Childhood Constipation and Bedwetting: The Pertinent Poop

In Pediatric Pelvic Health by Melinda FontaineLeave a Comment

By Melinda Fontaine, Clinic Director of PHRC Walnut Creek

Child: “Ms. Melinda, why did you choose to do what you do?”

Ms. Melinda: “Two reasons: I get to wear sneakers to work, and I get to laugh at potty humor forever!” 

Did you know that pelvic floor physical therapists also work with children?! I help all people pee and poop better and feel better, from age 5 to 95. Constipation affects a large percentage of the American population, including 29% of pediatric patients.1 Constipation in children can appear in a variety of ways.  Aside from infrequent, hard, or extra large poops, constipation may also present as frequent or loose poops. Does your child have less than three poops per week?  When they do poop, does the size of it threaten to clog your plumbing? If someone has been constipated for a while, the collection of poop expands the rectum, and can lead to recurrent large poops and recurrent clogged toilets. Sometimes the poop looks like rabbit pellets or a bumpy log with cracks in it. These poops indicate that the poop has been in the colon for too long and all the moisture has been sucked out of it until you are left with a hard dry solid mass. Some poops come out in small frequent poops that may even be loose, but there is a larger, less friendly poop remaining in the colon. This can be seen on an x-ray. 

Constipation can also lead to skid marks, itchy bottoms, or repeated trouble toilet training. Full rectums may also put pressure on bladders and lead to difficulty with bedwetting, urinary tract infections, frequent peeing, or belly pain.2 As if constipation wasn’t bad enough by itself, it can also set you up for increased incidence of anal fissures, hemorrhoids, and perianal scar tissue. In children with constipation and pelvic floor muscle dysfunction, over 80% had an acute or chronic anal fissure.1 children with constipation are also more likely to develop a pelvic pain condition. This tells me two things.  First, the cause of the constipation needs to be addressed swiftly to avoid other problems, and pelvic floor physical therapy addressing muscle dysfunction should be a part of the treatment plan. 

One cause of constipation is pelvic floor muscle dysfunction. The pelvic floor muscles are the gatekeepers; if they don’t open, then no poop shall pass. To open the pelvic floor muscles, they need to relax and lengthen. Sometimes, the muscles tighten and close instead. I can’t blame them. It may happen because they have had pain or injury in the past. Maybe there is a fear about the potty or a belief that it is dirty or shameful. It would be hard to relax in any of these situations. When poop is ready to come out, but the muscles won’t let it, people often hold their breath and strain to push it out. This can lead to a slew of complications, such as retention, hemorrhoids, fissures, continued constipation, etc. When the rectum is full of stool, it presses on the bladder and can cause bedwetting, frequent or urgent peeing, difficulty peeing, or accidents. 

As a parent, I know first-hand how awful it is when your kid is not well. Of course, you would do anything to help, and connecting with the right professionals and resources can be the first step. Pelvic floor physical therapists teach various methods to improve pooping in children in ways that are appropriate for their age. What can your kids expect in physical therapy? Talking, drawing, joking, playing, books, playdoh, and balloons. Sounds like fun.

 I make a point to talk openly and comfortably about all bodily functions because they are natural, and everybody does them. My goals are to reduce any anxiety or shame and to be very clear. This is where the talking, drawing, joking, and books come in to play. We can also get some work done by creating a plan for what to do at home or school when your body wants to pee or poop.2 What’s the best way to sit on a toilet? How long should you sit on a toilet? What should you do while you are sitting on a toilet? We can talk about what foods and drinks go into our bodies to make sure we have the right ingredients for good poops.2 What does a good poop look like? And we play games and do exercises to help us identify the muscles in our body.  Our games are really exercises for the diaphragm and pelvic floor. They help teach us what it feels like to relax and contract the muscles, so we can do it when we need to.3 These types of exercises in combination with medical care, help treat urinary incontinence, bedwetting, and urinary tract infections in children with dysfunctional voiding.4 If mature children would find it useful to use a biofeedback device to sense the activity in the pelvic muscles, we can do that, too. If you feel alone, you may just not have found the right resources yet. 

I am currently offering digital health appointments for patients who may live far from me or may not be able to come to the office during the pandemic. Here is the link to schedule

REFERENCES:

1. Sanchez-Avila MT, et al. Frequency and findings of the acquired anorectal disease in the pediatric population with chronic constipation. The Turkish Journal of Pediatrics 2018; 60: 547-553.

2. De Paepe H, et al. Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation BJU International 2000; 85: 889-893.

3. De Paepe H, et al. The role of pelvic floor therapy in the treatment of lower urinary tract dysfunctions in children. Scandinavian Journal of Urology and Nephrology 2002; 36(4)

4. Zivkovic V. et al. Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. European Journal of Physical and Rehabilitation Medicine 2012; 48: 413-21.

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