Most of the constipation that happens after early infancy is functional constipation. There are situations like, say, antibiotic use or travel to a different place that changes the gut microbiota, there may be changes in the diet related to starting weaning foods (especially if not giving enough water after starting complementary foods), the child gets hard stools. When they pass hard stools, they experience pain, and this may even lead to a fissure or a crack in the anal area and the child starts holding the stool. Once they start holding the stool, the water in the stool gets absorbed more and it becomes drier and even harder to expel. This becomes a vicious cycle where the child doesn't want to pass stools and holds the stools. This holding behavior is often evident-they are squirming, tightening their thighs with adduction, rocking back and forth-anything they can do to avoid passing the stool. But the parents may actually consider it as straining to pass the stools. If it goes beyond a certain level and is not recognized, stool incontinence may start because the rectum gets more and more distended with the undigested food leaking from above, through the sides of the impacted stools and leak. Incontinence and soiling are quite distressing symptoms, and this happens in more persistent functional constipation as well.

Do review this video to learn more.

Approach to constipation in children and its management. Dr Sridhar Kalyanasundaram #constipation