What is constipation? Constipation is the infrequent and difficult passage of stool. Chronic constipation can occur when the child resists the urge to defecate and stool becomes backed up into the rectum and colon. This will either lead to the passing of a very large, hard stool or the inability to pass the solid stool leading to Encopresis.

Signs and Symptoms? Signs and symptoms of stool retention include abdominal pain, body odor, stools plugging toilet, lack of appetite, urinary incontinence or increased frequency, and bypass diarrhea.

What are some causes of stool retention? Children can be retaining stool due to pain, illness with poor food intake and decreased physical activity, poor bowel habits such as avoidance or withholding, emotional stress, premature toilet training attempts, travel, poor diet including low fiber diets, low fluid intake, constipating medications, muscle or nerve damage, and lastly it might have no explainable cause.

How is constipation diagnosed? The Rome IV criteria is a commonly used tool for the diagnosis of functional constipation.

Your doctor may need medical history and to perform a physical exam. More extensive tests that cannot diagnose alone, but might be used in addition are abdominal x-ray, anorectal motility tests, barium enema x-rays, or transit studies

How is constipation treated? Constipation and other bowel problems must be treated before any coexisting urinary problems can be treated. First, the collected stool must be removed from the colon in the “clean out” stage. This can include laxatives, suppositories, or enemas. After this stage, the maintenance stage can begin including bladder retraining. This might include taking a stool softener or laxative regularly, altering the diet to include more high fiber foods, scheduling potty sitting times daily with proper posturing, encouraging physical activity, and possibly biofeedback for correct muscle engagement. Your child should be experiencing one BM at least every other day at this point or the doctor should be consulted.