Researchers looked at 248 children who came to the doctor with constipation and were later found to have celiac disease (a condition where eating gluten damages the intestines). The study tracked these children for about 5 years after they started eating a gluten-free diet. Surprisingly, only about one-third of the children got better, while two-thirds still needed laxatives to help them go to the bathroom. The study found that children who also had anxiety, depression, or thyroid problems were less likely to get better. This suggests that constipation in celiac disease is more complicated than just avoiding gluten, and other health factors may play an important role.

The Quick Take

  • What they studied: Whether children with celiac disease who have constipation as their main symptom get better when they stop eating gluten
  • Who participated: 248 children under age 18 who came to Mayo Clinic between 1994 and 2024 with constipation and were diagnosed with celiac disease. Most were girls (68%) and White (99%), with an average age of about 8 years old
  • Key finding: Only 32% of children had their constipation completely resolve after following a gluten-free diet without needing laxatives. The other 68% still needed medicine to help them have bowel movements, even after sticking to the diet for an average of 5.3 years
  • What it means for you: If your child has celiac disease and constipation, switching to a gluten-free diet alone may not completely solve the problem. It’s important to talk with your doctor about other possible causes and treatments, especially if your child also has anxiety, depression, or thyroid issues

The Research Details

Researchers looked back at medical records from Mayo Clinic over 30 years (1994-2024) to find all children who had constipation as their first symptom and were later diagnosed with celiac disease. They organized the information about each child, including what symptoms they had, how they were diagnosed, and whether their constipation improved after eating gluten-free. They followed these children for an average of 5.3 years to see what happened to their constipation over time.

The researchers divided the children into two groups: those whose constipation got better (resolved) and those who still needed laxatives (unresolved). They also looked separately at children who had a more serious type of constipation called encopresis, where children accidentally have bowel movements in their clothes. They checked for patterns, like whether children with other health conditions had different outcomes.

This type of study is important because it shows what really happens to patients over many years in real life, not just in a controlled experiment. By looking at actual medical records, researchers can see the true long-term results of treatment and discover which children are more likely to have problems. This helps doctors understand that celiac disease and constipation may be more connected to other health issues than previously thought.

This study has good strengths: it includes a large number of children (248), follows them for several years, and uses real medical records from a respected hospital. However, it also has some limitations: it only looked at children who went to Mayo Clinic, so the results might not apply to all children; the study is looking backward at old records rather than following children forward in time; and some information might be missing from the medical records. The researchers couldn’t always prove that one thing caused another, only that they happened together.

What the Results Show

The main finding was that most children with celiac disease and constipation did not get better even after following a gluten-free diet. Only 32% of the 248 children had their constipation completely go away without needing laxatives anymore. This means that 68% of children—more than two out of three—still needed medicine to help them have bowel movements after an average of 5.3 years on a gluten-free diet.

When the researchers looked specifically at children with the more serious type of constipation (encopresis), the results were even worse. Only 29% of these children got better, meaning 71% still had problems even after avoiding gluten. This suggests that the more severe the constipation problem is at the start, the less likely it is to improve with diet alone.

The researchers also noticed that children whose bodies were slower to heal (measured by antibody levels in the blood) were more likely to still have constipation problems. This suggests that the intestinal damage from celiac disease might take longer to heal in some children, and this could affect their constipation.

The study found some interesting patterns about other health conditions. Children who still had constipation problems were more likely to also have anxiety or depression (42% compared to 30% in the group that got better). They also had more thyroid problems (13% compared to 9%). These findings suggest that mental health and other body systems might play a role in whether constipation improves. Interestingly, children with type 1 diabetes seemed more likely to get better (14% versus 4%), though this difference wasn’t strong enough to be completely certain.

This research adds important new information because there hasn’t been much data on what happens to constipation in celiac disease children over the long term. Previous studies focused mainly on whether a gluten-free diet helps celiac disease in general, but didn’t specifically track constipation as the main symptom. This study shows that constipation in celiac disease is more stubborn than doctors might have expected, and that it’s not always solved by diet alone. The finding that other health conditions matter suggests that celiac disease and constipation might be more complicated than previously understood.

This study only looked at children who went to Mayo Clinic, which is a large hospital in Minnesota, so the results might not apply to all children everywhere. The study looked backward at old medical records rather than following children forward in time, which means some information might be missing or incomplete. The researchers couldn’t always tell if one thing caused another—for example, they found that anxiety and constipation happened together, but couldn’t prove that anxiety caused the constipation. The study also didn’t have a comparison group of children with celiac disease who didn’t have constipation, so we can’t be sure how different these children really are. Finally, the study was mostly White children (99%), so the results might not apply to children of other races or ethnicities.

The Bottom Line

If your child has celiac disease and constipation, a gluten-free diet is still important and should be the first step. However, parents should expect that diet alone may not completely solve the problem—only about 1 in 3 children get complete relief. Work closely with your child’s doctor to monitor progress over time. If constipation doesn’t improve within several months of starting a gluten-free diet, ask your doctor about other possible causes and treatments. If your child also has anxiety, depression, or thyroid problems, make sure these are being treated as well, since they may be connected to the constipation. Consider asking for a referral to a gastroenterologist (a doctor who specializes in digestive problems) if the constipation is severe or not improving.

This research is most important for parents of children with celiac disease who have constipation, and for doctors who treat these children. It’s also relevant for children with celiac disease who are struggling with ongoing constipation despite following a gluten-free diet. However, this study only looked at children, so the results don’t necessarily apply to adults with celiac disease. If your child has constipation but hasn’t been tested for celiac disease, talk to your doctor about whether testing makes sense.

Based on this study, parents should give the gluten-free diet at least several months to help with constipation, but should not expect immediate results. The study followed children for an average of 5.3 years, and many still had problems after that long. If constipation hasn’t improved after 3-6 months of strict gluten-free eating, it’s time to talk with your doctor about other possible causes and treatments rather than waiting longer.

Want to Apply This Research?

  • Track daily bowel movements and laxative use: Record whether your child had a bowel movement each day, whether it required a laxative, and any accidents (encopresis). Use a simple scale (1-5) for ease of bowel movement. Track this weekly to see if there are patterns or improvements over months
  • Use the app to set reminders for gluten-free meal planning and to log meals eaten, making it easier to identify if any hidden gluten might be causing problems. Also use it to track other symptoms like mood changes or anxiety, since the study suggests these might be connected to constipation
  • Create a monthly report showing trends in bowel movement frequency and laxative use over 3-6 month periods. Share this data with your child’s doctor at appointments to help them see whether the gluten-free diet is actually helping or whether other treatments are needed. This long-term tracking helps catch patterns that daily tracking might miss

This research describes what happened in one group of children at a specific hospital and should not be used to diagnose or treat any individual child. Every child is different, and constipation can have many different causes. If your child has constipation or has been diagnosed with celiac disease, please talk with your pediatrician or a gastroenterologist for personalized medical advice. Do not start, stop, or change any medical treatment based on this article without consulting your child’s doctor first. This article is for educational purposes only and is not a substitute for professional medical advice.