Chronic Constipation: Could Your Child Have a Stressed Stomach?

When a child has chronic constipation, the conversation often starts with food, fibre, fluids and toileting.

Those things can matter. But there is another part of the picture we need to understand:

the gut responds to stress.

And when I talk about a stressed stomach, I don't necessarily mean that something bad or particularly stressful is happening in the child's life.

A child can be safe, happy and well supported and still have a nervous system that is working incredibly hard.

What is a stressed stomach?

The brain and gut are in constant communication.

When our nervous system responds to worry, uncertainty, anticipation or pressure, the effects aren't confined to our thoughts and emotions. Our body responds too — and that includes our digestive system.

We all experience this differently.

Think about two people waiting for an important appointment. One might barely think about it until the day arrives. The other might think about it repeatedly for a week and feel it physically in their stomach.

The situation is the same.

The individual's response to it is different.

For children, everyday experiences such as uncertainty, changes in routine, sensory input, expectations, social situations or anticipating what is going to happen next can place demands on their nervous system that aren't always obvious to the adults around them.

That doesn't mean something is wrong in their life.

It means we need to understand how that particular child experiences it.

Where does constipation come into this?

Stress can affect the way the digestive system functions, including how quickly things move through the bowel.

Then another problem can begin.

If passing a stool becomes uncomfortable or painful, a child may start avoiding it or holding it in.

The longer they hold it, the harder and more difficult it can become to pass.

A cycle can develop:

stress → changes in the gut → constipation → pain or discomfort → withholding → more constipation

And once that cycle becomes established, it can be difficult to break.

It isn't automatically diet or parenting

This is important.

When a child is chronically constipated, parents can feel as though they are being judged on what their child eats, how much they drink or how they have managed toilet training.

Diet, hydration and toileting habits certainly need to be considered.

But chronic constipation doesn't automatically mean a child has a poor diet or that somebody has managed their toileting badly.

We need to look at the whole child.

That includes what their nervous system may be dealing with throughout the day.

Then constipation can affect emotional control

This is the other side of the cycle that can easily be missed.

Imagine trying to manage your day while you have constant abdominal pressure, bloating or stomach pain.

Then somebody asks you to stop what you're doing.

You have to wait.

The room is noisy.

Plans suddenly change.

You're asked to do something difficult.

Your tolerance is probably going to be different than it would be if you felt physically comfortable.

It's the same for children.

Physical discomfort uses capacity.

A child who is already uncomfortable may have less capacity available for emotional control when another demand, frustration or sensory experience is added.

We may then see increased irritability, avoidance, distress, emotional outbursts or behaviour that appears to come from nowhere.

But it hasn't necessarily come from nowhere.

The thing that happened immediately beforehand may simply have been the final demand on a system that was already struggling.

Look beyond the immediate trigger

If a child has chronic constipation and their emotional control is also becoming more difficult, look at the whole picture.

Consider their physical comfort as well as what happened immediately before an incident.

Notice whether particular situations repeatedly create worry or tension. Look at uncertainty, changes, sensory demands, anticipation and the amount of effort the child is using simply to get through their day.

And take persistent constipation seriously. Chronic constipation should be discussed with an appropriate healthcare professional so that medical causes can be considered and the constipation properly treated.

But alongside treating the bowel, we can also become curious about the child.

Don't only ask what triggered the behaviour.

Ask what their body was already dealing with before the trigger happened.

Sometimes understanding emotional control starts with understanding physical comfort.