'Her stool was so hard, said the grandmother, 'that I used two fingers to gouge it out. But it would not flush in the toilet, so I hurried to the store room and got a hammer with which I crushed the evil stool into pieces.' I attempted to laugh as I moved my eyes from the three-year-old girl back to her grandmother, but grandma was not kidding, so I stopped myself.

Hopefully, after reading this article, parents and clinicians won't wait until stools turn into cement before intervening. Time is of essence. Failure to pass stool after three days should be concerning.

A child who has not pooped for more than three days probably suffers from constipation. If he or she finally poops, and the stool is dry and hard like a giant rock or small stones, then they are definitely constipated.

Children who are constipated find it very difficult to move their bowels. In order to pass stool they sometimes strain so hard that the hard stool tears the inside of their anus, leading to bleeding during or after defecation.

Passing a hard stool is even more painful if there has been a cut or tear in the anal canal. The fear of pain means the child avoids using the bathroom, which compounds the problems of constipation in children and in adults as well. Every day, maybe for weeks, stools continue to build up inside a child with constipation. The buildup of stool leads to belly pain, a common complaint in children with this condition.

Because stools are stuck in their butt, children with hard-to-pass stool often have soiled underwear and pants. In school and in recreational facilities, stained, stinking underwear is a frequent cause of ridicule and isolation of these children and young adults.

Reasons for constipation in children

By and large, the reasons children become constipated depends on the age at which the constipation occurs. For example, the reason a three-month-old baby is not passing stool is likely to be different from the cause of the same condition in a three-year-old girl.

Unless there is a specific reason, such as when anxious mothers add, say, rice cereals to formula in a desperate effort to make a baby less hungry or sleep through the night, clinicians are usually at a loss to discover the real cause of constipation in the majority of young infants aged three months and thereabout.

But just because clinicians don't know why a baby is constipated does not mean they cannot relieve the problem.

A combination of factors is the most likely reason a three-year-old is constipated. Those factors are bad eating habits and toilet training gone wrong. Foods notorious in contributing to constipation include bread, pizza crusts, dry cereals, 'French toast sticks' and so forth.