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The Cycle of Constipation



It’s just a little constipation! It’s not THAT big of deal, right?


I wish that were true, but I have found that constipation can be a big deal. A really, big deal! It may start out as a minor issue, but if left untreated it can create a viscous cycle that becomes challenging to disrupt.


The type of constipation that I’m talking about is Functional Constipation. What exactly is functional constipation? Well, in simple terms, it is constipation that is not caused by another medical reason. Your child’s anatomy is normal and your child does not have another medical diagnosis that is causing the constipation.


Children with functional constipation often have some of these symptoms:

  • Stooling only two times a week or less

  • Hard or painful bowel movements

  • Large stools that clog the toilet

  • Excessive stool retention or large stool ball in rectum (usually seen on x-ray or felt on digital exam)

  • Stool incontinence (accidents) at least once a week, if previously potty trained.

  • Posturing or purposely retaining stool (withholding behavior; trying hard NOT to poop).

Your child’s Pediatrician or Nurse Practitioner can provide the specifics on diagnosing functional constipation. Give them a call if you have more specific questions about your child😊


So how does the viscous cycle of constipation begin? Well, it starts with a lack of dietary fiber intake. Ninety-five percent of Americans do not eat enough dietary fiber, including toddlers. Lack of dietary fiber leads to hard stools which can be painful to pass. Kids are smart, so when they have a painful, hard bowel movement they do everything in their power to prevent this from happening again. So, they squeeze and squeeze and hold in their stool for as long as they can (i.e. withholding behaviors). The longer the stool stays in the rectum and colon, the harder it becomes. The harder the stool becomes, the more painful it is to have a bowel movement, which reinforces the child’s withholding behavior. I should point out that there are other reasons a child can having withholding behaviors, such as fear of sitting on the toilet or other external stressors in the child’s life. However, the most common reason by far is having a painful bowel movement.


Overtime, withholding behaviors and stool retention stretches out the colon and it becomes very large. When this happens, the colon is not able to work well. It cannot contract and move stool down like it should. This makes it more difficult for the child to poop and contributes to worsening constipation.


Withholding behaviors and stool retention can also lead to pelvic floor dysfunction. What is pelvic floor dysfunction? Let me explain. Your pelvic floor is made up of muscles that hold up the organs in your abdomen. Think of your pelvic floor muscles like a hammock that holds up your bowel, bladder, and uterus (if you have one, lol). Normally, when you have a bowel movement, your pelvic floor muscles relax to let the stool out, then tightens back up. However, in children who are chronically constipated and constantly squeeze to hold in their stool, their pelvic floor muscles become dysfunctional and uncoordinated. They don’t do what they are supposed to do. They squeeze when they should relax, and they relax when they should squeeze. This contributes to worsening constipation. So, if your child says, “I’m trying to poop but it won’t come out”, believe them!


This viscous cycle only gets worse over time. The longer the cycle continues, the more difficult it is to break. Breaking the cycle will take time. Sometimes lots of time – like 6 months to a year. We’ll talk all about how to break this cycle in my next blog. Stay tuned!


Below is a visual diagram to better understand this cycle.



Written by Adrienne Flood, APRN, MSN, CPNP-AC, RDN, LD