Some toddlers poop three times a day, and others go once every three days. Both are normal. Just because one child poops less frequently than another does not mean that the child is constipated. The definition of constipation has two parts.
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First, a constipated ‘child goes less frequently than what is usual for him. Second, the stool is firm and difficult to pass. If the stool comes out soft, no matter how long it has been since your child’s last bowel movement, he’s not constipated.
Why do many parents automatically think that when their child poops infrequently, he is constipated? It is because the longer stool stays in the colon and rectum, the more firm it becomes. One of the jobs of the colon is to remove water from stool.
So it stands to reason that when the stool sits for a prolonged period of time, more water is removed from it, and the stool becomes hard and dry. (The opposite also is true: in the case of diarrhea, when stool passes through the intestine rapidly, there is not much time for the colon to remove excess water, and so it comes out wet and runny.)
A constipated child will eventually become uncomfortable. Older kids complain of lower abdominal pain, while younger toddlers often simply whine or cry while squatting. The pain generally comes from a spasm of the muscle in the anus (called the anal sphincter). These spasms can further slow down pooping, worsening constipation and creating a vicious cycle (it hurts, so he won’t go; he won’t go, so it hurts).
A child’s appetite can diminish with constipation, partly because of the associated abdominal pain and partly because the retained stool makes a child feel “full.”
When constipated stool finally comes out, it may well hurt. Constipated stool that is large and dry can tear the skin around the anus when it is passed, resulting in drops of bright red blood. Such a tear is called an anal fissure.
Fissures sting when urine or stool come into contact with the torn skin. If you look closely at your child’s bottom, you can usually see an anal fissure right at the anus.
Again, this creates a vicious cycle: for the broken skin to heal, the stools must be soft, but for the stools to be soft, your child must be willing to poop frequently.
There are many causes of constipation, but the most common is diet. Certain foods firm up stool, causing constipation; others help soften it, so their absence leads to hard stool.
Fluids are also important. For stool to remain soft, your child must drink a minimal amount of liquid. The combination of not enough liquid and a constipating diet can quickly lead to painful bowel movements.
Another cause of constipation is constipation itself. If your child has ever passed a painful stool, you know that he does not want to repeat this uncomfortable experience.
Constipation begets constipation because a child will hold his stool in an effort not to feel the discomfort of having another painful bowel movement. This response is not entirely unreasonable.
The pattern is especially difficult to curb in toddlers, because they are too young to reason with but too old to forget the prior pain. But once your child returns to normal, soft, painless stools, he is likely to resume regular pooping.