University of Virginia Health System

 What are the symptoms of chronic constipation?

Most typically, when we think of constipation, we think of hard and painful bowel movements, but there are many other symptoms than can occur:

In many children with chronic constipation, the large intestine gets stretched out of shape ("megacolon"), so that they pass extremely large bowel movements. Sometimes their bowel movements are so large they clog the toilet!.

Because of the pain associated with bowel movements, some young children will refuse to pass bowel movements or even attend the toilet. This can lead to all sorts of conflicts and behavioral difficulties.

When children with chronic constipation pass very large or hard bowel movements they may open up small tears or rips at their anal opening. These tears or rips are called anal fissures. While anal fissures are not dangerous, they can be extremely painful and are often associated with some bleeding with bowel movements. This can be very frightening for parents and children alike. The tears or rips tend to occur in little folds of skin at the anal opening and so they may take a long time to heal much like a paper cut on a knuckle that constantly gets re-opened when you bend your finger.

Many children who suffer from chronic constipation will have changes in their appetite. Parents often notice that their child gets full very easily. They will sit down at the table, eat several bites, and then complain that they are full. These children are often described as nibblers or grazers because they eat little bits throughout the day rather than eating three square meals. Some parents notice that their child's appetite improves dramatically for several days after they pass a large bowel movement, but then it slowly declines again.

Many children with chronic constipation may complain of frequent abdominal pain or cramps and they are often quite irritable and/or disagreeable.

Some children with chronic constipation may have recurrent attacks of nausea and vomiting. It has been clearly shown that the stomach empties much more slowly than usual when someone becomes constipated.

The bladder sits right in front of the rectum so if the rectum becomes enlarged and is chronically filled with stool, there may be less room for the bladder to expand with urine. This may cause a number of urinary problems. Many children with chronic constipation seem to have small bladder capacities and seem to have to urinate more often than usual. In some children, constipation may cause recurrent bladder infections, bedwetting, urinary dribbling, or difficulty starting their stream.

In older children, long-standing constipation can be associated with leakage or smearing of stool in the underwear. As the large intestine gets stretched larger and larger, liquid stool from the small intestine begins to "leak" around more formed stool in the large intestine. In the the beginning, the leakage is usually very small and most parents just assume their child isn't wiping his or herself very well. As the large intestine stretches further, the amount of leakage increases so that eventually children begin having "accidents" - they pass whole bowel movements in their underwear! This is called encopresis. Since these accidents represent "leaking" of soft stool through the colon, children don't usual feel the "accidents" happening - rather, they just happen.