Constipation and Faecal Soiling in Children
Are you in tune with your child’s toileting habits? Do you know how many bowel motions they may pass in a day? Do you know what their urine colour looks like?
The truth is that often when our children become toilet trained, it’s easy to lose track of our children’s daily bathroom habits.
While we don’t need to monitor every flush, it’s wise to have an awareness of their normal routines. Why?
1 in 12 children and teenagers will have a bowel or bladder problem.
Often these problems will affect them and cause issues well into their adulthood - but they don’t have to! This World Continence Week 2022, we challenge you to check in with your child’s bladder and bowel habits.
Constipation and Faecal Soiling in Children
What is considered constipation in a child? A diagnosis will be made for any child at the developmental age of 4-years or older if they have at least two or more of the following symptoms present at least once a week over the course of a month.
2 or fewer defecations in the toilet per week
At least 1 episode of faecal incontinence per week
History of painful or hard bowel movements
Presence of a large fecal mass in the rectum
History of large-diameter stools that may obstruct the toilet
The symptoms cannot be fully explained by another medical condition.
That being said, there are other signs and symptoms that your child could be constipated. As a parent, if you notice any of the following, it may be good to pay attention.
Faecal soiling – the vast majority (75-95%) of these children are constipated
Foul wind, stool and/or excessive wind
Daytime wetting or bedwetting
Urinary tract infections
Failure to toilet train
Abdominal pain, distension
Poor appetite, lack of energy, irritability etc.
What is faecal incontinence and how does this link to constipation?
“Mum! I pooped in my undies again!” Faecal incontinence is the term used for soiling in children over the age of four years old. In most cases, faecal incontinence actually develops as a result of chronic constipation.
Here’s why.
When your child’s bowel becomes blocked for long periods of time, their rectum (the section of our digestive tract where poo is held before it passes out) becomes more of a storage organ rather than a sensory organ.
The buildup of poo causes the muscles and nerves of the bowel to become so stretched that it cannot register that there is poo there. The usual signal that the bowel sends to the brain to empty is not sent and your child may lose their sense of “urge” to go to the bathroom. At this point, when more poo forms and moves down the colon, it has nowhere to go. This new soft poo can ooze around the hard poo and can trickle out, catching your child unaware. It looks like liquid, loose poo or skid marks on their undies. In most cases, your child doesn’t even know that this is happening!
They are definitely not lazy or forgetful in going to the bathroom. If this is an issue with your child, please don’t shame them as this can make toileting avoidance and anxiety worse.
What to do if your child is constipated?
If you feel your child is constipated or if you have concerns with your child’s bowel health, it is so important to speak to your GP or to a pelvic health physiotherapist.
It will take at least as long to resolve the problem fully as it does to get constipated! The earlier constipation in the child is addressed, the better. It is estimated that 30% of children with chronic constipation will continue into adulthood with the same problem. Let’s solve this problem earlier rather than later.
Here are some tips to help manage your child’s constipation at home.
Diet and fluids. Are they having plenty of water spaced throughout their day? Their urine colour (and ours) should be a pale yellow colour in mid-afternoon. Anything darker is a good indicator they may not be drinking enough water. Are they having 5+ a day of fresh fruit and vegetables?
Make sure they aren’t avoiding the toilet or waiting too long. Are they too busy and/or ignoring the signs that they need to empty? Do they feel as if they have to wait for an adult to give them permission to go to the bathroom at school or care? Waiting too long can cause their urge to pass and the stool then moves back into the colon. At this point, water gets reabsorbed from the poo which makes it harder and more difficult to pass. Always ensure that your child (and you) respond to the first urge to pass your bowels.
As it can be painful to empty bowels with constipation, children will often avoid going!
Keep them moving. Encourage your child to be physically active every day, this can stimulate the movement of poo through their colon!
Ask for help. If you are struggling to solve this problem on your own, Pelvic Health physiotherapy can help with the management of bowel dysfunction in children. We can assess what is happening and why, give you tips and strategies on the use of laxatives, toilet training, exercises, sensory processing techniques etc and point you in the direction of appropriate referrals if needed.
As pelvic health physiotherapists, talking about bladder and bowel health is part of our everyday conversation - for men, women and children. If you have any questions about your child (or yourself), do feel free to reach out to us.