Chronic constipation, or infrequent and/or hard bowel movements that last more than a few days, can be a frustrating and uncomfortable problem. Sometimes it can also lead to soiling of the underwear, something called encopresis. There are many things that can cause chronic constipation; some children are simply more prone to constipation, but even children who usually have normal bowel movements can develop chronic constipation after an illness, during toilet training, when they have a fissure or other skin condition around the anus, or when there is a life change (such as starting a new school).

There are also medical conditions, such as hypothyroidism, that can cause chronic constipation. So if there isn't a clear explanation for your child's constipation, if your child is having other symptoms such as frequent abdominal pain, fever, low energy, or vomiting -- or if the constipation has been going on for a long period of time (more than a month or two), you should call your doctor before using this guide. Remember that this guide is not meant to take the place of a visit to your doctor's office.

The treatment of chronic constipation involves clearing the bowel of the large amount of hard stool, preventing the return of constipation, and teaching normal bowel habits. This may involve medications in addition to changes in diet and toileting behavior.

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The first step in treating constipation is to "clean out" any stool that has built up in the intestines (bowels).

When a child has not pooped for several days, stool collects in the lower bowel (rectum). This causes the bowel wall to become stretched out. This feeling of the bowel being stretched is what normally makes us realize we have to go to the bathroom.

However, if the child isn't pooping regularly and the bowel wall stays stretched for a long time, it loses its normal muscle tone and feeling. Then it becomes harder and harder to pass the enlarging amount of stool, creating an unhealthy cycle.

In order to treat constipation, we must break this cycle.

The first step: emptying the rectum