More than 44,000 children were admitted to hospital with constipation last year, according to NHS figures that highlight the potentially serious health consequences of the condition.
Data for England and Wales reveals a 60% rise in hospital diagnoses of constipation in primary schoolchildren in the past decade, with increases also seen in preschool and secondary age groups. Experts say greater awareness is needed of the physical harm and misery that can be caused by the condition, which is sometimes trivialised.
“We shouldn’t be having that many children being treated for constipation in hospital,” said Prof Monica Lakhanpaul, a consultant paediatrician at Whittington Health NHS trust and University College London. “It’s hidden. People feel very embarrassed about it. People think they’ve done something wrong as a parent and they don’t seek early help.”
She added: “This isn’t a minor thing for children. “This causes time off school, physical problems and emotional problems.”
Constipation is very common in children and often starts around the time of potty training. Causes, in cases not brought about by an underlying medical condition, include not eating enough fibre, dehydration, anxiety about going to the toilet and broader emotional problems.
If not dealt with early, children can get into a vicious cycle in which they fear going to the toilet because it is painful, leading to chronic constipation. This requires treatment with laxatives – sometimes for several months – and toilet training to establish a regular bowel habit.
“It can cause stomach pain, it can cause vomiting, or you can get little tears when you’re trying to push too hard. Some people will soil at school because they’re constipated or have smelly wind, which can cause emotional difficulties,” said Lakhanpaul.
NHS admissions data showed a significant increase of primary and secondary diagnosis of constipation in hospital patients in England and Wales over the past decade. Diagnoses in patients aged 0-16 increased from 29,087 in 2014-15 to 44,161 in 2023-24, equivalent to a 46% increase when corrected for changes in the size of the population. The most significant increase was seen in children aged 4-11, from 9,977 in 2014-15 to 16,973 in 2023-24, which is a 60% increase in the rate per 100,000 of the population.
There was no increase in the number of patients admitted to hospital primarily due to constipation. So it is unclear whether overall rates are increasing or whether greater awareness means more cases are being picked up in children who are in hospital for other reasons. Some clinicians said they are seeing more cases and blamed factors including poverty, food insecurity, and children starting school before they are toilet trained.
“Constipation is increasing in children, we know from that national diet survey that fibre intakes are not adequate, coupled with food poverty and the cost of living crisis, it does impact children,” said Rebecca McManamon, a consultant dietitian and spokesperson for the British Dietetic Association. “Many food banks say the humble potato, a good source of fibre with its skin, are not taken as people can’t afford the energy costs of cooking them.”
McManamon said that the health consequences can be severe. “It can cause diverticular disease and haemorrhoids as well as discomfort or headaches that can impact children from concentrating at school for example,” she said. “It is important to talk about, especially for the most vulnerable in society.”
Juliette Rayner, chief executive of Education and Resources for Improving Childhood Continence (ERIC), a children’s bowel and bladder charity, said that some families struggle to get GP appointments and, with fewer health visitors, don’t receive help until the problem has become entrenched. “In an ideal world, no child should present at A&E with constipation,” she said. “They should see their GP.”
With one recent survey suggesting that one in four children starting school in England and Wales are not toilet-trained, teachers are increasingly on the frontline of teaching healthy toilet habits. But schools are not set up for this role – and in some cases may be exacerbating anxiety due to draconian rules.
Some secondary schools lock toilets outside break times, with one school in Wales reportedly fitting metal shutters to restrict access, while a recent report by ERIC described pupils having to navigate a “one-in-one-out” toilet policy.
“To have positive toileting habits you need access to toilets when you need to go,” said Lakhanpaul. “If schools are structured in a way that children are scared to put their hand up, that’s unhelpful.”
