Constipation and Bladder Dysfunction

Constipation is a common problem for children.  The bowel is very close to the bladder in the body.  The bladder is not able to expand and hold urine very well when a child has a large amount of stool in the rectum or bowel.

Constipation can cause the bladder to have spasms and not empty completely.  Bladder symptoms that can occur with constipation are day and night wetting, urinary tract infections, frequency, urgency and pain with urination.

It is very important to treat a child's constipation so that bladder symptoms can improve.

For the bladder to be healthy, a child should have a soft, easy to pass bowel movement at least once a day. 

Normal Bowel

Normal bowel.

Constipated Bowel

Constipated bowel.

Diet

Some children eat too many foods and drinks that are high in fat and low in fiber ("fast foods" and “junk foods" and colas).  Also some children do not drink enough water.

Lack of Exercise

Exercise helps move food through the intestines.  Children who watch too much TV or play too many video games may not be getting enough exercise.

Busy Children

Some children are too busy playing and forget to go to the bathroom.  Children ignore their bodies' signals that it is time to go to the bathroom.

Emotional Issues

Sometimes children may feel too much pressure to potty train.

Children will resist going to the bathroom and hold their bowel movements.  Also children might hold back the urge to have a bowel movement because they refuse to use public or even school bathrooms.

  • Less than one bowel movement (BMs) or stool daily
  • Children may skip several days between BMs
  • Hard, dry bowel movements
  • Trouble pushing the bowel movements out of the rectum (a part of the colon that holds stool/bowel movement)
  • Pain with bowel movements
  • Abdominal bloating, cramping or pain
  • Small liquid stools or smears in your child's underwear

When a child holds his or her bowel movements over time it can build up inside the rectum.  This causes the bowel movement to become larger and hard to pass. This can also stretch out the rectum. Runny stool can leak out around this build-up of hard stool and cause the child to soil his/her underwear.

Children often ignore the urge to have a bowel movement when they are busy playing, and the urge may not return until the next day or longer.

  • Set aside a quiet, unrushed time each day for toileting.
  • Because eating or drinking often stimulates bowel movements, after a meal may be the best time for your child to sit on the toilet.  Provide privacy.
  • Daily sit downs: Have your child sit on the toilet for 15-20 minutes once or twice a day after meals.
  • Positive reinforcement:  Be supportive and not discouraging.  It may take many months for your child's constipation to improve.
  • Liquids help to soften stools. Your child should drink plenty of liquids throughout the day.  Your doctor or nurse will recommend an amount of fluid to drink daily based on your child's weight.  Milk drinking should be limited to 3-4 glasses per day.  The remaining amount of needed fluids should be either water or fruit juice.  Soda should be avoided.  Be sure to offer extra fluids to your child during the warmer months of the year.
  • To increase dietary fiber, you can add the following to your child's soft foods.  You can add these to hamburger, meat loaf, mashed potatoes, scrambled eggs, muffins, cookies, spaghetti sauce, etc.:
    • 1-3 tablespoons per day of Miller's Bran
    • 1-3 tablespoons per day of All Bran Cereal
    • 1-4 tablespoons per day of Wheat Germ
  • It is important for you to know which foods make stooling more difficult for your child and which foods make stooling easier.
  • Please refer to high fiber diet handout for sample meal plans.

Children who are constipated and have bladder symptoms will often need medications to help resolve their constipation.  It is important to have daily soft bowel movements to allow the bladder to expand.  These medications are called stool softeners or laxatives. Children may need to be on these medications for 6-12 months.  There are usually three phases of taking bowel medication.

Clean-Out Phase

This phase may last 1-3 days.  During this time, your child will receive doses of laxatives that clean out any hard stool or impaction in the colon.  Your child will have a large amount of very soft, mushy stool during this phase.

Maintenance Phase

This phase can last up to 6-12 months.  During this time your child will take an oral laxative or stool softener along with a high fiber diet, increased fluids and behavior changes.  The dose of the bowel medication may need to be changed during this period of time. To make it easier to change your child’s bowel medication, it is helpful to follow this Bristol Stool Chart.

Weaning Phase

During this phase, the laxatives or stool softeners will be slowly decreased and then discontinued.  It is important for the child to remain on the high fiber diet and increased fluids.

What To Expect

Expect your child to have a daily soft bowel movement while taking the bowel medications. Use the Bristol Stool Chart to help keep a record of your child's bowel movements. The ideal bowel movement should look like type 4 or 5. If your child's bowel movements are ideal, the bladder should function better.

If your child is taking a bowel medication and has diarrhea that lasts more than a week, call your doctor or nurse practitioner.  Call for any bloody stools or extreme pain with bowel movements.


Last Updated 03/2014