According to the Mayo Clinic, several days between bowel movements; hard, dry and difficult-to-pass bowel movements; abdominal pain and/or irritability; nausea and/or poor appetite; the appearance of liquid or clay-like stool in the child's underpants or diaper; and/or bright red blood on the surface of hard stools suggest the presence of constipation in children. Signs and symptoms that last longer than two weeks are considered chronic and require evaluation by a doctor. Chronic constipation in toddlers poses both physical and psychosocial dangers.
Impaired Socialization
According to pediatric gastroenterologists Judith M. Sondheimer and Shikha Sundharam in the 2009 edition of "Current Diagnosis and Treatment: Pediatrics," chronic constipation in produces involuntary leakage of feces—called encopresis—in 60 percent of children. Children with encopresis frequently experience shame, guilt and loss of self-esteem. Toddlers who experience these symptoms may experience isolation and stigmatization from other children and even adults at a critical point in their development because of the stigma attached to involuntary defecation and the physical odor and mess it causes.
Problems with Toilet Training
Chronic constipation sets the stage for abnormal bowel habits that are difficult to eradicate and make toilet training much more difficult to achieve. According to the American Academy of Pediatrics, distention of the intestinal walls by accumulated stool actually decreases the bowel's ability to contract and expel fecal material. Chronic constipation can also cause nerve damage that leaves the toddler unable to recognize the urge to have a bowel movement or even detect that one has occurred. Toddlers who do recognize the urge to have a bowel movement may learn to voluntarily withhold feces, in an effort to avoid pain associated with large, hard stools.
Rectal Prolapse
According to the American Society of Colon and Rectal Surgeons, rectal prolapse occurs when the rectum actually starts to protrude from the anus. Chronic constipation can trigger the condition when the bowel becomes so habituated to distention from accumulated stool that it loses the ability to contract back to its normal size after stool is evacuated. Symptoms may include bleeding, itching, mucousy discharge and leakage of stool. Rectal prolapse requires surgical repair and, even then, a toddler may experience incomplete symptom resolution or require additional surgery as he grows older.
Megacolon and Megarectum
In the 2010 edition of "Schwartz's Principles of Surgery," Drs. Kelly Dunn and David Rothenberger explain that chronic constipation may also produce massive distention of the colon and/or rectum, conditions known respectively as megacolon and megarectum. Megacolon or megarectum with abdominal pain may constitute a medical emergency due to the risk of perforation or death of the bowel wall without perforation. Treatment begins with admission to the hospital for decompression of the bowel, an experience that may be extremely traumatic to the toddler, even in the absence of perforation. If perforation does occur, it may cause death from bleeding or infection. Treatment often entails surgical removal of the colon.
References
- “Current Diagnosis and Treatment: Pediatrics, 19th ed.;” W.W. Hay et al.(eds); 2009
- MayoClinic.com: Constipation in children
- American Academy of Pediatrics: Soiling (Encopresis)
- American Society of Colon and Rectal Surgeons: Rectal Prolapse
- "Schwartz's Principles of Surgery, 9th ed.;" F.C. Brunicardi et al. (eds.); 2010
