As a parent of young children, poos are just part of our daily lives. From infancy to toilet training years, we help our children learn to poop. However, what happens when they stop pooping.
In this article, we are going to be talking about poop! In particular, answering the most common questions around constipation, soiling, and stool withholding in children.
What is constipation?
Constipation in children & adults is a common issue that can happen. Constipation is when there are hard stools to pass, or if the individual does not go to the toilet regularly.
The regular frequency for a bowel motion for a child is at least once every one to three days (RCH, 2020). If your child does not have a bowel movement within this timeframe, it can make it harder for them to pass the stool (i.e. poo) and therefore lead to more painful bowel movements.
What are the symptoms of constipation?
Signs and symptoms of constipation in children are:
- Have a tight tummy
- Might look more bloated compared to normal
- Might not be as hungry
- Complain of tummy aches
- Farting frequently
- Refusal to go to the toilet
- Trying to hold onto their poos by crossing their legs or squatting
What causes constipation in children?
There are many reasons why your child might be constipated. Here are some common reasons:
- Child’s diet – Some children do not want to eat fruit and vegetables. This may limit their fiber intake and this can cause constipation. Sometimes cow’s milk can also cause constipation. Changes from breast milk to cow’s milk or liquid to solid food are actually a very common cause of constipation in children.
- Insufficient water intake – For your child to have a softer stool that is easy to pass, it is important for them to have sufficient water throughout the day. This works closely with a high dietary fiber diet.
- Withholding behavior – Some children try to hold onto their poos. This may be due to a negative relationship with pooing on the toilet. If your child has experienced a negative experience (like painful bowel movements), then they may not want to experience that again.
- Changes in the child’s toileting environment – For example, if they started school and do not feel comfortable doing poos at school.
- In rare cases, there may be medical issues impacting your child to have regular bowel movements.
How can constipation be prevented?
Constipation in children is common and if not treated quickly can lead to further problems. Here are some tips on preventing your child’s constipation:
- Regular bowel movements – Create a set routine of sitting on the toilet each day to have a bowel movement. If there is no routine, it can be harder for children to have a regular bowel movement and therefore can lead to constipation in children. Try sitting on the toilet about 30 minutes after mealtimes. Food can stimulate the need to perform a bowel movement.
- Physical activity – Having enough exercise and movement daily can help children digest and help with regular bowel movements. Encourage your child to do some exercises, even if it is running around the backyard, jumping on the trampoline or going to the park after school.
- A healthy diet with sufficient fibre intake is important to help digestion and promote child’s bowel movements. Great ways to increase fibre intake are through fruit, vegetables and whole grains being increased in the child’s diet.
- Sufficient water intake – Make sure your child is drinking plenty of fluids throughout the day. If they don’t like drinking water, you can dilute some juice or have cordial to ensure they still have good fluid intake.
How is constipation treated?
Treating constipation is dependent on two things – the reason why your child is constipated and how constipated your child is.
If your child is constipation due to lack of exercise or lack of fibre in their diet, then you can make these changes to their daily life to encourage their bodies to have regular bowel movements.
Some children may not like sitting on the toilet or the toilet environment in general. It is important to encourage them to go to the toilet and create a positive relationship with the toilet. You may want to have some nice smelling diffusers in the toilet, play a song while they are sitting on the toilet or have a toileting toy that they can play with.
Some children may not want to sit on the toilet because they are busy playing and do not want to go to the bathroom. Or if they want a sense of control over what they do. In this case, having a set toilet routine is helpful.
However, if your child is very constipated and you have tried all the strategies with nil success of having a bowel movement, they may need to go see a doctor. The doctor may recommend medication for your child to have to relieve their constipation.
Stool withholding behavior in children
Some children will display stool withholding behavior, meaning they may consciously or unconsciously avoid going to the toilet.
There are many reasons why a child may withhold going to the toilet. This behavior typically happens around 2-5 years old when children are still in the process of learning to be toilet trained.
- Not feeling comfortable with pooing on the toilet
- Negative experiences in the past
- Engaged in play activities
- Scared of the toilet environment
- Anxiety around separating from the poo
Not feeling comfortable with pooing on the toilet
Especially when your child is going through the toilet training process, it can hard for your child to always poo on the toilet. Childhood constipation can really affect your child’s relationship with toilet training.
If they do not feel comfortable sitting on the toilet, then it can be hard for them to relax and perform a bowel movement.
During toilet training, make sure they have a small toilet insert and foot stool. If they have trouble balancing on the toilet, then they may focus all their energy on trying to balance, rather than pooing on the toilet.
Negative experiences in the past
Negative experiences, like having painful bowel movements or hard stools can make most children not want to go to the toilet. They may remember the past experience and want to avoid this.
However, this can cause infrequent bowel movements which leads to more constipation and most likely, harder poo to pass.
Engaged in play activities
Most children are so engrossed in playing, that they do not want to go to the toilet. They may feel like if they leave their play activities, they may not be able to go back.
Sometimes when we are engrossed in our activities, we may not feel the need to use the toilet, and therefore accidents can occur.
During toilet training, it is important to develop some regular toilet routines.
