What is childhood constipation?
Up to 30% of children between the ages of 2-10 years are suffering from functional constipation. Constipation accounts for up to 25% of visits to paediatric gastroenterologists (Hodges, Steve & Schlosberg, 2012).
Functional constipation is characterised by having two or more of the following features present for at least once a week over a two-month period:
- Two or fewer empties per week
- At least one episode of faecal incontinence per week
- Stool withholding behaviours
- Pain or hard bowel movements
- Presence of a large faecal mass in the rectum or passing of large stool volume that may obstruct the toilet (Rome III Classification).
What symptoms should I look out for in my child?
- Emptying infrequently – acceptable is anywhere from three times per day to three times per week.
- Poor consistency – avoid stool that is hard, pebble-like or formed with lots of cracks on the surface (check out the Bristol Stool Chart below for optimal stool consistency, type 4 is ideal)
- Pain – your child may scream out, hold their breath or complain of pain just before, prior or after a bowel movement.
- Accidents – the rectum can be so full that the stool from above leaks around it, sometimes these symptoms can be confused with diarrhoea
- Blood passed with the stool – anal fissures can be caused by excessive stretching to the muscles in and around the lower rectum and anus resulting in small tears that then bleed when the next motion passes.
- Daytime incontinence and bedwetting – when the rectum is full there is less room in the pelvis taking up some of the space the bladder potentially sits in. This may present the bladder from properly expanding and can irritate it, hence meaning that the child may feel as though they need to empty more frequently or more often.
- Withholding – many children experience fear of missing out so when they get the urge to go, may ignore it. Or they may have had a painful bowel motion in the past and are trying to avoid this unpleasant experience again. Looks out for signs such as standing on their toes, hiding, rocking backwards and forwards and sitting on their heels.
How can a pelvic floor physiotherapist help my child?
It is essential that your concerns are discussed with a medical practitioner. Constipation is best managed using a multidisciplinary approach. Over time constipation can impact the coordination, strength and movement of your child’s pelvic floor muscles.
Treatment from a physiotherapist will commonly assist of:
- Education – how pelvic floor muscles are involved in control and emptying, toileting strategies and positions, lifestyle and diet and fluid intake.
- Pelvic floor muscle and general movement assessment and exercises – helping to retrain these muscles so that they are stronger, more flexible and are properly coordinated before and during a bowel movement. The muscles are assessed visually or via light touch with consent at all stages. No internal examinations will be performed. Exercises will aim to be fun and interesting and address any abnormalities found in either of these two points.
- It’s No Accident: Breakthrough Solutions To Your Child’s Wetting, Constipation, UTIs and Other Potty Problems. By Steve Hodges with Suzanne Schlosberg. Rowman & Littlefield, 2012.
- Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. Gastrointestinal Society, 2012.