or PEG (for example, Miralax), is another nonabsorbable substance that helps to increase the water content of and soften the stools. This tasteless powder is added to a child's favorite drink.

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Click here for information on lactulose or sorbitol.

Click here for information on senna and bisadocyl.

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Senna (for example, Senokot) and bisadocyl (Dulcolax) are motivating laxatives. They should not be used for prolonged periods.

For various reasons, these treatment options do not work for every child. If your child has repeated problems with constipation, you may be referred to a gastroenterologist, a doctor who specializes in problems with the gastrointestinal (stomach and colon) system.

Click here for information on mineral oil.

Click here for information on milk of magnesia.

Click here for information on lactulose or sorbitol.

Click here for information on polyethylene glycol (Miralax).

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You have completed this guide on the treatment of constipation in children. We hope this information has been helpful to you. Thank you for reading!