So many of you read and shared my post 12 Signs Your Child is Constipated that I knew constipation was a big concern. And no wonder: Constipation is the number-one cause of belly pain in kids! I’m so happy to have a guest post today by the expert in that piece, Steve Hodges, M.D., a pediatric urologist at Wake Forest University School of Medicine and the coauthor of It’s No Accident and Bedwetting and Accidents Aren’t Your Fault. He’s here on the blog to bust the most common myths about constipation in kids. I think you’ll be surprised by some of these–and I hope this is as helpful for you as it is for me!
By Steve Hodges, M.D.
If your child was chronically constipated, would you know it?
You might think, “Of course!” Yet chronic and severe constipation often goes undetected in children. This is a big deal, since constipation is by far the top cause of belly pain, bedwetting, pee accidents, and poop accidents–conditions that are epidemic among children in Westernized countries.
Even when constipation is noticed, it’s often undertreated, so belly pain and accidents (conditions that are totally fixable!) linger unnecessarily. Here are seven persistent myths about constipation that prevent many kids from receiving the treatment they need:
Myth #1: The key sign of constipation is infrequent pooping.
REALITY: The top two signs are 1.) XXL poops and 2.) poop shaped like pellets or logs. Children’s poop should resemble soft-serve ice cream, pudding, hummus — you get the idea! While infrequent pooping is indeed a sign of constipation, many chronically clogged children poop daily, even twice a day, because they never fully empty. So focusing on frequency can be misleading. (Get a free “How’s Your Poop?” download with illustrations that will help you spot constipation.)
Myth #2: Constipation is basically harmless.
REALITY: Occasional clogged pipes are no big deal, but chronic constipation can plague a child into adulthood. When a child withholds, poop piles up in the rectum, an organ not designed as a storage facility. A large, hard mass forms, not only causing discomfort but also, in many cases, stretching the rectum so it presses against and aggravates the bladder. The child may need to pee constantly or urgently, or the bladder may hiccup and spontaneously empty. A rectal clog also can flatten the bladder, making it impossible for the child to hold pee overnight.
Over time, a stretched-out rectum loses tone and sensation, and poop may just drop out without the child even noticing. Chronic constipation is also the major cause of recurrent urinary tract infections in young girls.
Myth #3: It’s obvious when a child is constipated.
REALITY: Constipation is commonly missed, even by doctors. I X-ray my patients who present with bedwetting or accidents, and more than 90 percent are shown to be severely constipated. Yet only about 5 percent of parents had any inkling, and most of these patients were referred by pediatricians who missed the boat.
It’s common for doctors to feel a child’s belly, ask about pooping frequency, and pronounce the child “not constipated.” But giant masses of poop can hide in the rectums of very young, lean children! On an X-ray, a rectal diameter greater than 3 cm indicates constipation. Most children who wet the bed or have accidents have rectums 6-7 cm wide.
Myth #4: Constipation is always triggered by a poor diet.
REALITY: The same highly processed diet driving childhood obesity also causes constipation — that’s true; however, many children with excellent eating habits end up constipated because they were toilet trained as toddlers or because their schools restrict bathroom access.
Two-year-olds simply don’t have the judgment to respond to their bodies’ urges in a timely manner. My research shows children trained before age 2 have triple the risk of later developing daytime wetting problems, but even older toddlers are prone to holding. I recommend waiting until around age 3 to toilet train. Many elementary schools contribute to the constipation epidemic by rewarding children who don’t use bathroom passes or punishing those who do.
Myth #5: Prune juice, fiber, and probiotics will fix constipation.
REALITY: When I recommend laxatives and enemas, some parents complain I’m “medicalizing” a problem that can be fixed with a healthier diet. But when a child is constipated to the point of having persistent discomfort or accidents, a dietary overhaul isn’t enough. No amount of prune juice can dislodge the large, hard mass of stool stretching the rectum. Probiotics may help a mildly constipated child but won’t resolve chronic constipation.
For children who have accidents, I recommend a regimen that combines enemas with laxatives (enemas are proven to work better than laxatives alone). For chronically constipated children who don’t have accidents, I recommend a daily osmotic laxative such as Miralax. (Is Miralax toxic? I address that here.)
Myth #6: Laxatives are addictive for children.
REALITY: While stimulant laxatives such as Ex-Lax can be habit forming (and should only be used under a doctor’s supervision), children will not become dependent on osmotic laxatives (Miralax and lactulose) or enemas.
Myth #7: For some kids, pooping every few days is fine.
REALITY: Children should poop every day — period!
Get FREE downloads that can help your family, including “7 Crazy Important Rules for Potty Training Success, “How’s Your Poop?”, and “When To X-Ray A Child for Constipation”.
Steve Hodges, M.D., is a pediatric urologist at Wake Forest University School of Medicine. He is coauthor of It’s No Accident and a book for children called Bedwetting and Accidents Aren’t Your Fault. Visit his website, Bedwetting And Accidents.
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My daughter was constipated, even when exclusively breast-fed. We tried all the “natural” remedies with no luck. At age 6 she started getting recurrent UTIs and would have what I liked to call “man-sized” poops. They were huge. We’ve cut back on her dairy and she now has a daily dose of Miralax. I tried to avoid it, but finally relented and it’s helped so much. She has a healthy diet but sometimes you need to use medication.
Thanks for your comment Pia. I’m so glad you found something that worked!
Happy to hear you found a solution Pia. My son suffers from chronic constipation as well and I’ve always been hesitant to give him a daily dose of Miralax. Just curios, what dose do you give your daughter?
My daughter is almost two and suffers from constipation. We give her miralax daily and that seems to work and helps her have soft bowel movements. However, my child only has a bowel movement once or twice a weeks and when she does it is massive. She seems afraid to go poop. She talks about it a lot and always seems scared to go do to her past experiences from having terribly hard biwel movements. What do you recommend our regimen be to help her finally be ok with going poop daily? Given her age in not sure what would be the best approach.
Not the first time I read about constipation being the cause for bedwetting. However, what if the child is a deep sleeper? Or their bladder is smaller and can’t hold a large volume of urine? There’s also the late development of bladder control in some children.