Health Topics

As a mother, I know firsthand how awful it is when your child can’t poop. This common issue often arises in households due to various reasons for stool withholding. Connecting with the right professionals and resources can be the first step.

What Causes Constipation?

Functional constipation is quite common in the pediatric population. A systematic review of the epidemiology indicates about 9.5% of children are affected. Constipation can present in a variety of ways, from infrequent stooling — three times or less per week — to huge toilet-clogging stools or tiny pebbles. Constipation can also be the main cause when kids have skid marks, itchy bottoms or repeated trouble toilet training. When the rectum is full of stool, it presses on the bladder and can cause bedwetting, frequent or urgent peeing, difficulty peeing or accidents.

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. And you can’t blame the kids. It may happen because they have had pain or injury in the past. Maybe there is a fear about sitting on the toilet 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.

How Is Constipation Treated?

Pelvic floor physical therapists teach various methods to help children in pooping in ways that are appropriate for their age. 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 anxiety or shame and provide ways for the family to help the child. Educational tools, such as the video “The Poo In You,” can help children understand their bodies. We discuss topics like:

• 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. We talk about what a good poop should look like. We play games and do exercises to help children identify the muscles in our bodies. Our “games” are really exercises for the diaphragm, abdominals and pelvic floor and help teach what it feels like to contract and relax the muscles so we can do it when needed. These types of exercises, in combination with medical care, help treat urinary incontinence, bedwetting and urinary tract infections in children — and even adults with dysfunctional voiding.

Some children find it useful to use a surface electromyography device where electrode stickers are placed externally for biofeedback to sense the activity in the pelvic muscles. This can help children learn how to coordinate the pelvic floor muscles to both contract and relax, as demonstrated in the above picture. In adults, internal balloon biofeedback can also assist with retraining sensation and developing coordination using pelvic floor muscles.

If your family is struggling with a child or adult with constipation, bed wetting, abdominal pain or other issues related to the pelvic floor, you don’t have to manage it alone. Our exceptional physical therapists are experts in pelvic health and can create a strengthening program specifically for your activities and goals. For more information, visit the Des Moines University — Physical Therapy Clinic website or call 515-271-1717.

Disclaimer: This content is created for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health care provider with any questions you may have regarding a medical condition.