Constipation consternation: Help your child be a super pooper

If your child is older than four and wets the bed or has accidents with soiling or incontinence, you've probably heard many theories about why it's happening.  

It may surprise you to know that constipation is often the reason a child wets the bed or has other bladder or bowel problems. Unless constipation is treated and resolved, these problems can continue into adolescence and have serious, lifelong consequences.  

Chronic constipation stretches the rectum and prevents the child from feeling the urge to have a bowel movement. The stretched-out rectum affects how nerves and muscles in the pelvic floor function. That's what leads to accidents and leakage. This video from the Children's Hospital Colorado offers a great explanation of what's happening in the body when someone is constipated.  

For many kids, the problems begin with toilet training. We recommend that parents check in with their child's health care provider before they begin toilet training, ideally when the child is about three years old. It's very important that you do not start toilet training if your child is constipated. Your provider can help you determine if your child is ready and if he or she may be constipated.  

Kids who aren't constipated have a good amount of soft stool on most days. It should be enough to curve around in the toilet bowl, and it should be the consistency of mashed potatoes or soft serve ice cream.  

Here are some common signs of constipation in children: 

• Frequent tummy aches
• Poor appetite
• Very large stool, like logs
• Very small stool, like pellets or lumps
• Smears in diapers or underwear
• Itchy anus
• Urinary leaks during the day or at night
• Infrequent or painful bowel movements
• Frequent urinary tract infections
• Abdominal bloating and frequent smelly gas

 If your toddler or preschooler is constipated, follow your provider's recommendations on diet and medicines.

If your child is older than four and has problems with urinary or bowel accidents, leakage and bed wetting, your provider may refer your child for pelvic floor physical therapy. We provide recommendations on diet and teach pelvic floor, relaxation and breathing exercises to improve bladder and bowel function. We may also use biofeedback and manual therapy. If your child has been constipated for a long time, it can take several months to a year for the rectum to return to its normal size and shape, but most children make significant progress within a few months.