Childhood Constipation

Causes of constipation in children include poor toileting positioning, frequent stool deferral and reduced relaxation of the anal sphincter. There can also be other reasons for constipation such as diet, reduced hydration, or medication side-effects. Constipation can also cause secondary issues such as daytime urinary incontinence or overnight bedwetting.

To maintain bowel continence children need to have the ability to detect when there is a stool in the rectum, good movement throughout the bowel (peristalsis) and good sphincter control.

If stool retention in the rectum is long-term such as when a child constantly defers passing a bowel motion, the body adapts by slowing down the speed in which food is digested. This is called slow transit constipation. This can cause increased absorption of water as the stool passes through the bowel and can therefore cause harder and more painful stools.

Poor toilet positioning contributes to an inability for children to relax the external anal sphincter and pelvic floor muscles. This can lead to straining and pain when passing a bowel motion. Children who experience pain when passing a bowel motion may then develop a fear associated with future bowel motions. Overtime, this can lead to a back-up of stool in the child’s rectum which can lead to increased distension in this area. A distended rectum leads to a reduced ability for a child to detect when it’s time to pass a bowel motion.

Neurologically involved children may also experience constipation. Causes can be the same as described above, however also may include generalised decreased peristalsis (slow digestion), weakness through the abdominal muscles and asymmetrical muscle strength. Medications that these children may be taking for other reasons can also play a role in reducing intestinal motility.

Physiotherapy treatment options for constipation can include toilet positioning education and modification, abdominal and pelvic floor exercises, kinesiology taping, abdominal massage, and establishment of a bowel routine. Children with constipation are usually best treated with a combination of medical management and physiotherapy.

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