Ode To Poop, Part One: Why Won't My Child Poop?

Many young children have a hard time pooping. Constipation is the first, second, and third most common cause of abdominal pain, rectal pain, and bloody stools in children.  So let's talk about poop!

What Causes Constipation?

Constipation usually starts between 2 and 5 years old, when children start using the toilet. It often develops because children become afraid or hesitant to poop, either because they are afraid of the toilet, or have had an uncomfortable bowel movement. When this happens, they try to hold in their poop as long as they can. The longer they avoid pooping, the more stool accumulates in the intestines, and the dryer it becomes as the colon continues reabsorbing water from it. This means that, when they finally do poop again, the stool is even harder and larger, making it more difficult and painful to pass than the last time. This vicious cycle can continue to the point that children develop a mass of stool so large and hard that it becomes impossible for them to pass on their own.  Those situations may require medications or even manual removal by a surgeon.

Of course, there are other causes of constipation as well. Children with developmental delays may be at higher risk for constipation due to difficulty listening to their bodies' cues or communicating their needs to their caregivers. Children with sensory processing challenges might struggle more with using a toilet and could also be prone to constipation due to severely restricted diets.

What Are The Symptoms of Constipation?

Many parents are surprised to learn that their children are constipated because they poop frequently. But constipation doesn't mean that children aren't pooping enough; it means that they have a significant amount of hard stool obstructing their colon that makes pooping difficult. This could mean they poop only once every week, or less, but it could also mean they are in the bathroom several times per day trying to poop and passing only small amounts of stool at a time. Many children with constipation will develop diarrhea because watery poop moves around a large obstructing ball of stool in the colon. 

Severe constipation commonly leads to abdominal pain that might worsen around meal time, abdominal and rectal pain with pooping, and bright red blood in the stool. In children, blood on the toilet paper is almost always due to a skin tear caused by straining with pooping. Sometimes a large amount of stool in a child's gut will put pressure on their bladder, leading to frequent urination. Children can also become unable to hold in their poop or pee and start having accidents.

Constipation is extremely common in children but can be disruptive. Check out our next blog post to learn about the tools we have to treat and prevent constipation. If you have questions about your child's constipation, speak with their healthcare provider for more information.