Scared of the toilet environment
Some children are scared of the toilet environment, like the noise it makes when you flush, the extra echoing from certain toilet environments, hand dryers or water splashback from the toilet bowl.
Sometimes children may just need to get used to certain toilet environments. However, if your child has sensory processing issues, then you may need additional support from an Occupational Therapist.
Anxiety around letting go of the poo
Some children may not feel comfortable letting go of their poo. In this case, it is important to teach children the process of what happens with food after it is eaten.
There is an app called “Poo goes to Pooland” that you can download. It is a story about a boy who learns when he needs to go to the toilet and helping “poo” go back to his family.
Alternatively, there are a range of books to help younger children understand what happens after food is processed in our body.
Medication for constipation
It is important to consult your child’s doctor before taking medication. There are different types of medication to help children treat constipation.
There are different oral laxatives that your doctor may recommend. These include fiber supplements, stool softener, and enemas.
Your doctor will be able to recommend the right medication for your child.
What is a natural laxative for a child?
There are food options that act as natural laxatives for children. These foods can help your child go regularly and avoid constipation. These include:
- Prune juice. Prune juice is one of the best natural laxatives for children.
- Whole grain cereals and bread (avoid highly processed foods)
- Cherries and apricots
- Seeds and nuts (The Nourished Child, 2020).
What is soiling?
Soiling, also known as encopresis, can look like diarrhea. You can often find a liquid stool in your child’s underwear.
This commonly happens when the child has severe constipation. Constipation in children means the old poo is hard and stuck in the child’s rectum. When the new poo develops, it cannot exit the body through the child’s rectum. The new poo is often softer and this liquid stool can squeeze around the hard stool and therefore look like diarrhea.
What to do if my child is soiling?
It is important to note that your child cannot control soiling. It is a symptom of severe constipation in children.
It is important to continue to practice the above strategies to help relieve the symptoms & the underlying issues behind constipation in children. These include:
- A healthy diet with enough fiber & high fiber foods, whilst limiting cow’s milk
- Sufficient water intake
- Regular exercise
- Encourage regularly toilet routine
However, in this case, you will also need to go to your local doctor to help relieve constipation. Until the old hard poo is removed, soiling will continue.
It can be a vicious cycle as passing hard poo can be painful and your child may not want to do this. Therefore it is important to go to your doctor who may recommend stool softeners or other medications to help pass the poo.
My child is no longer constipated but they are still soiling. What do I do?
Once the old poo is passed, it will take time for your child to be able to control their movements again. So even though the medication has helped and your child is no longer constipated, accidents may still happen. There are a few reasons for this:
- The muscles in the rectum (sphincter) holding the poo have been stretched due to the old poo. Because of this, it takes time for the muscle to go back to its normal size. With this muscle being stretched, poo can more easily pass through but it can be harder for your child to control their bowel movements.
- The nerve endings are not as responsive. At the end of your rectum, there are nerve endings that send signals to your brain telling them you need to go to the toilet. However, the nerve endings are not as responsive due to long-term overstretching from the old poo. Therefore, this also takes time for the nerve endings to recover.
It is important for you to continue to encourage regular bowel movements and engage in healthy habits like diet and exercise.
What is the difference between constipation and soiling?
Constipation is when there is hard poo or infrequent bowel movements.
Soiling is when the poo is so hard that the newer poo leaks around the old poo. Soiling is typically a result of constipation.
How can I help my child develop good bowel habits?
To prevent constipation, it is important for your child to regularly pass a bowel movement. This is known as good bowel habits.
If your child has trouble passing a bowel movement, that is when the poo can get hard and can lead to constipation.
Therefore to help your child develop good bowel habits, it is important for them to sit on the toilet on the toilet every day or at least as often as needed to help their body develop regular bowel movements.
Regular exercise, sufficient water intake, and enough fiber in their diet can also help. Good exercise includes playing outside and a good diet includes sufficient fiber.
When should I call my child’s doctor?
If your child has chronic constipation, meaning they have been constipated for more than 3 months, it is important to get help from your child’s doctor. Chronic constipation in children is very severe.
If you have used a variety of the strategies mentioned above and your child is still constipated, it is important to see a doctor. Doctors might recommend a laxative treatment, however, it is important to know that this will only treat the child’s symptoms and will not be a permanent solution for childhood constipation.
If your child has significant pain or there is blood in their stool, then you need additional help from a doctor.
When do I need an Occupational Therapist?
If your child has a condition, like
The Occupational Therapist will be able to help you and your family to help your child be successful in toilet training & can help with the underlying reasons and symptoms of constipation in your child.
Additionally, if your child has difficulty with the noises and smells in the bathroom, they may have some sensory issues. It is important to talk to a doctor or Occupational Therapist about this.
Kids Constipation: Quick Relief with Real Foods – The Nourished Child. (2020). Retrieved 3 November 2021, from https://thenourishedchild.com/natural-constipation-relief-kids/
Rch.org.au. 2010. Kids Health Information : Constipation. [online] Available at: <https://www.rch.org.au/kidsinfo/fact_sheets/Constipation/> [Accessed 2 November 2021].