Have you seen that movie about the constipated kid? Nope? Me either. That’s because it hasn’t come out yet! Ha! Potty humor at its best! While I’m channeling my inner middle school kid for a cheap laugh, true constipation in your child is no laughing matter. Constipation can cause pain, discomfort, and make it especially difficult for a toddler trying to potty train. However, in order to talk constipation (and explore helpful tips), I think it’s helpful for you to know all that’s involved in having a normal bowel movement.
From table to toilet—what’s the path?
Digested food leaves the stomach and passes in liquid form throughout the small intestines and into the large intestine or colon. One of the main jobs of the descending portion of the colon is to reabsorb water out of the colon. In fact, as the fluid is reabsorbed by the body, the liquid stool is transformed into more of a solid stool. This solid stool is what is known by many in the medical community and beyond as a turd.
How do you know when it’s time to have a BM?
It’s interesting that inside the wall of the colon are stretch sensors that are activated by a stool moving into the lower portion of the colon and causing it to stretch to accommodate the stool. When those stretch sensors are activated, a signal is sent to your brain telling you that it’s time to go #2. When the process is working normally, you feel the typical urgent “gotta go” sensation, promptly head to the toilet, making #2 your #1 priority and you get some relief!
We all know the feeling of an impending #2 all too well, but what happens if that feeling hits, and you happen to be at a cocktail party at your co-worker’s home? Do you take the walk of shame and head in to blow up your host’s bathroom? Most would not. Instead, you will likely do the #2 shuffle, suppressing the urge to go and miraculously after 5-10 minutes the sensation to have a bowel movement is gone. Whew! Glad that is over…narrowly escaped! But what has happened to the stool? Did it magically vanish? Not hardly! It is still in the exact same place you left it…in the distal/rectal portion of the colon. The reason that the urge to go is no longer there is because the stretch sensors reset to their new “normal” position. When they get stretched again, the signal will go to your brain and the entire process will repeat itself.
So what happens if you repeatedly suppress the sensation to have a bowel movement and withhold passing a stool? Well…the distal colon continues to do its job of reabsorbing water which causes the stool to become larger and harder. The stretch sensors continue to reset each time as the colon stretches, eventually ballooning out to the point where they are no longer working as well as they should. When this happens, the typical sensation to have a bowel movement is diminished or even absent. You have a colon full of poop, but the sensation that it’s time to go #2 is absent.
My kid hasn’t pooped in a week. That’s not good, right?
Here’s how it frequently goes down. The child becomes constipated for a variety of reasons such as lower fluid intake, limited dietary fiber, too many gold fish and French fries, etc… and tries to have a bowel movement. Unfortunately, the stool is large and hard and quite painful coming out. Most smart kids are quick to remember that painful bowel movement, so when the next time the sensation to have a bowel movement comes around, they withhold passing the stool and suppress the sensation until it goes away. Their little brains remember the last time they pooped—it about killed them and they don’t ever want that to happen again! Unfortunately for them, the problem only is going to get worse. They get into a cycle of suppressing/withholding which causes the stool to get bigger, drier, and harder which causes more pain when they finally do go, which reinforces the mindset of, “it hurts when I poop, therefore I am going to hold it in no matter what.” Often times when a child has chronic constipation and a large hard stool is stuck in the rectum, liquid stool will leak around the blockage, causing what appears to be diarrhea with frequent soiling accidents. One of the worst parts is that the child never even realizes that they are about to have an accident. It’s a terrible place to be as a parent and a child. Stuck in a vicious cycle.
How do we break this vicious cycle?
Making dietary changes is often the best place to start. Drinking lots of water, eating foods high in fiber such as prunes, pears, apricots, beans, and whole grains/cereals can often help to correct the issue. Fruit juices such as prune or pear juice can help as well. Avoid highly processed foods and other constipating foods such as bananas, rice, fried and fast foods. Getting plenty of exercise and activity can help get things moving as well. Establishing a regular bathroom routine is very important—giving your child designated “toilet time” following meals can also take advantage of the gastrocolic reflex, which is a normal reflex that involuntarily occurs after we eat. Food goes into the stomach (gastro) and signals the colon to work to move things out (colic). Children need to learn that passing a BM should not be painful. If they’ve gotten into a pattern of painful BMs, then it might take some time to retrain the brain that the BM is not going to be painful. Regularly keeping the stools soft will help this to happen over time.
Despite these dietary changes, if your child is stuck in this pattern, then it’s likely best to come in for an appointment to discuss the issue with your medical provider. The goal should be for your child to have 1-2 soft BMs/day. Signs that things are not going well and require an evaluation in the office are blood in the stool, continued pain despite dietary changes, and going more than 2-3 days between stools. Sometimes despite dietary changes, medications are needed to soften the stools. Occasionally, enemas or laxatives are recommended, but these should only be prescribed under the care of a medical professional.
Parkside wants to be #1 in helping you in the #2 department! If you need help with managing constipation in your child, please call our office to schedule an appointment.
Until next time,
Dr. Stephen Jones
Parkside Provider, father of three, and aspiring chicken farmer