Why is my Child Constipated?
WHY is my child constipated? That is the REAL question!
Before looking for a solution to your child’s constipation, the question of WHY should be what you’re asking any healthcare professional that is involved in your child’s care.
To help relieve constipation, you need to know what you’re dealing with. A child who has hard stools, but can feel the urge and desires to go, will need a much different course of treatment than a child that is afraid to poop, withholding or leaking stool.
There are multiple reasons why kids are dealing with constipation and encopresis. When we see kids in our clinic, we spend a lot of time gathering information about when the stool troubles began, diet history, toileting behavior and listening to any fears or concerns from the child when it comes to having a bowel movement. This helps us get to the ROOT CAUSE of why a child is struggling. Only then can we begin to work toward a solution.
Here are just a few reasons we commonly see in the clinic:
Nutrition and fluids When Jessica hears a mom talk about her child’s diet and finds that the child has a healthy appetite and eats a variety of produce, but is still having hard stools, low water intake is usually the culprit. Increasing water intake is the #1 thing you can do to help a child with hard, pebble like poop.
Poop is the by product of the foods we eat. After the food is broken down in the stomach it makes its way through the small intestine where all the nutrients get absorbed. Once the body has taken what it needs from the food, it travels through the large intestine and out through the colon. When waste sits in the colon, it becomes more dehydrated and hard. If it’s somewhat hard to begin with, this makes it travel slower and becomes more likely that the stool will sit for longer in the colon. Water helps prevent the poop from becoming dehydrated. A high fiber diet with very little water can actually make constipation so much worse. Make sure to read more about ways to help your child drink more water here.
A full diet history needs to be taken- does the child consume a diet that is primarily white? Are there lots of low nutrient snacks like goldfish, pretzels, crackers and white bread? Due to the amount of fluid needed to digest these kinds of foods, white foods can cause the stool to become hard and dehydrated. For some kids dairy can be very constipating. Things like cheese, milk and yogurt might be causing a backup for kids. Maybe there is an undiagnosed food allergy or sensitivity. When Jessica sees hard stools starting early in the child’s life, gut health and food sensitivities are often the reason. If your child’s poop is hard, but she’s willing and able to go, diet food and/or fluid should be explored.
Pelvic floor One of the main jobs of the pelvic floor muscles is to hold and release stool and urine at appropriate times. When these muscles are out of sync, it can prevent your child from having a bowel movement and eventually lead to constipation. Some of the things Annette addresses during the evaluation include potty posture, determining if the child is able to contract and relax his pelvic floor muscles at the appropriate times, assessing the pelvic floor for tightness or weakness, and whether the diaphragm and pelvic floor are working together. Annette also looks at core strength. Oftentimes, when a child’s core is weak, the child may have difficulty expelling stool as they are lacking the extra help from their transverse abdominal muscles. Once Annette has the answers to these questions, she can formulate a plan that brings the pelvic floor back in sync for the child and pooping becomes so much easier.
Potty posture How your child sits on the toilet is so important. Some kids we work with are sitting on the big toilet, legs dangling, holding the seat so they don't fall in- none of this is relaxing or conducive to having an easy bowel movement. We recommend using a floor potty for as long as possible or using a squatty potty or stool to support the feet with a toilet insert like. Why? This allows your child to have feet supported, knees higher than the hips and she doesn’t have to worry if she’s going to fall in. Her legs should be apart so that she can’t pull in other muscles that prevent a complete bowel movement. Once she’s sitting properly have her lean forward with a neutral spine. Take a look at this quick video Annette did on potty posture. And for a helpful visual reminder, garb our potty posture poster available for digital download.
Sensory Processing Disorder This can make toileting a challenge from so many angles! The bright lights in the bathroom or loud noise of flushing can be frightening or aggravating for a child with SPD. And we can’t forget to mention hand dryers- many kids can’t tolerate the noise or blowing air. Other kids don’t like the feeling of sitting on a toilet to poop. We see this often when a child starts to potty train. They have been laying down or standing up to poop for their whole life! Now you want them to sit? Their little brains are telling them this doesn’t feel right! Maybe the seat is too hard (or hot as one kiddo recently told us). If the stool has ever dropped in the toilet and splashed the child’s bottom, this can also create a feeling that pooping is yucky. Maybe your child takes off all his clothes before going to the bathroom or doesn’t like the smell of poop (I mean, who does). All of these are signs that your child may be dealing with a sensory processing disorder which could cause challenges with toileting. If your child has experienced any of these, it’s worth reaching out to a Pediatric Occupational Therapist for more help. We work with a fantastic OTin our clinic.
Traumatic Past Experiences Has your child had a negative experience with pooping? If so, your child might be remembering this every time she needs to go. Because she’s afraid to go, she may start withholding so she doesn’t have to go through that experience again. We see this in the majority of the kids we work with. Hard, painful stool is the top one we see but others include having an accident in front of friends or family which lead to shame and embarrassment, worry that someone will walk in on them while going and a bad diaper rash that burned when the child pooped. The first steps for a child with negative past toileting experiences is to make sure the stool is soft to prevent any pain that he might experience. Next is finding out what the child is afraid of and helping her see that pooping doesn’t hurt anymore. This can be done by putting happy faces on a calendar for days it doesn’t hurt to help remind her that it doesn’t hurt. Another great idea is taking a short video of your child saying it doesn’t hurt so you can show it to her the next time she is afraid. Some kids would benefit from working with a behavior specialist to overcome this fear.
A few other things we commonly see have to do with the home environment. Families that are busy and overscheduled often struggle with constipation and withholding. This is because the child doesn’t have a chance to be home for long periods of time which may mean rushing in the bathroom versus sitting and relaxing. For many families, we strongly encourage slowing down for a few weeks to give the child time to use the bathroom without feeling rushed. It’s also super important for mom and dad to be on the same page with the plan of treatment for constipation so the child isn’t receiving mixed signals each time he needs to go.
Lastly, some kids have lost feeling down there and actually don’t know when they need to poop. The ability to understand your internal sensations is called Interoception and some kids just can’t recognize it. This requires some work around helping your child learn what it feels like inside to have to poop and then what to do when he feels that way. To learn more about interoception and toileting, make sure to check out the well respected work by occupational therapist, Kelly Mahler.
As you can see the reasons for a child’s constipation, withholding or encopresis can be complicated and varied. Once you know the WHY, the how to treat becomes much easier. Often it’s a combination of a few things. If your child is struggling and you don’t know why, reach out! We’d love to be able to help you uncover the real reason your child is having bowel challenges and put a plan in place to overcome it.
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