October 15, 2013

Ask: How to deal with poop problems?

UNC pediatrician Mike Steiner gives us the straight poop (sorry!) on what to do when your child is constipated.

Q. My son is having problems with poop. He seems to get constipated a lot and I don't know how to help him. Any suggestions?


A. Parents worry about their children's stooling habits practically from Day 1. In children there is actually a very specific definition for constipation, but if your child is having hard, painful stools that come infrequently, then they likely meet the criteria.  


In severe cases in school-aged children or older, sometimes stools are so big that they won’t flush down the toilet and children can have uncontrollable watery stool leakage into underwear because hard stool balls are in the colon blocking normal function.


Infants often appear to be pushing hard for stool to come out, but if the stool is soft when it comes out then they likely have infantile dyschezia, which is a muscular discoordination of trying to poop but not being able to push things out right because nerves and muscles aren’t working together.


As children get older, constipation becomes more common.  Toddlers who are toilet training often become constipated in the battle over using the toilet.  Once children become constipated and have a stool that hurts to come out,  it can become a vicious circle where they hold their stool because they don’t want the pain, but then the constipation becomes even worse.  Another common time for children to become constipated is when they start in school in kindergarten or first grade.  This is due to the change in schedule and sometimes not wanting to stool during the day.


The best initial treatment for constipation severe enough to see a doctor is the use of laxatives.  In children we usually use laxatives that increase water absorption into the bowel to make the stools softer. This type of laxative is not addictive, and longterm use is thought to be safe.  However, we do sometimes need to use stimulant laxatives that actually make the bowel move faster too.   Children generally need to be treated for constipation for at least 6-9 months, and if after that things are going well, parents can slowly try to decrease the medication dose or frequency. However, if the child goes a day without stooling then they'll need the medication again the next day. 


We like for kids to have at least 2 stools a day that are soft and consistency of pudding or soft serve ice cream---so much for that next dessert.  


Counseling may have a role for some children.


Over the long term, once the bowel has healed, then dietary interventions can help prevent more constipation.  The good news is that with early and aggressive treatment almost all children can outgrow constipation, so it’s definitely worth addressing with your health-care provider.   


If you have a question about your child's health or happiness, ask Dr. Steiner or any of our experts by sending email to



Dr. Mike Steiner is a pediatrician in the division of General Pediatrics and Adolescent Medicine at UNC and North Carolina Children’s Hospital, a group of health-care professionals dedicated to improving the health of children and adolescents through clinical care, research, education and advocacy. The group includes over 35 physicians, practitioners, nurses and other health-care professionals. We supervise the care of children with general medical problems at N.C. Children’s Hospital, including hospitalized children, the newborn nursery, primary care clinic and a complex care and diagnostic clinic that also sees patients at the N.C. Children’s Specialty Clinic located on the Rex Healthcare campus in Raleigh.


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