Kids with chronic constipation are a challenge to train. It can often appear that withholding is the issue, and to be certain, fear and pain are real issues. But there are some physiological problems caused by constipation that contribute to bladder problems, and they aren’t always what your pediatrician is thinking about.
- The constant fullness of the colon can lead to bladder misplacement. The bladder can be compressed and even folded, depending on exactly where the blockages exist. This is not good for any organ, but it is especially a problem for a hollow organ that should be filling and emptying regularly. The sensation of fullness with a misplaced bladder is therefore corrupted, so the child is not receiving correct input. They may feel that they “have to go”, only to have nothing in their bladder, or very little. They may fill up really fast and have to run to the toilet before they have an accident. Too many accidents, and a child can beg for that pull-up so that they aren’t embarrassed or inconvenienced. Even the little ones are subject to shame that isn’t from you as a parent, but in comparison to older kids or sibling comments.
- Chronic constipation stretches the pelvic floor, and therefore there is both less stability and less control. The pelvic floor muscles help us to hold the urine into the bladder in time to get to the toilet, in conjunction with the sphincters. Poor control and poor awareness go hand-in-hand. There are physical therapists that specialize in pelvic floor rehab, but this isn’t easy to do with children that have limited language. Not impossible, but not easy. Letting the problem go until they are older means risking years of psychological and physical stress.
- Withholding due to pain or fear is a huge issue, and it can become automatic. This means that solving the constipation issue may not immediately result in continence. Using a wide range of approaches, including manual therapy, behavioral strategies, medications and diet control, and even core stability and sensory processing strategies, may be needed.
My final comment is that chronic constipation is nothing to ignore. It needs to be addressed well and early. It often doesn’t solve itself, and it may need more than a spoonful of Metamucil to clear up. Get help and request consultations early rather than waiting to see how things “go”!
This problem doesn’t always go away. Read Can You Prevent Pelvic Floor Issues in A Hypermobile Child? to learn how to prevent problems in teens and adults.
For more information about toilet training, see For Kids Who Don’t Know They Need to “Go”? Tell Them to Stand Up and The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!