Managing Constipation in Children

Did you know that between 10-20% of children are constipated? That is about 1 out of every 5 children! Some signs of constipation are obvious; only pooing every few days; super large poos or rabbit pellet poos that are dry and painful to push out. But, there are some signs that may not be so obvious. For very small children: difficulty potty training, hiding to do a poo, straining to do a poo are all classic signs of constipation. For children who are potty trained: belly pain, skid marks on their undies or an itchy anus, frequent urination, wee or poo leaks during the day, pooing many times in a day, very loose runny poos and bed wetting, can all be signs of constipation.

Choose Your Poo! 
We want kids to be doing Type 4 or 5 poos every day! If that isn’t happening they are very likely constipated.

hows my poop

Image taken from www.bedwettingandaccidents.com

I don’t think my child is constipated
“Wait, if my child is having multiple poos a day or their poo is super soft then they surely can’t be constipated? And bed wetting is about wees, not poos?”

I am going to try and explain some of the facts to help you understand better.

Multiple poos a day 
If a child is pooing multiple times a day they are probably not emptying properly and this can happen for a few reasons. The most common reason is that they have been constipated for a while and their rectum is stretched and actually can’t empty itself fully. Pooing more than twice a day can be a sign of constipation.

Very Soft / Runny Poos
“My child is having super soft poos every day, there is no way she is constipated?” If your child is very constipated the super hard poo stays where it is and the runnier poo behind it oozes past. This can sometimes result in a poo leak or else the child goes to the toilet but again they are still backed up! If they are having daily poos or having the other signs like complaining their tummy is sore, bed wetting or skid marks in their undies they are most likely constipated (Remember 1 in 5! So if your child is in a class of 20, 4 of those children are chronically constipated!)

Bed wetting
Bed wetting is a direct consequence of constipation. Why is this? A child’s pelvis is already so small and if you have a rectum that is filled with poo it doesn’t give the bladder much room at all and that poo keeps pushing on the bladder (if you have had someone push on your bladder you know you need to GO). Children who bed wet, or have leaks of their wee or poo during the day are needlessly shamed when actually they are just super backed up. The biggest thing is ITS NOT THEIR FAULT!

poo squashing bladder

Image taken from www.bedwettingandaccidents.com

What can we do?

Fixing the constipation, fixes the problem! This is easier said than done. It requires daily work on many different aspects, but the good news is it can come right!

How can Physio help?
A paediatric pelvic physiotherapist has advanced training in children’s bladder and bowels. They assess the child as a whole and help them get on a good bladder and bowel programme to “reset” their systems. Help with posture, breathing, core work and visceral massage. Children who have been constipated often have painful poos. This leads to a spasm in their pelvic floors and they need to be taught now to relax it again.

It does not involve any invasive examination and the first session is mainly talking and teaching how to do the tummy massage. Some Physio’s also use Real-time ultrasound (like the one the gynae uses to scan a pregnant tummy). This helps to assess the rectal diameter (to see if the rectum is stretched) and also to help retrain the pelvic floor muscles.


Written by Mandy Roscher – BSc Physio Wits – Roscher & Associates Physiotherapy

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