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  • By Steve Hodges, M.D.

Why So Many Kids Are Pooping in Their Pants

why more children are pooping in their pants

OK, let’s stipulate that asking fifth-graders to pull down their pants for a “poop inspection" is outrageous.

I’m surprised administrators at the Gustine Independent School District thought that was a remotely OK way of deducing the source of the poop teachers were “regularly finding” on the gym floor.

But what doesn’t surprise me is that there’s poop on the gym floor.

We have a children’s health crisis in Westernized countries that is being totally ignored: an epidemic of toileting troubles, aka dysfunctional elimination.

Not long ago, teachers in Spokane, Washington, complained that too many kindergarteners were “not potty trained.” A popular UK play center was just shut down because children were having “too many accidents.”

My clinic is booked solid with kids who have toileting problems — 1st-graders who wet their pants, 5th-graders who can’t even feel poop dropping out of their bottoms, 10th graders who wet the bed every night.

None of this is a “normal part of childhood” or an indication of behavior problems.

It’s happening because our kids have alarmingly high rates of constipation. Probably one-third of kids have rectums clogged with stool, and a good many of them are having accidents because of it.

When kids delay pooping, stool piles up in and stretches the rectum. A stretched-out rectum is like a stretched-out sock: it loses elasticity. So, poop just falls out.

A rectum that’s been enlarged by a mass of poop also loses sensation. That child in Gustine whose poop landed on the gym floor probably didn’t even feel it come out of his bottom.

Rectal poop masses in children can grow quite large — imagine a grapefruit or a Nerf basketball — stretching the rectum to five times its normal diameter. The big mass presses on and irritates the nearby bladder, triggering daytime and nighttime pee accidents.

As with our country’s childhood obesity epidemic, the worst cases of dysfunctional elimination are getting worse. Some children’s colons have been so stretched by giant stool masses for so long that in addition to having severe urinary problems, these kids need surgery to remove the segments of their colons that won’t shrink back to size.

Sadly, these kids’ problems go untreated for years because doctors don’t recognize the link between constipation and accidents. I just treated a 17-year-old boy whose pediatrician had told him, year after year, that he’d “outgrow” his bedwetting. Um, when exactly was that going to happen?

Thanks to enema therapy, the boy’s bedwetting has resolved, but he may need surgery to fix his chronically stretched colon.

Kids Often Shoulder the Blame for Potty Accidents

Yes, those students in Gustine were treated poorly, but their humiliation pales compared to the shame and abuse heaped upon many children who have chronic accidents.

Almost daily I read news reports of school-age children scalded, beaten, or humiliated for having accidents. Recently a Florida mom, fed up with her 10-year-old’s bedwetting, forced the boy to parade around in a princess gown — and then posted the pictures on Facebook. This week a Maui woman went on trial for allegedly abusing a child enrolled in her potty bootcamp.

Many of my patients have been referred to psychiatrists for their wetting problems, on the (completely faulty) assumption that they must be pooping in their pants on purpose.

Even prominent universities recommend that children who wet the bed be “rewarded” for having dry nights, sending the damaging message that these kids are somehow in control of their bladder or bowels. This is a travesty (and it’s why I wrote the children’s book “Bedwetting And Accidents Aren’t Your Fault”).

All toileting problems are treatable, often in a matter of weeks. First, the large, hardened lump of stool must be cleared out so the rectum can shrink back to size, regaining tone and sensation. Second, the stool must be softened so that pooping no longer hurts.

Shaming children in no way helps this process.

Constipation Nation

It’s well documented in the research that constipation causes toileting accidents and that clearing up constipation resolves these accidents. But what’s causing such widespread constipation?

•Our kids eat way too much processed food and aren’t active enough.

•Parents toilet train children too early, largely due to preschool deadlines.

•Dismal public school bathroom conditions and misguided restroom policies prompt children to steer clear of the toilet.

I discuss each of these issues at great length in It’s No Accident.

Some kids, because of their temperaments or genetic make-ups, are less affected than their peers by these factors and manage to avoid potty problems. However, enough forces in our culture conspire against healthy toileting behaviors that more kids than you can imagine end up pooping or peeing in their pants.

Educating Parents, Teachers, and Students About The Signs of Constipation

In response to the outcry from Gustine parents, school district superintendent Ken Baugh conceded the school crossed a line. “Maybe we can find a much better way to solve this,” he said.

Here are some ideas for starters.

•Educate parents and teachers on the signs of constipation. I suggest everyone involved in the Gustine debacle read our free download, 12 Signs Your Child is Constipated, available in both in English and Spanish. Teachers are on the front lines of this epidemic and are in a good position to catch these problems before poop ends up on the school gym floor.

•Educate teachers and school nurses on the causes of and treatments for dysfunctional elimination. We offer two free downloads: The School Nurse’s Guide to Childhood Toileting Troubles and The K-12 Teacher’s Fact Sheet on Childhood Toileting Troubles.

•Teach students about healthy elimination. Schools promote Obesity Awareness Week, Drug Awareness Week, and Sleep Awareness Week. Some public schools even have Rabies Awareness Week. But certainly more children develop medical problems from holding poop than get bitten by rabid dogs!

My dream is for school nurses to spearhead Toileting Awareness Week, but I’d settle for an annual assembly on what happens if you hold your poop. Exhibit A: the gym floor in Gustine.

Dysfunctional elimination is a serious and expensive problem that is completely preventable. We must all join forces to resolve this epidemic.

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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