Constipation in Children: The Emotional Impact and How to Help
Working with children and families for over twenty six years, I have noticed that many parents miss the signs of constipation, or what I call a poo jam. It is a friendlier name for something that causes enormous distress and is far more common than most people realise.
One in three children is estimated to experience constipation at some point. And yet it is significantly underreported, largely because of the shame and embarrassment that surrounds it.
Why I am writing about this
Constipation in children is first and foremost a medical issue. No amount of therapy will help if a child is still physically constipated. The first and most important step is always your GP, paediatrician, or school nurse. Please do not delay seeking medical help if you are concerned.
What I can help with is the emotional fallout. Because for many children and families, that fallout is significant. Children who have experienced painful poos, accidents, or years of undertreated constipation often develop intense anxiety around toileting. They may refuse to use the toilet, hide soiled pants, or become so distressed at needing to go that they hold on, which makes everything worse. The shame, embarrassment, and loss of self esteem that follows can be profound and lasting.
This is where therapeutic support, alongside medical treatment, can make a real difference.
Signs your child might have constipation
Extra large or hard stools
If you wonder how your child produced such a large stool, they are likely constipated. Hard stools that look like pellets or lumps are a clear sign. The Bristol Stool Chart, developed as a clinical assessment tool, describes seven types of stool. Types one and two indicate constipation. Types four and five are typical and easier to pass. Type seven can indicate overflow from impaction, which needs medical attention.
Tummy aches
A child with constipation often complains of tummy ache or a full stomach. Importantly, these symptoms are frequently relieved after going to the toilet, which is a useful indicator.
Bedwetting and daytime accidents
A large poo jam in the rectum presses on bladder nerves, which can cause bedwetting and frequent trips to the toilet during the day. Therefore, if bedwetting is a persistent issue alongside other symptoms, constipation is always worth investigating.
Wind and discomfort
Smelly wind, bad breath, and visible discomfort are all common signs. Additionally, some children experience bleeding when they poo, caused by an anal fissure or small tear, which is understandably frightening and can intensify their fear of going.
Straining and withholding
Children who have experienced painful poos often begin contracting their pelvic floor muscles instead of relaxing them. As a result, they strain on the toilet, avoid it altogether, or hide nappies. This is not naughtiness. It is a nervous system response to pain and fear.
Loose or frequent poo
Paradoxically, constipation can cause very loose poo. This happens because soft stool overflows around a hard impaction. Consequently, parents sometimes think their child has diarrhoea when the underlying issue is actually severe constipation.
Itchy bottom and soiled pants
When the bowel cannot empty properly, wiping becomes difficult and poo stains in pants are common. Furthermore, the bottom becomes itchy and sore, adding to the child’s distress and shame.
Infrequent pooing
Importantly, a daily poo does not rule out constipation. Research shows that fifty percent of children who poo every day are still constipated. Therefore, frequency alone is not a reliable indicator.
The difference between constipation and impaction
According to Bladder and Bowel UK, constipated children tend to pass infrequently formed stools that may be very large and hard, but are generally clean between bowel movements. Children who are impacted, however, cannot pass formed poos. Instead they pass loose, mushy, or semi-solid poos, sometimes numerous times per day, often without awareness.
It is essential to distinguish between the two because they require different treatment. If you are unsure, please speak to your child’s healthcare professional rather than trying to manage it alone.
What helps physically
Fluids
Increasing fluid intake is one of the most important things you can do. Water is removed as food digests, making stools dry and hard. The Bladder and Bowel charity recommends the following daily fluid intake:
600ml for children aged seven to twelve months. 900ml for one to three year olds. 1200ml for four to eight year olds. 1600ml for girls aged nine to thirteen. 1800ml for boys aged nine to thirteen. 1800ml for girls aged fourteen to eighteen. 2600ml for boys aged fourteen to eighteen.
Children who are very active or in hot environments will need more. If your child does not like water, foods with high water content such as watermelon can also help.
Diet
Soluble fibre is particularly helpful. Oats, beans, lentils, chia seeds, apples, and strawberries dissolve in water and draw moisture into the stool, making it easier to pass. In contrast, white bread, white pasta, bananas, and highly processed foods can contribute to constipation. Therefore, looking at what your child is eating regularly is always worthwhile.
Sitting position
How a child sits on the toilet matters enormously. Feet should be flat on a stool with legs apart, knees higher than hips, leaning slightly forward with elbows resting on knees. This position relaxes the pelvic floor and makes passing stool significantly easier. Additionally, building in regular toilet times, particularly after meals when the bowel is naturally stimulated, helps establish a routine.
Working with school
Many children struggle at school because teachers do not always understand that constipation is a medical issue. Consequently, a child fidgeting, asking repeatedly to use the toilet, or having accidents may be misread as a behaviour problem. It is worth speaking to the class teacher or SENCo and explaining the situation clearly. A pass card so your child can leave the class without having to ask publicly, and a bag with spare clothes and wipes, can make an enormous difference to their dignity and confidence.
Interoception and the body
Interoception is the sense that lets us notice internal body signals. A full bladder, a growling stomach, the urge to poo. Over time, children who have been constipated for a long time can lose sensitivity to these signals. As a result, they may not feel the urge to go until it is too late, or may not be aware that they have had an accident.
Working on interoception, helping a child tune back into their body’s signals, is an important part of recovery alongside medical treatment. Kelly Mahler’s work on interoception is excellent and well worth exploring. You can find her resources at kellymahler.com.
The emotional impact
Research from the NHS shows that parents notice their children are more irritable, aggressive, and prone to tantrums when constipated. Furthermore, sleep is often disturbed. However, beyond those immediate effects, the longer term emotional impact of ongoing accidents and constipation can be significant.
Children who have experienced years of soiling often carry real shame. They may feel unloved, embarrassed, and hopeless. They may avoid school trips, sleepovers, or any situation where an accident could happen. In addition, the anxiety around toileting itself can become a major barrier to recovery.
Therapeutic support, alongside medical treatment, can help children process that shame, rebuild their confidence, and develop a different relationship with their body and the toilet.
I am also currently writing a healing story specifically for children who are afraid of the toilet, which will be available in my shop very soon.
How I can help
I work with children and families where toileting anxiety and the emotional fallout from constipation and soiling are affecting daily life. This work always happens alongside medical treatment, not instead of it. If your child is not yet seeing a GP or paediatrician about the physical side, that is always the first step.
Once medical support is in place, I can help with the anxiety, shame, and avoidance that so often remain even after the physical picture has improved.
You can get in touch via my contact page.
Useful resources
Bladder and Bowel UK has excellent resources for children and families.
ERIC is the children’s bowel and bladder charity and a brilliant source of practical support and information.
Free resources
Understanding Your Child’s Guard Dog Brain
Both are free to download.
And if you would like occasional guidance and support straight to your inbox, you are very welcome to join my newsletter.
With warmth,
Catherine
