Some Physical Causes and Features of Constipation in Infants and Children
Some Physical Causes and Features of Constipation in Infants and Children
| Cause | Common Features* | Tests |
| Birth defects of the anus | ||
| Abnormal position of the anus | Opening of the anus that appears closer than normal to the genitals | Measurements to determine the exact location of the anus’s opening |
| Anal stenosis (a narrowed anus) | Delayed passage of the first BM (called meconium) during the first 24–48 hours of life Explosive and painful BMs A swollen abdomen Abnormal appearance or position of the anus | A doctor's examination |
| A swollen abdomen No BMs A blockage of the anus detected during a doctor's examination | A doctor's examination done soon after birth | |
| Spinal cord problems | ||
| A raw, red area on the back where the spinal cord protrudes, seen at birth A decrease in reflexes of the legs or in muscle tone Absence of the normal reflex of the anus (a tightening when lightly touched, called anal wink) | Plain x-rays of the lower spine MRI of the spine | |
| Occult spina bifida (incomplete formation of the bones of the spine) | Possibly a tuft of hair or dimpling on the skin over the defect, seen at birth | MRI of the spine |
| A tethered spinal cord (during fetal development, the spinal cord is stuck at the lower end of the spinal column and cannot move up to its normal position) | Problems with walking, pain or weakness in the legs, and back pain Urinary incontinence | MRI of the spine |
| A tumor near the tailbone (sacral teratoma) or other spinal cord tumor | Back pain, problems with walking, and pain or weakness in the legs Urinary incontinence | MRI of the spine |
| Infection of the spine or spinal cord | Back pain, problems with walking, and pain or weakness in the legs Fever Urinary incontinence | MRI of the spine |
| Hormonal, metabolic, or electrolyte disorders | ||
| Diabetes insipidus Central Diabetes Insipidus Central diabetes insipidus is a lack of the hormone vasopressin (antidiuretic hormone) that causes excessive production of very dilute urine (polyuria). Central diabetes insipidus has several... read more (due to problems with antidiuretic hormone, which helps regulate the amount of water in the body) | Excessive thirst and excessive crying that is quieted by giving children water Excessive urination of dilute urine Weight loss and vomiting | Urine and blood tests to measure how dilute urine and blood are (osmolality) Blood tests to measure antidiuretic hormone levels |
| Hypercalcemia Hypercalcemia (High Level of Calcium in the Blood) In hypercalcemia, the level of calcium in blood is too high. A high calcium level may result from a problem with the parathyroid glands, as well as from diet, cancer, or disorders affecting... read more | Nausea and vomiting, loss of appetite, weight loss, muscle weakness, and abdominal pain Excessive thirst and excessive urination | Blood tests to measure the calcium level |
| Hypokalemia Hypokalemia (Low Level of Potassium in the Blood) In hypokalemia, the level of potassium in blood is too low. A low potassium level has many causes but usually results from vomiting, diarrhea, adrenal gland disorders, or use of diuretics. A... read more (an abnormally low potassium level in the blood) | Muscular weakness Excessive urination and dehydration Not growing as expected (failure to thrive) Possibly use of diuretics or certain antibiotics | Blood tests to measure levels of electrolytes |
| Poor feeding A slow heart rate In newborns, large soft spots (fontanelles) between the skull bones and slack muscle tone Dry skin, intolerance of cold, fatigue, and jaundice | Blood tests to measure thyroid hormone levels | |
| Intestinal disorders | ||
| Delayed passage of the first BM Poor weight gain or failure to thrive Frequent bouts of pneumonia | A sweat test Possibly genetic testing to confirm the diagnosis | |
| Delayed passage of the first BM A swollen abdomen Green or yellow vomit, indicating that it contains bile A narrowed anus detected during a doctor's examination | X-rays of the lower digestive tract after barium is inserted in the rectum (barium enema) Measurement of pressure inside the anus and rectum (manometry) Biopsy of the rectum | |
| Vomiting Poor feeding Weight loss, poor growth, or both Blood in stools | Stool tests Symptoms that lessen when the formula is changed Possibly endoscopy, colonoscopy, or both | |
| Abdominal pain Bloating Weight loss Fatigue | Blood tests Endoscopy | |
| Long-standing (chronic) abdominal pain Diarrhea and constipation that come and go A feeling of incomplete emptying after a BM | Evaluation of BM patterns and the timing and characteristics of pain Exclusion of other disorders by history, physical examination, and possibly blood tests, stool tests, imaging, or colonoscopy | |
| Pseudo-obstruction (which causes symptoms of a blockage but no blockage is detected) | Nausea and vomiting Abdominal pain and a swollen abdomen | X-ray of the abdomen Tests to assess how well the bowel functions (bowel motility studies) |
| A tumor in the abdomen | Weight loss, night sweats, and fever Abdominal swelling or pain An abdominal mass detected during a doctor's examination | MRI |
| Drug side effects | ||
| Use of drugs with anticholinergic effects Anticholinergic: What Does It Mean? Drugs, the most common medical intervention, are an important part of medical care for older people. Without drugs, many older people would function less well or die at an earlier age. Older... read more | Use of drugs that can cause constipation | A doctor's examination |
| Toxins | ||
| A sudden reduction in the ability to suck Loss of muscle tone Sometimes consumption of honey before age 12 months | A test for botulinum toxin in stool | |
| Usually no symptoms Possibly abdominal pain, fatigue, and irritability Regression in development | Blood tests to measure the lead level | |
| * Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
| BM = bowel movement; MRI = magnetic resonance imaging. | ||
