There are many different causes of constipation. By far the most common is a lack of fibre or bulk in the child’s diet. Some children hold back, often because they are too busy playing or it is otherwise inconvenient, so that stool accumulates and having a bowel movement causes discomfort and pain. Sometimes, especially in babies and toddlers, passing a hard bowel motion may cause a tear in the lining of the anus (anal fissure), causing painful defaecation and leading the child to hold back because of the pain. In this way, a vicious cycle is created, with holding back because of pain causing further constipation, which then means more pain. Toddlers may hold back during attempts at toilet training, so beginning this cycle. In rare cases, there are neurological reasons for constipation.
The child will have less frequent bowel movements than usual, and may complain of difficulty in passing a movement. Often there will be associated discomfort and sometimes pain on defaecation. In some children there is abdominal pain, usually in the centre of the abdomen around the umbilicus, and often spasmodic like colic. Parents will comment that the child is listless and has lost his appetite.
*345\90\8*
