What is functional constipation?

Functional constipation, or stool withholding, occurs when a child holds in stool, resulting in infrequent bowel movements and hard stools. This is stressful for parents, uncomfortable for children and can be frustrating for everyone involved.

“This is an extremely common issue, especially among children aged 1-2 years. In fact, some literature reports that 80% of all toddlers will have some degree of stool withholding for a period of time,” explains Dr. Vincent Biank, a pediatric gastroenterologist at Advocate Children’s Hospital.

Toddlers and young children may withhold stool because they are concerned it will hurt to pass, out of a desire to maintain control over when they go or because they don’t want to stop playing. Whatever the reason, it’s important to resolve the situation.

“Stool withholding has a tendency to stretch out the rectum, resulting in worsening constipation, and can ultimately lead to fecal incontinence and encopresis (stool leakage),” says Dr. Biank. “Reach out to your child’s pediatrician for guidance and support. If you do not see improvement through recommendations offered by your pediatrician after 3-6 months, or if your child is experiencing fecal incontinence or encopresis, blood or pain when defecating, I recommend seeing a pediatric gastroenterologist.”

Dr. Biank explains the first step in treating stool withholding is breaking the child’s fear of potential pain associated with the actual event of going to the bathroom.

“We often need to take a step back before we can move forward,” he says. “However long this has been going on is usually the same amount of time needed to treat the problem. There are no magic pills. Helping a child who withholds stool takes a lot of time, patience and consistency.”

Initial treatment usually involves lifestyle changes, including increasing a child’s water intake and offering more fiber-rich foods, such as kiwi, broccoli and pears.

“If there are no improvements over a period of time, we will advance to more aggressive treatment measures as well as obtain lab work and consider more invasive testing, such as a barium enema, anorectal manometry or potentially rectal biopsies,” Dr. Biank says.

Reach out to your child’s pediatrician if you are concerned about your child’s bowel habits.

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