Shedding Light On A Sneaky Issue: Addressing Pediatric Functional Constipation

Let’s talk about something that often gets brushed under the rug by many parents and healthcare providers: functional constipation in kids. You may recall that I discussed chronic constipation in children in my previous blog post, but who is catching the kids before they become chronically constipated?

Constipation is a bigger deal than many people (including both kids and adults) realize, and as pediatric pelvic floor therapists, we’re in a prime position to tackle this common, yet misunderstood, issue head-on.

Here’s a shocker: a lot of constipated kids don’t even think they have a problem! Studies indicate that nearly 50% of children rate their bowel habits as okay, and another whopping 50% don’t even mention their symptoms to anyone1! Plus, when kids are questioned about usual bowel signs, like how often they go and what their poop looks like, their answers don’t always tell the whole story.

So, your job is to dig deeper to get to the root of the issue!

In this blog post, you will learn about functional constipation, how it is diagnosed, and how you can help children and families to identify and begin treating this. Delving into the full medical management of constipation is a lengthy topic for another time, but I know you will appreciate these essential initial steps.

When a family sees you, this experience is quite unique to them! Oftentimes, you are the first healthcare provider to give them heart-centered time and attention. This opens the floor for trust and true connection.

Many physicians simply scratch the surface when inquiring about kids’ bowel health, with basic questions about frequency and consistency. These are important questions, but as this concerning condition is very prevalent among children these days, healthcare providers need to be more vigilant about detecting and treating constipation.

When you are looking to identify underlying constipation, it’s essential to ask questions that provide insights into kids’ bowel habits, dietary intake, and overall health. Here are some good questions to ask parents:

1. Bowel Habits:
   How often does your child have a bowel movement?
   Does your child strain or have difficulty passing stools?
   Have you noticed any changes in the frequency or consistency of your child’s bowel movements in the past or recently?
   Does your child avoid going to the bathroom?
2. Stool Characteristics:
   What does your child’s stool typically look like? (hard, dry, small, large, etc.)
   Have you noticed any blood in your child’s stool?
   Does your child experience pain or discomfort during bowel movements?
3. Diet and Fluid Intake:
   What does your child typically eat and drink in a day?
   How many fiber-rich foods like fruits, vegetables, and whole grains, does your child consume?
   How much water does your child drink daily?
   Have you made any recent changes to your child’s diet?
4. Medical History:
   Does your child have a history of constipation or digestive issues?
   Is there a family history of constipation or bowel disorders?
   Has your child experienced any recent illnesses or changes in medication?
5. Behavioral and Emotional Factors:
   Does your child show signs of discomfort or irritability before or after bowel movements?
   Has your child experienced any stressful events recently?
   Does your child express any fear or anxiety about using the toilet?
6. Physical Symptoms:
   Have you noticed any bloating or abdominal pain in your child?
   Does your child complain of a feeling of fullness or incomplete evacuation after going to the bathroom?
   Have you observed any soiling or accidents in your child’s underwear?
7. Toilet Routine:
   Does your child have a regular routine for going to the bathroom?
   Does your child have privacy and feel comfortable using the toilet at home and in other places?
   Does your child have access to a clean and child-friendly toilet when needed?
8. Sleep Habits:
   How many hours of sleep does your child typically get at night?
   Does your child experience any disruptions in sleep patterns, such as waking up frequently during the night, snoring, or bed-wetting?
   Have you noticed any changes in your child’s sleep habits recently?

While the parents’ answers are extremely important, directing some of the subjective questions toward the kids is equally as pertinent. Kids don’t tell their parents everything, so directly asking them these seemingly “embarrassing” or “insignificant” questions may be quite eye-opening to the family.

The Rome IV criteria is used to accurately diagnose functional constipation. These criteria include various indicators such as straining during defecation, lumpy or hard stools, sensation of incomplete evacuation, and anorectal obstruction. Merely relying on stool frequency and consistency is inadequate, so you should be aware of these diagnostic criteria.

