How much do you know about constipation ? Click here to test your knowledge with our 10-question multiple-choice quiz.
Here is question #4:
If a child tends to poop more than once a day, which of the following is true? There may be more than one correct answer:
A) You know the child is not constipated
B) The child is probably eating too much
C) You know the child is getting plenty of fiber
D) The child is very likely constipated
At the end of the quiz you'll receive the answers for each question, plus your score. Detailed answers, with links to scientific studies and helpful blog posts, are provided below.
Don't peek until you've taken the quiz!
How'd you score? Here's an explanation of the answers.
1. A, B, C and D.
XXL stools, skid marks, rabbit pellets, and the urgent need to pee are all signs of constipation. For a more comprehensive list of the common signs, download our free infographic, "12 Signs Your Child is Constipated," available on our Downloads in English page.
2. C and D.
Abdominal X-ray and anorectal manometry are both reliable methods of detecting constipation whereas
the two most common methods used by pediatricians — feeling a child’s belly and asking about the child’s pooping frequency — are highly unreliable.
A tiny, wiry body can harbor a huge mass of hardened stool that a doctor can’t feel. And many severely constipated children poop every day; they don’t fully empty. That’s why I X-ray all my enuresis patients. I discuss the safety and benefits of X-raying for constipation in our free guide, “When to X-ray a Child for Constipation” and in The M.O.P. Book: Anthology Edition. It is important to measure the child’s rectal diameter. A measurement exceeding 3 cm indicates constipation.
In rare cases, a plain X-ray does not pick up the hardened mass of stool, and a contrast enema may be warranted, as I explain in “An 11-Year-Old Bedwetting Patient, A Lucky Mistake, and a 'Wow' Moment."
Anorectal manometry is an even more precise, though more invasive, way of detecting constipation, by measuring how stretched the rectum is. A balloon is inserted into the child’s anus and then gradually inflated while a machine records the rectal contractions. In chronically constipated children, the rectum is so stretched out and floppy that the child may not be able to sense the balloon even when it’s fully inflated. Anorectal manometry was used by Dr. Sean O’Regan in the studies that provided the basis for the Modified O’Regan Protocol.
Children should poop every day. It is a myth that pooping every few days is “normal” for some kids. Every person who eats every day should poop every day. Period.
Pooping multiple times a day is a red flag for constipation — not a sign of “regularity.” It means the child is not fully emptying when he or she poops.
5. A, C, and D.
A child has an elevated risk of becoming chronically constipated if the child toilet trains before age 2, has a family history of constipation, and/or eats a highly processed diet.
Parents who train their children early — to meet preschool deadlines, to save landfills from diapers, or because other cultures train early — should know there can be serious repercussions, as I explain in “7 Super Important Rules for Potty Training Success: A Guide for Parents.”
Children who train “late” (after age 3) do have high rates of constipation, but that is because they were already constipated when training began and therefore struggled. This is demonstrated in my study "The association of age of toilet training and dysfunctional voiding" and explained in "Children Toilet Trained Before Age 2 Have Triple the Risk of Wetting Problems" as well as “The Problem With Preschool Potty Deadlines.”
Some children have a genetic predisposition to constipation and become constipated even before toilet training. It’s important for parents to be aware of the signs of constipation and treat this condition early and aggressively.
6: A, B, C and D.
Chronic constipation can lead to bedwetting, daytime pee accidents, poop accidents, and chronic urinary tract infections.
In fact, chronic constipation is almost always the main reason children develop these conditions, although chronically holding pee exacerbates the problems.
When a child regularly delays pooping, stool piles up in and stretches the rectum, which in turn presses against and aggravates the bladder. The rectum can become so stretched and floppy that it loses tone and sensation and stool just falls out of the child’s bottom, without the child even noticing.
I explain all this in my children’s books Bedwetting and Accidents Aren’t Your Fault and Jane and the Giant Poop. I explain the constipation-UTI connection in “Why 1 Million Girls a Year Get UTIs.”
7: B, C, and D.
Poop shaped like cow patties, thin snakes, or a frozen yogurt swirl suggest a child is not constipated.
There's no such thing as "nice" big log — logs are a sign of constipation. A child who has watery diarrhea may also be constipated; it may mean the child has a hardened mass of stool in the rectum and all that’s coming out is watery stool that oozes by the mass.
Our free “How’s Your Poop?” chart offers helpful visuals! Thumbs-up poop: thin snakes, mushy blobs, frozen yogurt; thumbs-down: rabbit pellets, logs, turkey sausages.
8: A, B an D.
In a chronically constipated child, the rectum stretches and commonly loses tone and or sensation, and the bladder nerves may become aggravated.
However, while stool can accumulate in other parts of the colon, the stretching and loss of sensation is typically confined to the rectum.
Toilet training too late is not a cause of constipation.
While toilet training before the child is ready can cause constipation, as my research demonstrates, there is no such thing as “toilet training too late.” When a child has difficulty toilet training, parents are often blamed for “waiting too long,” but the waiting isn’t the problem; it’s the fact that the child was already constipated.
Probably the most common cause of childhood constipation is the “standard American diet” — high in processed foods and low in whole, high-fiber foods such as fruits and vegetables. However, early toilet training and a genetic predisposition toward constipation also can play a role, as can restrictive school restroom policies play. If your child's school restricts restroom access, download our free guides "4 Tips to Help Your Child Manage Toileting Troubles at School" and "The K-12 Teacher's Packet on Student Toileting Troubles," available on the Teachers and Nurses page of our website.
In a small minority of children, dairy intolerance can contribute as well.
10. A, B, C, an D.
Stomach ache, frequent peeing, hiding to poop, and chronic urinary tract infections are all red flags for constipation.
Further reading: "The Real Reason Some Kids Pee All the Time (No, Not to Get Attention)" and "Why 1 Million Girls a Year Get UTIs."
Also, "12 Signs a Child is Constipated," a free infographic available on our Downloads in English page.