Bleeding while passing hard stools is a sign you should see a doctor. It may be due to fissures or can lead to habit of withholding because of fear. Skipping days for long time sometime denotes possible impaction.

Do not scold your child. It is called “encopresis”. It needs pediatric gastroenterologist and surgeon opinion. Commonly, it suggests long-standing constipation. Sometimes children suffering from constipation may pass large number of stools in pants (overflow incontinence). The children need treatment urgently as prolonged leaking of stools can have significant impact on his psychosocial behavior and overall confidence.

Do not scold your child. It is called “encopresis”. It needs pediatric gastroenterologist and pediatric surgery opinion. Commonly, it suggests long-standing constipation. Sometimes children suffering from constipation may pass large number of stools in pants (overflow incontinence). The children need treatment urgently as prolonged leaking of stools can have significant impact on his psychosocial behavior and overall confidence.

Ideal time to initiate potty training is 2–3 years of age depending upon the child’s acceptance. It should be very gradual and too rigrous training should be avoided. If using western style toilet, please use a small stool for the child to rest his legs while sitting on pot.

It is normal for breastfed infants to pass five to six stools in a day and also to pass stools once in 5–6 days. As long as the stools consistency is pasty and baby is doing well, they are of no concern to us.

• Persistence of constipation beyond 4 weeks
• When the child is standing to pass stools or straining significantly to defecate.
• There is fecal soiling of pants.
• Child is afraid to evacuate or cries while passing stools.
• Pain or bleeding while passing stools.
• “Ribbon stools” (more likely in a child younger than 1 year)
• Abdominal distention with vomiting accompanied by constipation
• Urinary tract symptoms such as retention of urine, urine infection or incontinence

Mainly by history taking and clinical examination. Your doctor may go for per rectal examination or maybe ask for tests further, if needed, based on your clinical evaluation.

• Diet and lifestyle modification are the first tier treatment for constipation.
• Dietary changes—restriction of milk intake, stopping bottle feeding, encouraging high fiber diet (leafy vegetables,fruits), drinking lots of water
• Restriction of screen time and encour- aging physical activities
• Regular toilet training
• Medicines: Your doctor may prescribe some drugs such as polyethylene glycol or lactulose. Sometimes a suppository may be needed.

• Constipation onset <1 month of age Passage of first stool after > 48 hours of birth
• Family history of Hirschsprung’s disease
• Ribbon stools
• Growth failure
• Persistent yellow green vomiting
• Abnormal thyroid gland
• Severe abdominal distention
• Abnormal position of area of stool passage
• Tuft of hair or minute hole at lower back
• Extreme fear while examining area of stool passage
• Scars/fissures at stool passage area