Worldwide about 16% of children suffer from constipation. Physiotherapist Karen Swanepoel gives you the low-down on how to deal with it.
Constipation can be painful and distressing for toddlers and parents to deal with. The good news is that many children with constipation don’t have a structural fault or a neurological cause for their constipation, and simply need to change some of their habits.
When doctors look at what’s causing your toddler’s constipation, they’ll start by taking a history. This may include asking if your child:
- Only defecates twice (or less) in the toilet weekly
- Leaks faeces at least once a week
- Has a history of holding back a bowel motion and adapting certain positions like crossing their legs or holding over their crotch to avoid passing a stool
- Has a history of painful or hard stools
- Has a large volume of faeces inside the rectum – this can be seen on an X-ray
- Passes large stools, which sometimes obstruct the toilet or flush incompletely.
Constipation can also be associated with irritability, decreased appetite and/or feeling full sooner when eating. These children show an improved appetite soon after emptying their bowels.
Bowels and bladders
Many children might pass a stool every day but still suffer from constipation. Over time, some hard poo can accumulate in the rectum, and this blockage may only allow small bowel motions to pass into the toilet.
Constipation can sometimes also present as a bladder problem, like bedwetting. A stretched rectum full of faeces will irritate the child’s bladder at night. This irritation eventually causes the bladder to empty spontaneously. Not all children who wet their beds ‘sleep too deeply’ or are ‘naughty’. In the majority of bedwetting children, constipation is the main cause!
When does constipation start?
Babies are constipated from birth. It’s often seen in formula-fed babies, or when the baby starts eating solids. Because breast milk has a natural laxative effect, lower rates of constipation are reported in breastfed babies.
Many toddlers begin to hold back their poo when they start going to preschool. Many of these children are hesitant to visit the bathroom in a new environment, or because they lack privacy. Also, most public toilets are far from inviting, which makes children avoid going to the toilet all together.
Children at school are also prevented from going to the toilet at any time during the day, and thus have to wait until break time, so they start ignoring the urge to defecate. When a child has experienced a bad episode when visiting the toilet they often respond by postponing the next visit to the toilet as much as possible.
Physiotherapists and constipation
Physiotherapists with a special interest in women’s health or pelvic health can assist. They use a variety of non-invasive techniques to assist children older than five years with bladder and bowel problems.
Children will be referred by a doctor after they have been placed on a laxative or medicine to soften the stools. A pelvic physiotherapist will do an interview to understand the history of the problem, and explain normal bladder and bowel function, as many children (and even parents) don’t know what’s normal and what’s not.
Physiotherapists will use a bladder diary to assess the urine and bowel output. It includes what the child eats and drinks during the day, and if specific dietary advice is needed, these children are referred to a registered dietician.
The physiotherapist will also teach your child the correct toilet position and breathing to aid the complete emptying of the bowel. Most children will benefit from placing a step underneath their feet while sitting on the toilet, which helps the muscles of the belly and pelvis to relax fully while the child is sitting on the toilet.
Many children with constipation may have characteristic postural problems, and these are addressed with postural exercises, which are prescribed specifically for each child. Pain relief techniques and massage are used to relieve tension in the abdominal area, and the physiotherapist will provide a programme of exercises to continue using at home.
These simple exercises include deep breathing exercises to help the abdominal muscles relax, as well as pelvic tilt exercises to create awareness in the pelvic area. A child who can recognise tension in the pelvis area will be able to relax these muscles during defecation.
Here are some examples of exercises – but these should only be used after you have sought medical advice and in children who are 5 years and older. There are many relaxation techniques available, but because many parents have little time to spend on exercise, I have combined some breathing, visualisation and progressive muscle relaxation into a home exercise programme that can be accessed at http://regain.co.za/visualization-relaxation-and-breathing-for-constipation/.
Pelvic tilt exercises
The child can sit on an exercise ball with the feet supported. The child first rolls the ball forward by pulling the tailbone in underneath their body. This causes the arch of the lower back to flatten. Then the child rolls the ball backwards by arching the back and pushing the tailbone backwards. The lower back will arch/hollow out in this position. You can repeat this 10-20 times. For a video of this exercise you can look on https://instagram.com/p/BgebFSflYTU/
The child can also roll the ball in circles. This is good for posture control and relaxing the pelvic area. This can be repeated 10-20 times to each side. For a video of this exercise please look at https://instagram.com/p/BgfxVhAIVGT/
If your child is constipated, don’t try to sort it out yourself – always consult a medical doctor to rule out any structural or serious causes of constipation, and to get age-appropriate medication that won’t leave your child dehydrated.
Many children with constipation will experience relief simply by taking their medication and implementing the specific habit modifications and simple exercises prescribed by their physiotherapist.
There are also more advanced treatment options available for children who struggle with bladder and bowel issues, and these will be discussed by your physiotherapist at your consultation.
To find a physiotherapist near to you, visit www.saphysio.co.za and click on the ‘find a physio’ icon.