If you work with someone who is constantly constipated you know what a big deal this is. Think about it, when your stomach is upset and cramping it’s hard not to be grumpy. We shouldn’t be surprised that people with chronic constipation do poorly in school, seem distracted, and are not interested in play or interacting with others. No one wants to work or socialize when they don’t feel good.

Chronic constipation can make defecation painful, this can cause a child to resist toilet training or even try to hold in a stool causing impaction. If a child passes a hard stool it can be painful and may even cause an anal fissure, causing unexpected pain. Fear of facing this pain again often makes a child unwilling to try a new way of defecating i.e. going on the toilet. If this is your child’s situation you must take into account your child's feelings and perceptions while potty training.

Signs and symptoms of constipation include:

• Less than three bowel movements a week.
• Hard stools
• Pain, cramping, toe-walking, holding the stomach
• Holding in stools or resisting defecating
• Blood on the stool or when wiping indicating an anal fissure
• Rectal impaction or abdominal fecal mass.

Encopresis Encopresis is a condition that can develop in children who have chronic constipation. This often develops as the result of a vicious cycle: the child becomes constipated, they feel pain when they defecate, they withhold defecation, become constipated, feel pain when they defecate and so on. This can cause the stool to become impacted, lead to enlarged intestines, and eventually cause the child to have problems even sensing when they need to go to the bathroom. Eventually, liquid stool will start to leak around the hard, dry, impacted stool, soiling a child's clothing. Unfortunately, this can be misinterpreted as diarrhea.

For an encopresis diagnosis, a child must meet the following DSM IV-TR criteria:

• 1). repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or intentional;
• 2). at least one such event a month for at least 3 months;
• 3). chronological age is at least 4 years (or equivalent developmental level);
• 4). behavior is not due exclusively to the direct physiological effects of a substance (e.g., laxatives) or a general medical condition except through a mechanism involving constipation