At Pelvic Wellness Center, we often see child patients who are experiencing constipation and bladder control problems. This week, Shannon fields a question from a parent who wonders if the two may be connected.
Q: My child has been having only occasional, large BM’s and also having wet underpants during the day. Is this constipation, and why is the bladder leaky as well? Could they be connected?
Shannon Forrestall, PT: You’re right to connect the dots. Does your little one sometimes clog the toilet? We might try to blame it on Dad, but it’s true—our little ones can pass very large BM’s. Does this also seem to coincide with ‘’accidents’’? If this sounds like your child, than he/she might be struggling with constipation.
What is constipation?
Constipation is defined as the infrequent and difficult passage of stool. According to the National Institute of Health (NIH), having less than 3 BM’s a week qualifies, if the stool passed is lumpy, hard, large diameter, and often painful.
It can get tricky though! If your child is impacted (meaning stool has remained in rectum and NOT passed) due to constipation, then the stool he/she may eventually pass will look more like diarrhea. This may happen in the toilet, or often in their underwear (leakage).
Confusing, huh?? We’ll get to why this happens in a bit. First here are some other ways you might me able to identify constipation in your child.
Signs of child constipation
1) Pain. Your child might express abdominal or back pain either verbally, or with gestures (ie hands over the regions) due to bloating.
2) Bad breath, and/or offensive body odor, even after washing.
3) As I noted above, BMs clogging the toilet.
4) Lack of appetite.
5) Urinary symptoms, including bladder leakage or frequency of needing to ‘’go’’.
6) Fecal leakage (encopressis). Your child may have very soft stool which will make its way around the very hard stool impacted in the rectum. The muscles, due to long standing stretch, will become fatigued and will not be able to ‘’hold on’’ anymore, allowing the soft stuff to slip to the outside (underwear!)
Why is my child constipated?
Good question. Here are a few common reasons why your child might be dealing with constipation.
1) Illness: Sometimes constipation will result following a bout of poor food intake, limited physical activity, or a fever which may happen with sickness.
2) Constipating medications: Ritalin, Anticholinergics (Imipramine, HCL, Tofranil), Narcotics (codeine, morphine), Phenytoin (dilantin), or Antacids
3) Traveling: This may be due to long periods of time of needing to ‘’hold on’’ (limited facility accessibility), changes in diet or fluids, changes in schedule, etc.
4) Unpleasant experiences with bathrooms: As we discussed in past blogs, your child might have some issues with school or other bathroom environment (privacy, odors, embarrassment, automatic flush toilets etc).
5) Poor bathroom habits. Children who constantly ignore the urge to defecate may start a cycle of constipation. They may even get ‘’too busy’’ to visit the restroom.
5) Pain. If your child had a bout of constipation due some cause, he/she may have developed a rectal or anal fissure which will be painful with later stool evacuation attempts. This may be a reason your child is withholding.
6) Diet. Constipation may result from a lack of high fiber food intake (fresh veggies, fruits and whole grains). And of course, not drinking enough water!
7)Emotional problems: sometimes children dealing with recent stressors, or other emotional situations may voluntarily withhold stool and develop constipation.
Why is it important to treat my child’s constipation?
So many reasons—including taking care your child’s bladder health! If chronic constipation is left untreated, the pressure on the bladder from the constantly full rectum (yes, the bladder and the rectum are very close neighbors) will likely limit the bladder from filling (causing the need to go ‘’pee’’ often, or urinary frequency). Constipation may also cause the muscles around the bladder to relax and cause a leaky bladder (urinary incontinence).
Having a backed up amount of stool in the rectum can also cause rise in bacteria which may migrate to the urethra (muscular tube to the bladder) and cause infection within the bladder and kidney organs. In general, fecal material contained in the rectum and colon is not poisonous to the body. However fecal impaction and constipation will ultimately affect a child’s day to day functioning. Having a tired, irritable child not wanting to eat or play, and may be having distressful ‘’accidents’’ is generally not on the ‘’must see and do’’ parent’s list.
Now you know what constipation may look like and what we can do about it. If you have questions or concerns about your child’s constipation, please feel free to contact us here at Pelvic Wellness Center. Our pediatric program will be able to help you and your child tackle their constipation and bladder incontinence problems.