Fecal Impaction (Child)

A normal stool is soft and easy to pass. But sometimes stools become firm or hard. They are difficult to pass. They may pass less often. This is called constipation. It is common in children.

If a child is constipated, stool can harden in the rectum. New stool will keeping forming in the colon but can’t pass the blockage. This is called fecal impaction. Fecal impaction can cause symptoms like:

  • Inability to pass stool

  • Passing only pea-sized stool

  • Uncontrolled watery diarrhea (if the bowel is not completely blocked)

  • Swollen and painful abdomen

  • Refusal to eat

  • Problems holding in urine

  • Painful bowel movements

  • Postures or behavior that show discomfort

  • Stool in child's underwear

  • Bloating

  • Vomiting

  • Painful bowel movements

  • Itching, swelling, bleeding, or pain around the anus

Fecal impaction from constipation can have many causes, such as:

  • Eating a diet low in fiber

  • Eating too many dairy foods or processed foods

  • Not drinking enough liquids

  • Lack of exercise or physical activity

  • Stress or changes in routine

  • Ignoring the urge to have a bowel movement or delaying bowel movements

  • Medicines like prescription pain medicine, iron, antacids, certain antidepressants, and calcium supplements

  • Dehydration from vomiting or diarrhea

  • Underlying illness

Fecal impaction can also be caused by a child holding in stool on purpose. This may be out of fear of pain with their bowel movement. Some children hold in stool to avoid using public or school restrooms.

Home care

Your child’s healthcare provider may prescribe a stool softener. This will help your child have a bowel movement. In some cases, other methods may be advised to loosen hard stool. These may include a glycerin suppository or laxatives. You may need to use an enema or irrigation to loosen hard stool, which is then removed. Follow all instructions on how and when to use these products. It is no longer thought that laxatives can cause damage to the intestine. However, some are better choices for occasional and long-term use. Your healthcare provider will help with the decision on whether laxatives are necessary.

Food, drink, and habit changes

You can help treat and prevent your child’s constipation with some simple changes in diet and habits.

Make changes in your child’s diet, such as:

  • Replace cow's milk with a nondairy milk or formula made from soy or rice. Discuss any change with your provider first.

  • Increase fiber in your child’s diet. You can do this by adding fruits, vegetables, cereals, and grains.

  • Some fruit juices, like pear and prune, can also be helpful.

  • Make sure your child eats less meat and processed foods.

  • Make sure your child drinks more water.

  • Be patient and make diet changes over time. Most children can be fussy about food.

  • If you are unsure about your child's intake, try keeping a diary for a few days of everything he or she eats and drinks. This can help your healthcare provider determine if your child's diet may be causing the constipation.

Help your child have good toilet habits. Make sure to:

  • Teach your child not wait to have a bowel movement.

  • Have your child sit on the toilet for 10 minutes at the same time each day. This helps to create a routine. Doing this after each meal can be very helpful. This helps create a routine and uses the body's natural tendency to move the bowels after meals.

  • Give your child a comfortable child’s toilet seat and a footstool.

  • Talk with your child’s school. Ask them to allow your child use the restroom on a regular basis. If your child is not able to use a public bathroom, ask if the school may allow your child to use a private bathroom, if available.

  • Read a book or keep your child company, if that helps.

Follow-up care

Follow up with your child’s healthcare provider. If X-rays were done, you will be told of your child's results.

Special note to parents

Learn to be familiar with your child’s normal bowel pattern. Note the color, form, and frequency of stools.

Call 911

Call 911 if your child has any of these symptoms:

  • Firm belly that is very painful to the touch

  • Trouble breathing

  • Confusion

  • Loss of consciousness

  • Rapid heart rate

When to seek medical advice

Call your child’s healthcare provider right away if any of these occur:

  • Abdominal pain or swelling that gets worse

  • Fussiness or crying that can’t be soothed

  • Refusal to drink or eat

  • Blood in stool

  • Black, tarry stool

  • Constipation that doesn’t get better

  • Weight loss

  • Vomiting

  • Fever (see Fever and children)

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

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