During all my well child visits I ask, “Are you pooping okay?” This question is frequently met with a smirk or a nervous laugh and generally some response along the lines of, “Yeah, it’s okay.” For something we do frequently, and hopefully every day, it is interesting that many parents seem more comfortable talking about the birds and the bees than talking about their child’s poop. So, in an attempt to clear the air on going number two, I would like to discuss some common myths and misconceptions about one of the most common issues in the world.
Myth#1: It is obvious when your child is constipated.
REALITY: Constipation is truly the Phantom Menace (apologies to all the Star Wars fans who liked Episode 1). It generally takes a long time for the parent and the child to become aware that an issue has developed. In one study it was found that in approximately 50% of children presenting to the ER with sudden onset severe abdominal pain, constipation was found as the cause. During the potty-training process, it is very common for children to become confused that the goal is never to have accidents instead of learning that what we really want is for poop to go into the toilet. This is what commonly leads to children holding their stool instead of learning to just “let it go”.
Alternatively, when many kids start school, they develop avoidance behaviors to pooping because the bathrooms at school are scary and gross. Every October, just about 4-8 weeks after school begins, I have a rush of families presenting to discuss their child’s abdominal pain. Even after I perform a careful history and exam, many families still have doubts that constipation is the cause of the pain. In these situations, I will perform an x-ray of a child’s abdomen and it will confirm that the colon is full of poop which has built up over the preceding months.
Myth #2: Constipation is defined by infrequent pooping
REALITY: The main two signs of constipation are extra-large man-sized poops and poops shaped like pebbles or logs. Many people consider this type of poop normal. If a child is pooping regularly, their poop should have more in common with soft-serve ice cream or pudding. While infrequent pooping happens with constipation, many chronically clogged children poop daily, even twice a day, because they are never fully empty. So, frequency is only half the equation in deciding if a child is constipated.
Myth #3: Constipation is no big deal
REALITY: Frequently, children who are constipated become adults who deal with constipation. While occasional constipation occurs to everyone, chronic constipation leads to a whole range of issues. The rectum, the final portion of the large intestines, was never designed to hold large amounts of stool for extended periods of time. Once the rectum becomes overly extended, a person may lose the sensation that poop is even present. This can lead to ‘encopresis’, a condition where a person has the inability to sense or even stop the leakage of stool. In addition, when the poop piles up a large, hard mass forms, leading to both discomfort and issues with the bladder as this mass of poop sits on top of it. A child may need to pee frequently and urgently or may even have spontaneous emptying of the bladder. In some cases, bed wetting can be caused by this buildup of poop flattening the bladder, making it impossible for the child to hold pee overnight. It is also well established that constipation is a risk factor for recurrent urinary tract infections.
Myth #:4 Prune juice, fiber and a dash of probiotics will fix constipation.
REALITY: While a good diet can go a long way to help prevent constipation, once constipation has set in it will likely take a little bit more to fix the problem. This is because once the large intestine becomes overly burdened with stool it stretches beyond its normal diameter. Once the intestines become overly dilated, the stretch receptors that sense when poop is present no longer function correctly and the muscles struggle to move the poop along. The purpose of using stool softeners such as MiraLAX and the occasional enema is not simply to clear out the poop that has built up but also to help retrain the bowel to what normal stool sensations feel like. Since constipation didn’t happen overnight, it often takes at least 3 months of daily poops that have the consistency of soft serve ice cream before the rectum and colon return to their normal size and starts to function normally.
Ultimately, having the child buy into the mantra of letting the poop go as soon as they feel it is what brings long term success in dealing with constipation.
Myth #5: Becoming constipated is a moral failing.
REALITY: In my experience, there is a huge stigma associated with constipation and often parents or children feel like they have failed when constipation is recognized. I want to make it clear that when a child becomes constipated it is not because of bad parenting or because a child has failed, it is most often because environmental factors beyond their control trained them that holding onto poop was better than just letting it go. When a child becomes constipated, assigning blame never helps the situation, but creating a positive team effort that removes barriers to using the toilet is essential to success.
I hope this journey into the world of constipation has been helpful in understanding not only how common this problem is, but also how fixable this issue is as well. If your attempts to fix your child’s constipation have not been successful, please make an appointment with one of the Pediatricians at Canyon View Pediatrics to discuss your child’s specific needs.
Patrick McVey, MD
Canyon View Pediatrics