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  • By Steve Hodges, M.D.

Free Download: 12 Surprising Signs Your Child is Constipated

12 signs your child is constipated chart

Fact: Most parents — and many, MANY physicians — do not recognize constipation in children.

In our clinic at Wake Forest, X-rays confirm 90 percent of potty-trained children with toileting problems are severely constipated. Yet only 5 percent of parents even had an inkling their child was backed up.

Most of these kids were referred by pediatricians who didn’t notice the baseball-sized poop clogs in their patients’ rectums. Many of these doctors had ordered expensive and fruitless medical workups in an attempt to find the cause of their patients’ accidents, bedwetting, and recurrent UTIs.

Constipation is easily missed because parents and many physicians don’t know what to look for.

Sure, everyone knows a kid who poops once a week is constipated. But a child who poops twice a day might also be harboring a lump of poop the size of a Nerf basketball. Few adults realize that giant poops and hard logs are far more telling than poop frequency.

We hope our free, downloadable infographic, 12 SIGNS YOUR CHILD IS CONSTIPATED, will help parents, physicians, and schools detect constipation in kids. It's available in English and Spanish.

Why “Patient History” is Meaningless

Many pediatricians don’t realize you can’t determine whether a child is constipated by pressing on her abdomen, nor can you rely on a “patient history” provided by parents.

The inadequacy of these measures was confirmed back in the 1985, in a published study by Dr. Sean O’Regan, a pioneering and brilliant pediatric nephrologist.

Dr. O’Regan’s study concerned 47 girls with recurrent UTIs. When Dr. O’Regan asked parents whether their daughters were constipated, nearly half said absolutely not. Yet air-filled balloon testing (aka anal manometry) showed every one of the girls’ rectums had become severely stretched from holding mega-loads of poop.

Yes, that test is just what it sounds like! Dr. O’Regan inserted balloons into these girls’ rectums and then began to gradually inflate the balloons. A child with normal rectal sensation will notice a balloon filled with just 5 to 10 milliliters of air; the girls in Dr. O’Regan’s study could withstand 80 to 110 milliliters of air without discomfort.

At 110 milliliters, the balloons were fully inflated, to the size of a medium tangerine!

This finding tells you why constipation is so easily missed. Often, the rectum simply expands to compensate, like a squirrel’s cheeks or a snake’s belly.

So much poop builds up in the rectum that even though the child may still poop regularly, she never fully empties. Many severely constipated kids poop daily, fooling their parents and doctors into thinking all is fine.

Somehow, Dr. O’Regan’s findings were ignored, and to this day, medical schools do not properly train students to diagnose constipation in children.

In fact, medical training has become progressively worse in this regard. Back in the 1980s, urology textbooks recommended anal manometry and rectal exams for diagnosing constipation in children. But today’s textbooks recommend less invasive and less accurate means: a general physical and patient history.

Some textbooks even recommend against the use of X-rays because they don’t correlate well with the frequency of stool—which is exactly my point! Frequency tells you almost nothing. (X-rays are both helpful and safe, as I explain in It’s No Accident.)

Today, few doctors diagnose constipation in children who come in with urinary problems or treat constipation aggressively enough when they do recognize it. They may recommend a small daily dose of laxative, fiber supplements, and frequent trips to the potty and call it a day.

This is a sad state of affairs, given that undiagnosed constipation in kids is the cause of virtually all pee and poop accidents, recurrent urinary tract infections, and bedwetting.

Our epidemic of toileting problems is needlessly causing pain and anxiety and costing families and the health-care system massive amounts of money.

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Must-read books for kids by Steve Hodges, M.D.

• Bedwetting and Accidents Aren't Your Fault

• Jane and the Giant Poop