Constipation in children

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Evidence last reviewed: 6 Sep 2026

Topic last updated: 04 Sep 2026

Childhood constipation is typically characterized by infrequent bowel evacuations, large stools, and difficult or painful defecation.

Symptoms often result from low fiber, poor nutrient, poor stooling technique, and/or insufficient water intake, which leads to excessive hardening of the stool. This often starts as an acute problem but can progress to fecal impaction and chronic constipation.

Particularly in young children, any cause of painful defecation may provoke active withholding. Withholding may worsen the constipation and lead to a vicious cycle.

Duration of constipation and amount of stool burden may depend on capacity of the child's rectum, the degree of rectal dilation (if excessive, often called megarectum), and other factors including rectal sensory function.

After fecal disimpaction, maintenance stool softeners are essential and are often required for many months or years to reduce relapse risk.

Definição

Constipation in childhood is the infrequent passage of stools leading to 1 or more of the following: painful defecation; overflow fecal incontinence; rectal fecal impaction; or active defecation avoidance behavior.

História e exame físico

Principais fatores diagnósticos

difficult or painful defecation
long interval between stools
fecal incontinence
small-volume, soft, incontinent stool
palpable fecal mass per abdomen
otherwise healthy child

Detalhes completos

Outros fatores diagnósticos

abdominal pain
abdominal distention
anal fissure
associated bladder problems
abnormal anal appearance

Полная информация

Факторы риска

low-fiber diet
poor-nutrient diet
genetic predisposition
infection
stress
obesity
low birth weight
psychiatric history
physical disability
poor toilet training
immune dysregulation
low fluid intake
trauma

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

no initial test

Полная информация

Исследования, проведение которых нужно рассмотреть

abdominal radiograph
radiopaque marker colonic transit study
abdominal ultrasound
contrast enema
rectal suction biopsy
psychological assessment

Полная информация

Неотложные исследования

anorectal manometry
colonic manometry

Алгоритм лечения

Острый

no impaction: <1 year of age

no impaction: ≥1 year of age

with impaction: <1 year of age

with impaction: 1-3 years of age

with impaction: ≥4 years of age

Составители

Авторы

Jaime Belkind-Gerson, MD, MSc

Director Neurogastroenterology and Motility Program

Digestive Health Institute

Children's Hospital Colorado

Associate Professor of Pediatrics

University of Colorado School of Medicine

Colorado, CO

Раскрытие информации

JB-G declares that he has no competing interests.

Claire Zar-Kessler, MD

Instructor in Pediatric Gastroenterology

Massachusetts General Hospital for Children

Boston, MA

Раскрытие информации

CZ-K has received support from Takeda for a clinical trial on prucalopride.

Выражение благодарностей

Dr Jaime Belkind-Gerson and Dr Claire Zar-Kessler would like to gratefully acknowledge Dr Corey Baker, Dr Wael El-Matary, Dr Steffen Reinsch, and Dr Meghan McPherson, the previous contributors to this topic.

Раскрытие информации

CB, WE-M, SR, and MM declare that they have no competing interests.

Рецензенты

David C.A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU

Consultant Paediatric Gastroenterologist

Royal West Sussex NHS Trust

Chichester

Declarações

DCAC has served as a consultant to, and spoken at symposia sponsored by, Norgine Ltd.

Vikram Boolchand, MD

Gastroenterology Fellow

University of Arizona

Tucson, AZ

Declarações

VB declares that he has no competing interests.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh, PA

Disclosures

DJH declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Rubin G, Dale A. Chronic constipation in children. BMJ. 2006 Nov 18;333(7577):1051-5.Full text Abstract

Mulhem E, Khondoker F, Kandiah S. Constipation in children and adolescents: evaluation and treatment. Am Fam Physician. 2022 May 1;105(5):469-78. Abstract

National Institute for Health and Care Excellence. Constipation in children and young people: diagnosis and management. Jul 2017 [internet publication].Full text Abstract

Benninga MA, Faure C, Hyman PE, et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016 Feb 15 [Epub ahead of print]. Abstract

Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016 Feb 15 [Epub ahead of print]. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Hirschsprung disease
- Anorectal anomaly
- Group A streptococcal perianal skin infection
More Differentials
Guidelines
- Constipation in children and adolescents: evaluation and treatment
- Constipation in children and young people: diagnosis and management
More Guidelines
Patient information
Constipation in children
More Patient information
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Constipation in children

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Неотложные исследования

Алгоритм лечения

no impaction: <1 year of age

no impaction: ≥1 year of age

with impaction: <1 year of age

with impaction: 1-3 years of age

with impaction: ≥4 years of age

Составители

Авторы

Jaime Belkind-Gerson, MD, MSc

Раскрытие информации

Claire Zar-Kessler, MD

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

David C.A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU

Declarações

Vikram Boolchand, MD

Declarações

David J. Hackam, MD, PhD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice