What causes a vicious cycle of constipation in children and what is the treatment?

Updated: Jul 05, 2019
  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
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Answer

Painful defecation produces a vicious positive feedback cycle in these children. The child suppresses the urge to defecate, and this results in the formation of a larger and harder stool. When the stools eventually emerge, the pain of defecation is worse, encouraging the child to retain the stools further. Thus, the vicious cycle continues.

Prescribing long-term laxatives for a period of several weeks may be necessary in order to force the child to defecate daily until the cause of the anorectal pain is resolved and the fecal retention behavior is unlearned. Once this pattern has been unlearned, usually within several weeks, laxatives should be gradually tapered off while the use of fiber and fluid supplementation should indefinitely continue. Failure to taper the laxatives without the return of constipation indicates the need for a gastroenterologic consultation to rule out an underlying problem.


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