Childhood constipation is typically characterized by infrequent bowel evacuations, large stools, and difficult or painful defecation.
Symptoms may result from low fiber, poor nutrient, and/or insufficient water intake, which leads to excessive hardening of the stool. This often starts as an acute problem but can progress to fecal impaction and chronic constipation.
Particularly in young children, any cause of painful defecation may provoke active withholding. Withholding may worsen the constipation and lead to a vicious cycle.
Duration of constipation and amount of stool burden may depend on capacity of the child's rectum, the degree of megarectum, and other factors including rectal sensory function.
After fecal disimpaction, maintenance stool softeners are essential and are often required for many months or years to reduce relapse risk.