Fecal Impaction (Child)

A normal stool is soft and easy to pass. But sometimes stools become firm or hard. They are difficult to pass. They may pass less often. This is called constipation. It's common in children.

If a child is constipated, stool can harden in the rectum. New stool will keep forming in the colon but can’t pass the blockage. This is called fecal impaction. Fecal impaction can cause symptoms like:

  • Inability to pass stool

  • Passing only pea-sized stool

  • Uncontrolled watery diarrhea (if the bowel is not completely blocked)

  • Swollen and painful belly (abdomen)

  • Refusal to eat

  • Problems holding in urine

  • Painful bowel movements

  • Postures or behavior that show discomfort

  • Stool in child's underwear

  • Bloating

  • Vomiting

  • Painful bowel movements

  • Itching, swelling, bleeding, or pain around the anus

Fecal impaction from constipation can have many causes, such as:

  • Eating a diet low in fiber

  • Eating too many dairy foods or processed foods

  • Not drinking enough liquids

  • Lack of exercise or physical activity

  • Stress or changes in routine

  • Ignoring the urge to have a bowel movement or delaying bowel movements

  • Medicines like prescription pain medicine, iron, antacids, certain antidepressants, and calcium supplements

  • Dehydration from vomiting or diarrhea

  • Underlying illness

Fecal impaction can also be caused by a child holding in stool on purpose. This may be out of fear of pain with their bowel movement. Some children hold in stool to avoid using public or school restrooms.

Home care

Your child’s healthcare provider may prescribe a stool softener. This will help your child have a bowel movement. In some cases, other methods may be advised to loosen hard stool. These may include a glycerin suppository or laxatives. You may need to use an enema or irrigation to loosen hard stool, which is then removed. Follow all instructions on how and when to use these products. It's no longer thought that laxatives can cause damage to the intestine. However, some are better choices for occasional and long-term use. Your healthcare provider will help with the decision on whether laxatives are necessary.

Food, drink, and habit changes

You can help treat and prevent your child’s constipation with some simple changes in diet and habits.

Make changes in your child’s diet, such as:

  • Replace cow's milk with a nondairy milk or formula made from soy or rice. Discuss any change with your provider first.

  • Increase fiber in your child’s diet. You can do this by adding fruits, vegetables, cereals, and grains.

  • Some fruit juices, like pear and prune, can also be helpful.

  • Make sure your child eats less meat and processed foods.

  • Make sure your child drinks more water.

  • Be patient and make diet changes over time. Most children can be fussy about food.

  • If you are unsure about your child's intake, try keeping a diary for a few days of everything they eat and drink. This can help your healthcare provider determine if your child's diet may be causing the constipation.

Help your child have good toilet habits. Make sure to:

  • Teach your child not to wait to have a bowel movement.

  • Have your child sit on the toilet for 10 minutes at the same time each day. This helps to create a routine. Doing this after each meal can be very helpful. This helps create a routine and uses the body's natural tendency to move the bowels after meals.

  • Give your child a comfortable child’s toilet seat and a footstool.

  • Talk with your child’s school. Ask them to allow your child to use the restroom on a regular basis. If your child is not able to use a public bathroom, ask if the school may allow your child to use a private bathroom, if available.

  • Read a book or keep your child company, if that helps.

Follow-up care

Follow up with your child’s healthcare provider. If X-rays were done, you will be told of any new findings that may affect your child's care.

Special note to parents

Learn to be familiar with your child’s normal bowel pattern. Note the color, form, and frequency of stools.

When to get medical advice

Call your child’s healthcare provider right away if any of these occur:

  • Abdominal pain or swelling that gets worse

  • Fussiness or crying that can’t be soothed

  • Refusal to drink or eat

  • Blood in stool

  • Black, tarry stool

  • Constipation that doesn’t get better

  • Weight loss

  • Vomiting

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