Des Moines University Clinic Physical Therapy, Pediatric Pelvic Health and Incontinence

Constipation and kids: physical therapy can help

As a mother, I know first-hand how awful it is when your child can’t poop. The struggle is real and is common in many households with kids holding their stool, for a variety of reasons. Connecting with the right professionals and resources can be the first step.

What causes constipation?

Functional constipation is quite common in the pediatric population. A systematic review on the epidemiology indicates about 9.5% of children are affected. Constipation can present in a variety of ways, from infrequent stooling (3x or less per week), huge toilet-clogging stools, or tiny pebbles. Constipation can also be the main cause when kids have skid marks, itchy bottoms, or repeated trouble toilet training. When the rectum is full of stool, it presses on the bladder and can cause bedwetting, frequent or urgent peeing, difficulty peeing, or accidents.

One cause of constipation is pelvic floor muscle dysfunction. The pelvic floor muscles are the gatekeepers; if they don’t open, then no poop shall pass. To open the pelvic floor muscles, they need to relax and lengthen. Sometimes, the muscles tighten and close instead. And I can’t blame the kids. It may happen because they have had pain or injury in the past. Maybe there is a fear about sitting on the toilet or a belief that it is dirty or shameful. It would be hard to relax in any of these situations. When poop is ready to come out, but the muscles won’t let it, people often hold their breath and strain to push it out.

How is constipation treated?

Pelvic floor physical therapists teach various methods to help children in pooping, in ways that are appropriate for their age. I make a point to talk openly and comfortably about all bodily functions because they are natural, and everybody does them. My goals are to reduce any anxiety or shame and provide ways for the family to help the child. For example, children may learn a lot about their bodies and the natural process of what occurs by watching “The Poo In You” video. We discuss topics like, “What’s the best way to sit on a toilet?”, “How long should you sit on a toilet?”, and “What should you do while you are sitting on a toilet?” We can talk about what foods and drinks go into our bodies to make sure we have the right ingredients for good poops. We talk about what a good poop should look like. We play games and do exercises to help us identify the muscles in our body. Our “games” are really exercises for the diaphragm, abdominals and pelvic floor, and help teach what it feels like to both contract and relax the muscles, so we can do it when we need to. These types of exercises, in combination with medical care, help treat urinary incontinence, bedwetting, and urinary tract infections in children–and even adults–with dysfunctional voiding.

Some children find it useful to use a surface EMG device where electrode stickers are placed externally for biofeedback to sense the activity in the pelvic muscles, which can help them learn how to coordinate the pelvic floor muscles to both contract and relax, as demonstrated in the above picture. In older children and adults, internal balloon biofeedback can also assist with retraining sensation and develop coordination in using the pelvic floor muscles.

If your family is struggling with a child (or adult) with constipation, bed wetting, abdominal pain or other issues related to the pelvic floor, you don’t have to manage it alone. Our exceptional physical therapists are experts in pelvic health and can create a strengthening program specifically for your activities and goals. For more information, visit the Des Moines University Physical Therapy Clinic website or call 515-271-1717.

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