Common Ways Constipation Presents in Children

What are the Common ways Constipation Presents in Children?

  1. Urinary Frequency – A common reason why young children under 6 years old go to the bathroom a million times during the day and perhaps have an occasional bed wetting incident is constipation.  Due to the sudden increase in urinary frequency, parents come to see us out of concern for diabetes, but 90% of the time the problem is poop!
  2. Uncomplicated Urinary Tract Infections. The most common reason in healthy children for urinary tract infections without fever is constipation.
  3. Abdominal Pain in Teens.  The most common reason for abdominal pain in teen girls seen in the ER is constipation. In fact 75% of ER visits for severe abdominal pain in teen girls is not appendicitis, it’s constipation.
  4. Encopresis.  This is when kids smear their underwater with poop.  Generally, it’s not a whopping issue

How can this possibly be true?

Let’s talk anatomy!
See diagrams below of the side view of the woman and man anatomy.

Some Basics:

– The bladder neck sits in front of the rectum, where the colon takes a downward turn towards the butt.

– The bladder has valves (doors if you will) that keep the pee in so we don’t pee on ourselves all day. When pee builds up, it creates pressure, the bladder spasms a bit to let us know it’s time to go to the bathroom, and as we sit and relax on the toilet, the valves open and pee comes out.

– If poop builds up in the colon, it pushes on the bladder neck where the valves are located and therefore closes those valves tighter. This results in more pee in the bladder needed to push the valves open because of this pressure. However, when kids pee, they quickly jump to finish and do not empty their bladders all the way. Pee is always sitting in the bladder and makes kids feel like they have to pee every 30 min. When they pee it’s only a tiny amount. And the process repeats all day. At night, kids relax, the bladder relaxes, and all that pee that has been sitting in their bladder all day, comes out and they wet the bed.

– Pee that sits in the bladder all day due to build up pressure from poop in the colon, can get infected with bacteria and cause a urinary tract infection. If constipation is not treated , this problem will continue to recur.

– Poop that sits in the colon all the time causes the colon to spasm, especially when eating and this causes abdominal pain. When poop sits in the colon for days, the bacteria in the colon responsible for digestion, causes gas to build up and this can lead to HORRIBLE pain.

– Overtime stool can build up in the colon even though kids may poop every.  The longer the stool sits in the colon, the more water the body absorbs from it and the harder it becomes.  As the poop mass enlarges, so does the colon.  This results in a looser a anal sphincter, which means it’s hard to keep the poop inside the body. This combination of things leads to stool leaking around the giant mass and constant smears in underwater, known as encopresis.

But wait the kids poop all the time, and they say they are regular!!

Regular bowel habits generally = daily soft medium to larger logs

  • pebble poop generally is constipation.
  • pooping 4 times a week, generally is constipation, esp. if there is abdominal pain or peeing issues.

What are the cause of  Constipation?

– WATER!! Children in general do not drink enough water, teens especially. Goal of water intake a day: 1/2 your body weight in pounds = oz of water a day. So if you weigh 70lbs, you should be drinking 35 oz of water a day.

– WHOLE MILK is constipating in some folks, so if your child is drinking 24-32 oz of whole milk a day, that may be the issue. Change to 2% milk and decrease daily milk intake to 18-24 oz a day.  I am a huge proponent of whole milk, but not everyone can digest it properly.

– BATHROOM HABITS. Not going to the bathroom regularly and not relaxing while going to the bathroom.  This is called stool withholding.  Generally, this is caused by objections to Potty Training or the Fear Of Missing Out for the older crowd (I mean 4 year olds and older).  True story.

– FIBER – see Fiber Outline Below for age specific fiber needs.


What can be done about  Constipation?

Read here : 

Behavioral Modifications for Treatment of Constipation

Nutritional and Supplements options for treating Constipation

In Good Health, Ana-Maria Temple, MD

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