Treating Constipation in the Urology Patient

Important information:

Constipation goes hand in hand with the management of many urologic complaints such as:

• Urinary frequency 

• Day and nighttime wetting

• Bladder or pelvic pain

• Vaginal pain in girls

• Penile or testicular pain in boys

• Frequent urinary tract infections

There is a close relationship between the muscles and nerves that control bladder function and those that control bowel movements:

• Children with daytime wetting often have problems with their bowels in the form of constipation or encopresis (fecal soiling).

• Children with constipation may tighten their pelvic floor muscles, hold back when they urinate, and not completely empty their bladders. 

• Stool in the lower colon and rectum can put pressure on the bladder, resulting in urgency and more frequent bladder contractions. 

• Many children with recurrent urinary tract infections often have constipation as well.

Many parents don’t realize that constipation is a problem for their child. Once children are out of diapers and using the bathroom on their own, parents may not have a clear picture of their child’s bowel movements.

How do I know if my child is constipated?

Sometimes constipation is obvious, such as when a child is passing hard, dry, pellet-like stools with straining or only moves their bowels every few days.

Your child may be constipated even if they have a daily bowel movement. These are some signs of constipation:

• Hard and/or large stools 

• Painful stools that cause bleeding 

• Intermittent diarrhea 

• Abdominal pain 

• Encopresis (stool accidents)

• Decrease in appetite 

• Increase in day and nighttime wetting

• Clogging the toilet with stool 

• Soiling of the underwear

Why is my child constipated?

Children become constipated for many reasons, including family history of constipation, diet and emotional stress. Constipation occurs when stools move too slowly through the bowel and fluid is absorbed by the body. This makes stool hard.

Why does my child leak stool?

Over time the large hard stool causes the rectum to stretch. The child does not get the feeling in the rectum when it is time to stool. When this happens, the watery stool formed high in the bowel leaks around the hard stool in the rectum and soiling occurs. It can look like diarrhea, smearing, or stool. It happens when a child has been constipated for a long time. Children have no control over soiling (encopresis).

Instructions for managing constipation:

There are many steps to treating constipation and soiling. Your child may need some or all of the treatments listed below. To be successful, follow the plan made by your healthcare team.

• Clean out the rectum and intestine with enemas.

• Take medicines to keep the stool soft and slippery, making it easy for your child to pass. Follow the dosing instructions given by your healthcare provider. They may differ from the instructions on the label. Call your team with questions.

• A high-fiber diet increases the amount of water held in the stool, making soft, bulky stools that are easy to pass. Fiber also produces gas in the bowel, which stretches the muscles and increases the urge to pass stool.

• Increase water in the diet to soften the stools. An easy way to gauge enough water intake is to make sure your child’s urine is pale yellow or a clear color. 

• Find a time that is convenient for your child to use the bathroom each day. This should be 20 to 30 minutes after a meal.

• Have your child sit on the toilet for 1 minute per year old (for example, a4-year-oldd should sit for 4 minutes), up to 10 minutes each session. Use a timer to keep track of time. 

Other helpful hints for your child

• Move a footstool into the bathroom. Place both feet on the stool. This will help the muscles to relax.

• Do a few Kegel exercises as you were taught. This will also help the muscles relax.

• Do not strain. To bear down, pretend you are blowing up a balloon. Do not get upset if this does not work immediately. Sit back and do a few slow, regular, deep breaths. This will also help the muscles to relax.

• If you feel the urge to have a bowel movement, do not wait to go to the bathroom.

• Keep track of your child’s progress by noting sitting and stooling on a calendar. 

• Praise your child for stooling in the toilet.

• Reward your child for sitting on the toilet and stooling.

Managing soiling episodes

• Do not punish your child for soiling.

• Remind your child to clean up after soiling.

• Encourage toilet sitting after the soiling episode.

• Ask the school nurse or teacher to permit your child to use the bathroom as needed.

• Praise your child for staying clean.

Reviewed February 2024 by Jennifer Kirk, CRNP