Signs your child might be constipated (some may surprise you!)
Our large intestine or colon, extends around the perimeter of our abdomen so constipation pains and symptoms can be anywhere from the pelvis to the lower ribcage and our low back. The rectum is very close to other pelvic structures in the pelvis such as the bladder, so oftentimes, the symptoms may appear to be coming from there. Here is a list of some common constipation symptoms:
Pain in the abdomen, low back or pelvis.
Leaking urine during the day or night.
Leaking fecal matter (even really runny poop) during the day or night.
Difficulty eating/ feeling sick.
Really hard stool consistency.
Large diameter stools that may block your toilet and feel painful.
Bloating or hard belly.
Inability to feel urge to poop.
First steps if your child is constipated
If your child is totally unable to eat, has a fever, blood in the stool, severe pain and/or rectal prolapse (part of the intestine being pushed out the anus), please seek medical help immediately.
Aside from the extreme cases, there are steps you can do before seeing anyone to help with constipation.
1) Make sure your child is drinking plenty of water (non carbonated or flavoured). Their pee should be light yellow in colour.
2) Encourage your child to move. Go for a walk, play their favourite active game etc.
3) Let them have a warm drink such as a hot lemon water, herbal tea, or vegan hot chocolate (sometimes dairy can make constipation worse).
4) Help them calm down in the bathroom. You can encourage them to do deep breathing (avoid breath holding/ straining), play some relaxing music, dim the lights and do whatever else may help relax from a sensory perspective.
5) Squatty potty! Have a stool under their feet so that their knees are higher than their hips when pooping. This will help their pelvic floor relax.
What a physiotherapy session may look like
The first thing we need to do is find out what is driving the constipation symptoms. Is it physical or does it warrant investigations from mental health providers or GI doctors?
I tend to have you complete a bladder/bowel diary with your child in the early stages as well. You'll write down everything they eat, drink, when they pee, poop and how much, every day for 3 days. This way I'll get to see if there is anything in the diet and routine that may be contributing to the constipation.
We will have a look at pelvic floor and breathing mechanics and teach them strategies to help the stool come out more easily. During the session we may develop a home exercise program to help keep the muscles in their pelvis and abdomen functioning well.
Sometimes we may collaborate with your doctor to implement enema protocols and start laxatives, especially if the constipation has been going on for a while. What this does is help to empty the colon from the bottom up and allow the rectum to return to a normal size after being stretched for so long. Not every child will need to do enemas but it is a possible treatment and has good evidence in the literature.
How to prevent constipation
Sometimes, even with the best efforts, we can't prevent constipation. So if your child is in this position, don't feel guilty- it may be out of your hands. Generally there are some tips for preventing constipation and here are a few ideas:
Drink plenty of water (non carbonated and non flavoured). Pee should be light yellow in colour
Move often. Encourage your child to find ways of moving their body that they enjoy. Kids yoga, going for a walk, dancing in the kitchen, sports etc.
Keep bathrooms clean and inviting. We need to relax to properly let the pelvic floor lengthen and it's hard to do this in a stressful, dirty environment. This is particularly important for school bathrooms! There are so many studies looking at constipation rates increasing during school terms.
Education and poop check ins! The bowels are part of the same digestive system that starts at your mouth. We often talk to kids about eating habits and tend to shy away from the bowels. By doing family check ins to see if everyone drank water that day, if everyone had a good poop, it'll create a safe environment for kids to raise concerns when something doesn't feel right.
Use a squatty potty! Every human can benefit from pooping with their feet on a stool. This mimics the squat position we evolved to poop in. When we get our knees higher than our hips, the pelvic floor muscle that wraps around the rectum loosens and makes it way easier to poop. It might take some time to get used to as it shifts your weight backwards on the toilet seat but I promise after a little while you'll notice a difference.
If you need help and support in BC or Alberta, Catherine sees kids for pelvic health concerns on telehealth/ online physio. You can self refer to physiotherapists in Canada and don't need to wait until you've been seen by a GI specialist. This may be particularly useful given the current wait lists. As long as you have a video calling device and a stable internet connection, you can access Shine Therapy Services!
Happy pooping!
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