Identifying and diagnosing constipation is just the tip of the iceberg. Many families are dismissed with “quick fixes”, but the actual issues are never addressed. Educate your families on how constipation is more than a bowel issue! Let’s take a quick look at why treating constipation is important and its health implications in children.

Constipation is not just about having regular bathroom habits and avoiding discomfort. Untreated constipation can affect multiple body systems, and have severe long term effects. Tackling constipation early is key to keeping these kiddos feeling their best and establishing good health from a young age:

1. Bowel and Bladder Health: Addressing constipation helps prevent fecal impaction, encopresis, enuresis, and urinary retention and infections.
2. Digestive and Immune Function: Regular bowel movements ensure proper digestion and nutrient absorption in children, while also helping them to maintain a robust immune system by preserving the gut microbiota balance.
3. Mental Health: Remember the gut-brain axis? Toxin buildup in a child’s colon directly influences their brain. Constipation adversely affects cognitive function, mood, and behaviors. , highlighting its impact on brain health and cognitive function.
4. Psychological Implications: Constipation can contribute to heightened stress and anxiety among children, negatively affecting their overall well-being and self-esteem.
5. Social Impact: Concerns about bowel movements or accidents can lead to anxiety, isolation, and avoidance of social activities, affecting kids’ confidence and social interactions.

Addressing constipation comprehensively is essential for maintaining children’s overall health and well-being now and into the future! Don’t let that constipation become chronic. The longer a child is constipated, the more difficult it is to treat later down the road.
So ask the right questions now, and educate your parents on the importance of treatment.

As you know, constipation doesn’t have a one-size-fits-all solution because there are multiple causes and contributing factors. Is a child constipated due to slow motility or a functional outlet obstruction? Or both? Knowing the difference will help you to pick the right approach for each kid.

As we discussed previously, education should always come first. Parents often feel unsure about how to help their child. Providing them with comprehensive information about constipation and effective management strategies can alleviate their concerns and guide them to take appropriate action. Parents should understand that constipation is a common issue and not a reflection of parental failure.

Additionally, education for the kids is critical as well. Empowering children with knowledge not only helps them understand what’s happening in their bodies but also encourages them to take an active role in their own health. There are many great children’s books they can have fun reading and learning!

Build awareness around kids’ behavioral patterns, especially related to toileting habits. Establishing a bowel and bladder diary is necessary to track progress and identify any underlying patterns or triggers contributing to constipation. Encourage regular toileting routines, such as sitting on the toilet after meals or at specific times during the day.

Identifying children with sensory processing disorders is also important, as this will affect your treatment interventions. Sensory issues can play a big role in how kids handle going to the bathroom.

Of course, it should go without saying, dietary and fluid intake must be managed when treating kids with constipation. Consumption of appropriate types of fiber (soluble versus insoluble) and amounts (based on age and symptoms) must be implemented.

Furthermore, treating constipation will take time and may require possible disimpaction, laxatives, pharmaceutical interventions, and maintenance therapy. Unfortunately, there isn’t enough space here to delve into the complexities of constipation treatment. If you’ve taken my online Peds Level 1 course, where you’ve covered the basics of constipation, then you can enroll in Peds Level 2. In Peds Level 2 — Advanced Pediatric Bowel and Bladder Disorders, you will learn all the stepwise details to treat chronic constipation.

Fixing constipation isn’t always quick. In fact, only about half of kids are back to normal within a year of starting treatment. So, we’ve got to manage expectations and remind families it’s a marathon, not a sprint.

Reference:

Timmerman, M.E.W., Trzpis, M. & Broens, P.M.A. The problem of defecation disorders in children is underestimated and easily goes unrecognized: a cross-sectional study. Eur J Pediatr 178, 33–39 (2019). https://doi.org/10.1007/s00431-018-3243-6