My child goes every day, so how can they be constipated?

By Dr Rohan Malik

Paediatric gastroenterologist in Woolloongabba, Brisbane

If your child does a poo every day, constipation might be the last thing you’d suspect.

But how often a child goes to the toilet is only part of the picture. Children can open their bowels every day and still be constipated. This is something that can come as a surprise to families when constipation is suggested as the cause of their symptoms.

So, if frequency isn’t the only measure, what should parents be looking for?

Constipation isn’t just about how often your child goes

When we talk about constipation in children, we’re also interested in what the bowel motions are like and how easily they’re passed.

A child may be constipated if their stools are very large or hard, bowel motions are painful, or they’re not emptying their bowel completely – even if they’re still going regularly.

Some children may pass a small amount each day while stool continues to accumulate in the bowel.

That’s why simply counting trips to the toilet doesn’t always tell us what’s happening.

What other signs should parents look for?

There can be clues that a child is constipated despite regular bowel motions.

These may include:

• large or hard stools
• pain or straining when passing a bowel motion
• abdominal pain or bloating
• reduced appetite
• nausea
• skid marks or stool accidents in underwear
• avoiding or delaying going to the toilet
• very large bowel motions that may block the toilet.

Children don’t always tell parents they’re avoiding the toilet either. Withholding can look like standing stiffly, crossing their legs, going up on their toes or hiding when they feel the urge to go.

These behaviours can sometimes be mistaken for a child trying to do a poo when they’re actually trying very hard not to.

How can poo accidents be caused by constipation?

This is another part of childhood constipation that can be confusing.

When stool builds up in the bowel, the rectum can gradually stretch. Over time, a child may become less aware of the sensation that tells them they need to go to the toilet.

Softer stool can then leak around the retained stool and into their underwear. This is sometimes called overflow soiling.

Importantly, these accidents aren’t deliberate. A child may not even realise they’ve happened until afterwards.

Why do children hold on?

A painful bowel motion is a common starting point.

A child remembers that going to the toilet hurt, so the next time they feel the urge, they hold on. Unfortunately, withholding can make the next bowel motion harder and more uncomfortable, reinforcing the behaviour.

Other children may avoid toilets at school or childcare, become reluctant during toilet training, or simply not want to stop playing to use the bathroom.

Once this pattern becomes established, it can be difficult to break without addressing the constipation itself.

When is it worth getting checked?

If your child is having regular bowel motions but also experiencing ongoing abdominal pain, painful or unusually large stools, soiling, withholding behaviours or other bowel symptoms, it’s worth discussing constipation with your doctor.

The pattern over time is often more informative than bowel frequency alone.

Looking at the whole picture

A daily bowel motion doesn’t necessarily mean everything is moving as it should.

When assessing constipation, we look at much more than how often a child goes, including stool consistency and size, whether passing it is comfortable, withholding behaviours, accidents and other symptoms.

Recognising constipation early can help prevent the cycle from becoming established and get children back to comfortable, healthy bowel habits.