Poop is a very frequent topic of conversation in my office. It is a rare day when I don’t hear about a child’s poop or even see a poop sample. Is it too hard? Is it too soft? Is the color ok? Bowel habits can be very stressful to parents.
One of the frequent problems I encounter is constipation. Sometimes, if a toddler or small child gets constipated (usually due to dietary issues–such as poor fiber and water intake or too may carbohydrates) and has a painful bowel movement, they might associate pooping with pain. They may become fearful of pooping, and they might try their best to “hold it in”. Normally, as stool is formed, it is stored in the rectum. When the rectum fills up, it stretches and sends a signal to the brain that is time to go to the bathroom. If a child develops a pattern of holding onto their poop, however, over time the rectum can stretch too much. Now it takes more stool than normal for the rectum to fill up. The child may not even feel that he has to go until many days have passed. Then, when they finally feel the need, the stool is huge and hard, reinforcing the painful and fearful association they have with pooping. This leads to a cycle of chronic constipationabdominal pain. and episodes of
The problem is two-fold. Not only do we have to break the association of pain and fear, but the stretched rectum needs to be returned to normal. The best way to do this is to keep the rectum empty by having a daily stool. Sometimes this can be done by dietary means alone, such as increasing fiber, water, and juices and decreasing constipating foods. Frequently, medications are used to soften the stool and facilitate daily pooping.
One of the misconceptions that parents have is that once their child poops, the problem is solved. The patient usually comes to the pediatrician during a crisis of abdominal pain, and measures are taken to clean out the constipation. But, because of the fearful association and the changes is the rectum, the problem reoccurs. Once the patient is on a good regimen and having soft, non-painful regular stools, the rectum returns to its normal size and the fear of pooping goes away.
I try to reinforce to parents not to stop the regimen too quickly. If a toddler has 99 normal stools in a row and then has one hard painful one, you can guess which one he remembers!
Constipation and stool holding can be very stressful for the family, and very uncomfortable for the child. It is also extremely common, so if you suspect the problem, it should be discussed with your pediatrician.
All information given is not a substitute for the advice of your pediatrician, primary care provider or trained health professional. Always consult with your pediatrician or health care professional.
