Despite common knowledge, constipation is one of the most frequent childhood ailments that we see. Most individuals assume that constipation means a complete lack of bowel movements (B.M.) or difficulty having bowel movements. This assumption is not wrong, but it only encompasses one aspect of constipation. In fact, the most common type of constipation that pediatricians see is a child who actually stools once or more a day. For many parents this is confusing and often not believable. The following information should help to demystify and simplify constipation.
The bowel (aka intestines/ colon) is like an elastic band. It stretches in response to digested food passing through. Not only can it stretch, but it can also contract and squeeze waste through. The act of stretching and contracting eventually sends a message to the brain that an individual should feel the urge to defecate. The difference between a baby and a potty trained child/ adult is that the baby will defecate whenever that urge comes on, and a potty trained individual will only defecate if the time is appropriate. For instance, everyone has felt like they could use the bathroom at some point during the day, but found that life got in the way. Instead of using the bathroom at that point, an individual can shut off or ignore the signals from the brain until the time is right.
How constipation begins
Everyone can feel constipated at some point due to small circumstantial events like travel, illness, etc. Often these discrete episodes are easily resolved and do not have long term consequences. The type of constipation that we are describing here usually takes much longer to occur and much longer to resolve. Although it is a luxury to turn off the urge to defecate when it is not appropriate, this can become problematic when used too often. In this day and age, children (at least in our society) are very busy and very scheduled. Let’s take a minute to reflect on a typical school-aged child’s day. A child wakes up in the morning, rushes to eat some kind of breakfast (or doesn’t eat at all), runs to catch the bus. At school, the bathroom breaks are limited and most children do not wish to defecate at school for privacy issues as well as cleanliness issues. After school, many children have activities which they are rushing to attend. Then it is home, homework, dinner, and bed. Most children will have had the feeling that they could use the bathroom at least once or twice during the day, but most have ignored it. There is just no time. Even when there is time, many children do not want to stop what they are doing to use the bathroom. If you ignore the brain’s messages too much, it is like crying wolf. After a while, the body stops giving the same messages. Even when it does tell the child to use the bathroom, the message may be confused or weaker.
What is happening inside the body
It is a double edged sword that the bowel is made up of such elastic material. The elasticity gives us the ability to decide our own bowel habits, but it can also us to store lots of waste. Most children don’t sense they’re constipated until things get very severe because the bowel keeps stretching and stretching to accommodate more. When the bowel is stretched continuously for so long the elastic gets damaged. The damage prevents the elastic from contracting back onto itself and the stool just sits because it is not getting contracted through.
Constipation can manifest itself in a variety of symptoms, but some of the more common issues that we see are urinary frequency, bedwetting, abdominal pain, and urinary tract infections. Another common symptom that can be very misleading is the child that has frequent, small amounts of loose stool. Most parents assume that their child has the opposite problem to constipation. Loose stool is a common symptom of constipation because it is the waste that leaks around a larger mass at the bottom of the bowel.
How do we help?
The first step is a “clean out” process (think mini-colonoscopy prep). We basically clean out the bowel because the bowel is no longer able to do its job. It takes about 6 months for the elasticity of the bowel to heal, therefore most children are on some kind of maintenance regimen for months after the cleanout. Without maintenance, the constipation reoccurs quickly. Your pediatrician will tailor the clean out and maintenance to be specific for your child. The second step is behavioral modification. The body needs to be retrained to relearn appropriate bowel habits. Your pediatrician will go over these in more detail but this entails timed bathroom breaks, relaxation, etc.