The number of children admitted to urgent care with constipation in England and Wales has increased by 60% over the past 10 years, according to NHS data.
In 2024, more than 44,000 children were admitted to hospital with constipation, highlighting the potentially serious health consequences of the condition.
This extra pressure for families and the NHS can be avoided with better information for parents and access to dedicated bowel and bladder services, according to specialist children’s nurse Davina Richardson.
Families have nowhere to go except A&E
“There’s a lack of evidence as to why more children are presenting to A&E with constipation,” says Davina, who works for charity Bladder & Bowel UK.
“Changing diets (a lack of fibre), whether a child is drinking enough and a lack of exercise can all contribute to constipation when there’s no other physical or medical cause.”
Concerns around toileting are often a mix of medical, social and reduced local bowel and bladder services.
“Many regions don’t have dedicated children’s bladder and bowel services, or services are overstretched,” says Davina. “This means children with toileting issues often fall through the gaps, symptoms escalate and families have nowhere to go except A&E.”
Common issue
The rise in the number children ending up in A&E with constipation isn’t about the condition suddenly becoming more common – it’s about more cases becoming severe enough to need emergency care, and families struggling to get help earlier.
Constipation in toddlers and primary-aged children is common, often functional (no underlying physical cause), and characterised by infrequent, hard, painful bowel movements, small or very large stools.
It can also cause loose stools, known as overflow diarrhoea. Common signs include infrequent pooing (less than three times a week), abdominal pain, and accidental overflow soiling. Withholding, to avoid opening the bowels, is also a common sign.
If left untreated, constipation can lead to chronic constipation and faecal impaction – a serious condition where poo becomes a large mass. For children with bowel impaction, awareness of the messages to the brain signalling that the rectum needs to empty become weaker, until they eventually lose the feeling that they need to poo.
Impaction can lead to soiling. Families might find it difficult to understand this is happening outside of the child’s control, increasing stress and toileting trauma issues. It’s more likely a child will end up in A&E with an impacted bowel if they’ve not been able to successfully seek treatment.
We need nurse-led bowel and bladder clinics
“Attitudes, lifestyles, diets and how we parent has changed significantly, and the lack of access to specialist bowel and bladder services has only exacerbated the problem,” says Davina.
As part of her role at Bladder & Bowel UK, Davina runs an advice helpline as well as providing education and learning for caregivers, parents and professional health staff.
“Some children have sensory processing issues, difficulty with toilet training or there’s an anomaly in their anatomy that hasn’t been picked up from birth, but often there’s no underlying cause and that can be frustrating for parents,” says Davina.
“There’s no simple answer to this problem, but if we could address issues earlier and have nurse-led bowel and bladder clinics, this could lead to much better outcomes for families and children.”
Inconsistent advice
Although there appears to be a wealth of information around potty training, Davina says families receive confusing advice around when and how to introduce a potty – a good way to begin good toilet habits for children.
“There’s been a cultural shift in how we approach toilet training,” she says.
“Today there’s easier access to disposable nappies and children continue to use them for much longer than previous generations. Prolonged nappy use can lead to bowel issues as children might start to withhold poo or want to continue to go in a nappy rather than a potty or toilet.”
Waiting until the child is ready is not the best advice
As well as the financial cost to the NHS of children presenting at A&E with constipation, there’s the financial, social and emotional cost to families and children themselves.
“They’ll likely miss school, parents take time off work, their learning is affected, and even their future health if not addressed and treated from an early age.”
Davina says parents are being told to “wait for the child to be ready” to potty train, but this is not necessarily the best advice.
“A young child will rarely tell you when they’re ready; it’s up to adults to support the child from as early as six months old with getting used to the idea of a potty and moving away from nappies.”
Five ways nursing staff can support families
- Improve early recognition – understand what healthy bowel patterns look like and identify any issues.
- Promote earlier toilet learning – encourage parents not to wait for “readiness” but to introduce toileting gradually and positively.
- Address withholding behaviours – help parents understand how withholding develops and how to break the cycle before it becomes severe.
- Signpost to community and charity resources – direct families to bladder and bowel charities, helplines such as Bladder & Bowel UK, and evidence based-guidance when local services are limited.
- Advocate for service development – highlight gaps in provision and push for better training and dedicated continence pathways.
Potty talk
Davina says all children without any medical reason for continence and bowel difficulties, including neurodiverse children, those with sensory issues, and learning disabilities, can learn to sit on a potty from a very young age and parents should gently introduce the potty as soon as a child is able to sit unsupported.
“A potty is the best way for children to poo as it’s designed to encourage a bowel movement (legs are supported and the child sits in a squat position), rather than waiting until the child is older and then sitting on a full-sized toilet, which makes it harder for the child to go to the toilet.”
I would like to see the potty introduced in the first year
If it’s part of their routine from an early age, a child is much more likely to be familiar with the potty and less likely to have accidents or issues with toileting.
“I would like to see a change in our culture where we’re introducing the potty within the first year universally, and having conversations at a child’s first-year check about potty training,” says Davina.
“This is not about taking nappies away, but about introducing the potty from a young age where children are encouraged after they’ve eaten to sit on a potty for a short while and for parents to feel confident in this vital stage of development.”
What nursing staff can do
Davina says some nursing staff may feel unprepared or unqualified to ask about bowel movements with parents and caregivers, but she says we should be asking the questions as this will help prevent issues in the future.
“Talking about bowels and continence can sometimes be brushed over too quickly, or families might feel unsure about what’s normal, so it’s important we’re able to signpost and advise, which can prevent hospital admissions.”
Nursing staff in all settings and particularly those working in early years assessments, nurseries, GP surgeries and schools, can play a key role in reducing A&E attendance and supporting families earlier.
More information
- Davina is a committee member of the RCN Bowel and Bladder forum, which seeks to inform and advise nursing staff about updates, news and education in the specialty. Join for free and find out more about their work.
- The RCN has various advice guides around bowel and continence care including this updated publication on bowel care.
- Bladder & Bowel UK have many resources to support nursing staff with bowel and bladder care including a yearly symposium and lunchtime learning session.
- Read NHS England’s national clinical guidance for children with constipation in primary care.
