Don’t Think Your Child Is Constipated? Read This!

Constipation in kids is a huge problem and a hidden cause of bed-wetting, daytime accidents, and UTIs. Here’s what every parent should know!

I’m so pleased to have another guest post from Dr. Steve Hodges, a pediatric urologist and co-author of a book for parents called It’s No Accident and a new book for kids called Jane and the Giant Poop. Dr. Hodges is passionate about helping kids who suffer with constipation, which is a hidden cause of bedwetting, daytime accidents, and urinary tract infections. In this post, he writes about how often constipation in kids goes undetected (and untreated)–even by doctors–plus the red flags of constipation that every parent should know. Some of them may surprise you!

By Steve Hodges, M.D.

Would you know if your child was severely constipated?

Would your doctor?

Most parents assume the signs of constipation are obvious. If a child poops every day and eats nutritiously, they figure all is good!

Doctors, too, tend to think the diagnosis is a simple one. They’ll ask parents how often the child poops and feel around the child’s belly. If nothing seems amiss, they’ll give the child the A-OK.

Problem is, these methods of detecting constipation are wholly inadequate. Large masses of poop — I mean, large, like the size of a softball — can hide in the rectums of small, wiry 5-year-olds and wreak all kinds of havoc. They trigger stomach aches, the constant or urgent need to pee, potty-training struggles, and bedwetting and daytime accidents.

You can see these masses on X-rays, as I do every day, but you often can’t feel them.

Here’s a typical Facebook post from a mom in my bedwetting support group: 

My daughter has both daytime and nighttime wetting and complains of tummy ache. The doctor dismissed my suggestion that she’s constipated. He said tummy ache is really common and wetting is usually behavioral — something kids grow out of. He said he’d be able to feel constipation in a child as skinny as my daughter and I was ‘barking up the wrong tree.’

Unconvinced, this mom insisted on an X-ray. The doctor “begrudgingly agreed.” What did it show?

Lo and behold, she’s completely backed up with poop — it was all the way up her intestines. After the X-ray, our doctor’s attitude changed completely. 

I’m not suggesting every child with a stomach ache needs an X-ray. (Some do.) But I can tell you most of them are clogged with poop, and virtually all children who pee too often or have accidents — day or night, pee or poop — are severely constipated.

It’s critical for parents and doctors to know the signs, so these kids can get properly treated, rather than dismissed or blamed for problems they can’t control.

Sure, stomach aches are a common complaint among kids — but that’s because constipation is epidemic, not because kids are complainers!

Furthermore, bedwetting is not behavioral or caused by stress. What happens is that the poop-clogged rectum stretches (think: rat in snake’s belly) and starts pressing against the bladder. The nerves feeding the bladder go haywire, and the bladder hiccups randomly, emptying before it’s even full and before the child can make it to the toilet. The stuffed rectum often squishes the bladder to the point where it just can’t hold enough urine overnight.

While X-rays aren’t necessary, they are instructive. One mom told me: “Until you actually look at the film, it’s hard to understand. I was blown away. My son was so stuffed with poop that his bladder was basically flattened. I could totally see why pee could not stay in there all night.”

This boy not only wet the bed but also had poop accidents. That’s because a stretched rectum can lose tone and sensation; poop just falls out, and the child doesn’t even notice.

All these problems are fixable by aggressively treating constipation. For children who have accidents, this means, ideally, a combination of enemas and laxatives. (A daily dose of Miralax won’t cut it, and while healthy eating is important, dietary changes usually aren’t enough.) When the rectum is cleared out and remains clear for months, it can shrink back to size, stop bothering the bladder, regain tone and sensation, and stop giving the child stomach aches. I also recommend kids poop with their feet on a tall stool which positions their body for easier pooping. (I’ve endorsed the Squattypottymus and have a small financial stake in this product, but any tall stool will do!)

But when the constipation is overlooked in the first place, kids can’t get the treatment they need. Instead, many kids are blamed or bribed.

As one mom in my support group posted: “The diagnosis really decreased our frustration with our 5-year-old. We thought his accidents were a behavior or anxiety issue.” After seeing the X-ray, she stopped rewarding her son for dry nights, and the boy stopped trying to hide his wet underwear from her.

So, short of getting an X-ray, how do you know if your child is constipated?

• A pattern of extra-large poops. The kind that clog toilets and make you go, “Holy moly!” In fact, XXL poops are such a reliable sign of constipation that I co-wrote a book called Jane and the Giant Poop!

• Hard, formed poops. Healthy poop looks like total mush — like pudding or frozen yogurt or thin snakes. Poop that resembles logs, sausages, or rabbit pellets indicates constipation. This is something Jane learns in our book.
• Underwear “skid marks.” Parents assume it’s because the child didn’t wipe well, but in truth it’s because the child didn’t empty completely.
• Too-frequent or urgent peeing, bedwetting, and/or accidents. Any child who struggles with this is almost assuredly constipated — yes, even children who eat very healthy diets.

Don’t put too much stock into the frequency of your child’s poops. Yes, a child who poops three times a week is constipated; all kids should poop every single day. However, many severely constipated children poop daily — they just never fully empty. This isn’t well known. In response to a recent blog post I wrote about bedwetting, a mom commented: “I know for a fact my daughter not constipated. She poops every single day”, and “I should know — I’m the one who flushes the toilet.” This kind of thinking is common!

It’s true that many children outgrow toileting problems, but some children don’t. I regularly treat teenagers whose bedwetting and accidents were dismissed for years. Their constipation had gone unnoticed, but the red flags were there all along — if only they’d been recognized.

Steve Hodges, M.D., is a professor of pediatric urology at Wake Forest University Medical School and co-author, with Suzanne Schlosberg, of Bedwetting and Accidents Aren’t Your Fault, Jane and the Giant Poop, and The M.O.P. Book: A Guide to the Only Reliable Way to STOP Bedwetting and Accidents. His website is Bedwetting And Accidents.