Constipation in Kids

This battle can feel endless. Trying to convince a wiggly child to sit on the toilet for any length of time is a challenge on a good day, let alone if the desired outcome is uncomfortable for them.

Constipation in children can either be defined as infrequent bowel movements or hard, dry stools. If a child is having less than three bowel movements a week, they fall into the category of constipated. Another, less talked about sign of constipation in children specifically is evidence of liquid/pasty stool in their pull-ups or underwear. This can be evidence that stool is backed up in the rectum and small amounts of stool escaped.

Below I have listed five tips I provide children and their family in the clinic that have been proven to make heading to the toilet for a bowel movement less terrifying for the child as well ease the actual passing of stool without the dreaded straining or grunting on the toilet.

1. Provide child with a stool to place under feet, no dangling toes! A stool/support that allows for a child to have their knees slightly above the level of their hips works the best. This forces a muscle called the puborectalis to relax. This muscle can be especially troublesome for little ones as it can pinch off the rectum so stool can become trapped. This can lead to increased incidence of straining and frustration. By relaxing this muscle, stool has a more straightforward route out of the body. 
2. Blow out on the “push.” It’s very easy for kids to want to push their stool out by gritting their teeth together and bearing down. However, this closes off the muscles around the anal opening and prevents stool from easily exiting the body. Instead, I teach my patients to “blow as you go." It’s important to not only make this exhale long in duration through pursed lips, but also loud enough for the child to hear in order to ensure the appropriate muscle is being used. One way to make this fun is to provide your child with a small pinwheel or noise maker to exhale into.
3. Push the fluids! Getting a child to drink water or clear liquids can be very troublesome. There can also be a lot of apprehension to sit on the toilet especially if a child had an incident of a hard, large stool that was difficult and painful to pass. One of my favorite activities I complete with my patients is to use Play-Doh and make what a difficult bowel movement to pass would look like vs. what an easy bowel movement to pass would look like. This prompts the discussion of how we can make our bowel movements look nice and smooth “like a snake." I like to say the secret ingredient is water and the more we drink the less scary our bowel movements will be. The American Academy of Pediatrics recommends four cups of beverages per day, including water or milk, for children 1 to 3 years old. This increases for older kids to around five cups for 4- to 8-year-olds, and seven to eight cups for older children.
4. Retrain the bowels. One concept that is very important when treating constipation in the pediatrics population is understanding that progress can be slow, but consistent training is key. The probability that a child may have a bowel movement is highest 20 to 30 minutes after they eat. This is called the gastrocolic reflex, and it happens as a response to any food entering the stomach, which releases a hormone that causes the colon to begin contracting. I suggest that the child sit on the toilet for approximately five minutes, 20-30 minutes after a meal to “teach” their bowels that this is when a bowel movement is desired by the child. This process can be daunting, however, setting a kitchen timer or providing the child with a short YouTube video on a cellphone or tablet can be a helpful distraction. (Check out the YouTube video- “The Poo in You- Constipation and Encopresis Education Video” from GI Kids; 5:45).
5. Poop Chart. This concept is generally something that families have heard of before. I generally suggest that families create some sort of a chart that a child can independently track how consistent they are with sitting on the toilet for the desired five minutes following meals discussed in the last tip. This can be especially helpful for visual learners to see that progress is being made while retraining the bowels. Rewards do not have to be expensive and can be established based on what each family feels is appropriate. Some common rewards my patients have used include a trip to the library, one dollar to spend at the dollar store and picking out the pizza toppings for the family.

If your child is experiencing any signs of constipation, toilet avoidance, or incontinence do not hesitate to reach out to a pelvic floor physical therapist. These symptoms are incredibly common in children of all ages and small changes to their mechanics and/or routine can drastically improve both a parent’s and child’s quality of life.

Olivia Shelton P.T., D.P.T., Cert. D.N., specializes in pelvic floor physical therapy, treating all symptoms involving bowel, bladder and sexual health. Olivia treats pelvic floor dysfunction in all ages and genders. She is accepting new patients at MyMichigan Rehabilitation at the Campus Ridge Building, on the campus of MyMichigan Medical Center Midland. Those interested in scheduling an appointment with her may call (989) 837-9100.