The Common but Often Missed Cause of Abdominal Pain in Children
By Dr Daniel Gordon • 11, May 2026
Does your child keep complaining of tummy pain, only to be told each time that nothing serious is wrong? There is often a clear explanation, but it has not been properly broken down. In many cases, the cause is something far more common than expected.
Here’s the uncomfortable truth. By the time recurrent abdominal pain becomes a concern, the underlying issue has often been building for weeks or even months. What seems minor at first can quietly develop into something much more persistent.
I’m Dr Daniel Gordon, a GP in London, and constipation in children is one of the most common presentations I see in general practice. In my experience, it is also one of the most misunderstood.
Watch the full video The Common but Often Missed Cause of Abdominal Pain in Children on my YouTube channel The Health Perspective.
If you prefer reading, you’ll find the full explanation below.
Why Constipation Is a Common Cause of Abdominal Pain in Children
Constipation is one of the most frequent reasons children present with ongoing tummy pain. Parents often feel something is being missed, especially when symptoms continue despite reassurance.
What is often overlooked is how gradually this condition develops. By the time a child is experiencing daily abdominal pain, accidents, or avoiding the toilet, the bowel has usually been affected for some time.
In clinical practice, constipation in children is frequently under-recognised and under-treated. Understanding how it builds over time is key to managing it properly.
Why Childhood Constipation Is Often Misunderstood
Many parents think of constipation as a short-term issue that resolves quickly. The expectation is that a few dietary changes or a brief course of treatment will fix the problem.
In reality, childhood constipation often behaves very differently. It tends to develop over weeks or months and does not resolve with short-term measures.
By the time families seek medical advice, the situation has often progressed beyond a simple, acute problem.
How Constipation Develops in Children
What Happens Inside the Bowel
The large bowel absorbs water from waste as it moves through the body. When stool stays in the bowel for too long, it becomes harder and more difficult to pass.
This can happen for several reasons, including holding on, low fibre intake, low fluid intake, or a previous painful experience when using the toilet.
The Self-Reinforcing Cycle of Constipation
Hard stools are painful to pass. A child quickly learns to associate going to the toilet with discomfort and begins to hold on.
Holding on leads to more stool building up in the bowel. The stool becomes harder, and the cycle continues.
Over time, the bowel stretches to accommodate this build-up. A stretched bowel becomes less efficient, and the signals that tell a child they need to go become weaker.
Parents often tell me their child says they do not feel the need to go. That is a direct consequence of how a stretched bowel affects those signals.
What Is Overflow Soiling in Children
When a large amount of stool builds up in the bowel, looser stool from higher up can leak past it. This can come out without the child having any control.
This is known as overflow soiling, and it can be very distressing for both the child and the family.
Parents sometimes interpret this as behavioural or assume their child is regressing. In reality, it is a physical consequence of long-standing constipation.
It is important to be clear. Overflow soiling is not a behavioural issue. It is not the child’s fault, and it is not a reflection of parenting.
Symptoms of Constipation in Children
Common Signs Parents Recognise
The more obvious symptoms include infrequent bowel movements, hard or pellet-like stools, straining, pain when going to the toilet, and active avoidance.
Tummy pain that comes and goes is also common. It is often felt around the belly button or lower left side, and can appear after eating.
Bloating, reduced appetite, and a general sense that the child is not quite themselves are also frequent features.
Less Obvious Symptoms That Are Often Missed
Constipation can also present in ways that do not immediately seem related to the bowel.
A full bowel sits close to the bladder. When it is loaded, it can press against it and cause urinary symptoms.
These can include bedwetting in a child who was previously dry, urgency, or even urinary tract infections.
Sleep can also be affected. Some children wake during the night due to discomfort, which can lead to irritability and changes in mood.
Another symptom that can cause concern is small amounts of blood when passing stool. This is often due to a small tear caused by hard stool, known as an anal fissure. It looks alarming but is usually linked to the constipation itself, although it should always be discussed with a doctor.
Why Constipation in Children Is Often Missed
Constipation is not always obvious. Some children continue to pass stools regularly, but do not fully empty their bowel.
Over time, a backlog builds up without being recognised.
Abdominal pain in children has many possible causes, and constipation is sometimes only considered later. In practice, when the right questions are asked about stool consistency, effort, and behaviour around toileting, the pattern often becomes clear.
Treatment for Constipation in Children
Why Short-Term Treatment Often Fails
When constipation has been present for some time, a short course of laxatives is unlikely to resolve it.
If there is a significant build-up in the bowel, the first step is often disimpaction. This involves a higher dose of laxative over several days to clear the backlog.
This process can be uncomfortable and messy, so families need to be prepared and supported through it.
The Importance of Long-Term Management
After the bowel has been cleared, ongoing treatment is usually required.
Maintenance laxatives are often needed at a lower dose for a longer period to allow the bowel to recover. This can take weeks or months, and sometimes longer.
A common mistake is stopping treatment too early when symptoms improve. The bowel may not have fully recovered, and the problem can return.
Building Healthy Toilet Habits
Toilet habits are an important part of treatment.
Children should sit on the toilet comfortably for a few minutes after meals, ideally with their feet supported. This works with the body’s natural reflex that encourages bowel movement after eating.
Consistency is key. Small, regular habits can make a meaningful difference over time.
When to Speak to Your GP About Constipation
If your child has been treated for constipation but symptoms persist, it is important to go back and review the plan.
Ask whether disimpaction is needed, how long treatment should continue, and what a realistic timeline looks like.
If your child is experiencing soiling, it is important to raise this openly. It is a common clinical presentation, and discussing it helps move towards the right treatment.
What Every Parent Should Understand About Childhood Constipation
Constipation in children often develops gradually and can remain unnoticed for some time.
Symptoms such as abdominal pain, reluctance to use the toilet, soiling, and disrupted sleep can all be part of the same underlying issue.
Treatment usually takes longer than expected. It often requires consistent management over weeks or months.
This is not a reflection of parenting, and it is not a behavioural issue. It is a medical condition with a clear mechanism and an effective treatment approach when managed properly.
Most children improve with the right support and time.
Disclaimer
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