Bowel
- Digestion
- Absorption
- Excretion
- Protection
Every day you eat food to give you energy. When you eat food, it is chewed into small pieces, so, it is easier to swallow. As you swallow the food is travels down the food pipe (oesophagus) to the stomach. In the stomach the food turns into a thick liquid like a soupy mixture. The soupy mixture then moves to the small intestine where all the good nutrients get absorbed. This watery waste is then transferred to the large intestine. The large intestine has strong muscles that move and propel the waste along. The body soaks up some of the water in the poop and the poo and it changes to solid waste. This solid waste moves to the rectum where the rectum will tell the brain that there is some poo that needs to be pooped.
- Physical ability to get to the toilet and to undress
- Cognitive ability to sense and act on the urge
- Coordinated and functional muscle activity between the pelvic floor muscle, the anal sphincter, the angle of the pooping muscle and the speed that poop is moving in the colon- the poop highway- and the awareness that poop is at your buttock opening and that it is time to have a bowel movement.
- A powerful colon and rectal contraction-the poop highway needs to move the poop, the end
- Soft poop
- Kids need to poop daily
- Relaxed pooping muscles- Physiotherapy helps
Chronic constipated children tense their pelvic floor muscle instead of relaxing it when
pooping, an understandable reaction, given their history of large, painful bowel movements.
The pelvic floor muscle is often hypertonic- too tight with a constipated child due to
contracting against the heavy load of a loaded rectum. It is difficult for the child to relax the pelvic floor to completely empty. Having these muscles constantly “on guard” only worsens their difficulties. Eventually, all this holding inhibits the natural reflex to pee or poop, and these kids may not even feel the urge. What is more, the pelvic-floor muscles fatigue, like an overstretched rubber band that has lost it's elasticity, and poop just falls out or pee leaks out during activities such as running or jumping. Sometimes these children not only contract muscles at times they should be relaxed, but they also relax muscles when they should be contracted. With examination externally there is reduced active range of motion of the Pelvic floor muscle due to continuous conscious contraction of the muscle called, Dyssynergia Defecation
Constipation in new-borns
• Babies will strain and cry for 10 – 30 minutes while trying to poop
• Their stools are normal, and the baby is not in pain, just lacking the coordination to poo
because pooping is reflex activity and not yet a voluntary control.
• To have a bowel movement, the baby needs to increase intra-abdominal pressure and
relax the pelvic floor muscle. Babies are not always able to generate pressure in the
abdomen, so they scream to create the pressure.
• At 4 months it is common to get constipated when the baby gets introduced to solids and
starts to wean from the breast
• If constipation occurs at time of dairy introduction, liaise with doctor, and stop for 2 weeks
to see if there is any difference
• Introductions to solids foods makes the poo consistency harder, so pooping can feel
uncomfortable.
Children who experience pain or discomfort when pooping quickly learn to withhold their
poop because they are afraid that the poop will hurt. They learn that the pain or discomfort
can be avoided by simply contracting the muscle (sphincter) around their anus whenever
they feel the need to poop.
Withholding begins as a voluntary response (a conscious decision), but if the painful or
uncomfortable bowel movements continue, withholding can become involuntary. This means
that the anal muscle "closes" automatically whenever the rectum contracts which is what
causes the feeling of urgency, the need to poop. Withholding is no longer a conscious decision it has become a habit.
Constipation has a peak incidence between the age of 2 and 4 when potty training starts
The rectum transitions from a sensory organ to a storage organ and it becomes so stretchy that it loses its tone and can’t pump the stool out as effectively.
How Constipation Triggers Bedwetting and Accidents
A normal rectum is no wider than about 3 cm. Bedwetting patients have rectums stretched to
6 or 7 cm — sometimes wider.
When a child regularly withholds, stool piles up in the rectum, forming a large, hard mass.
The rectum stretches to accommodate this mass. Eventually, the stretched rectum becomes
so large that it squishes and aggravates the bladder. The stretched rectum can cause poop accidents (encopresis) as well as pipi accident (enuresis). The rectum becomes so stretched that it loses tone and sensation, so poop drops out of the child’s bottom, often without the child even noticing.
The Poo in You - Constipation and Encopresis Educational Video:
Click the button below to watch
| Learn more |
This is a common disorder in toddlers, defined by use of diapers and refusal
of toilet for defecation.
• Usually associated with previous constipation and episode of painful bowel movements
• Can cause functional constipation as child withholds until they have a nappy
• This is frustrating the parents. Parents need to let go.
How to transition onto a toilet:
• Child needs to be doing soft poo daily in the nappy. Delay all following steps until child is
happy to poo daily and not constipated
• Always allow the nappy so they can poo. We do not want these children withholding
• Explain how the poo’s wanting to go to the part in the poo land. Begin dropping poos out
nappy and into toilet. Can add confetti
(Poo goes to home to Pooland: https://www.youtube.com/watch?v=ZD0ZjAAJybg)
• Encourage child to squat to poo
• Encourage blowing while pooing e.g. balloon, bubbles, party poppers
- Disimpaction
- Maintenance therapy with laxatives
Physiotherapy:
- Toilet training
- Effective straining
- Increasing awareness of sensation as urge
- Pelvic floor muscle training i.e. awareness, relaxation during bowel movement or activation of pelvic floor muscle to prevent faecal incontinence
- Balance and core stability
- Posture
- Breathing exercise
- EMG: The use of animated computer game has expedited results, allowing excellent resolutions of dysfunctional voiding and co existing conditions, such as vesicourethral reflux and constipation with outpatient treatment
What causes constipation? - Heba Shaheed
https://youtu.be/0IVO50DuMCs?si=8DeMnwFQG1uyz9VU
1. Extra-large poops.
- This is the top sign!
2. Firm poops.
- Poop should be a pile of mush like pudding or frozen yogurt, not a log or rabbit pellets. These signifies that your child is constipated!
3. Poop accidents.
4. Bedwetting and pee accidents.
- Virtually all kids with enuresis, daytime, or night-time, are chronically constipated.
5. Recurrent UTIs.
- Chronic UTI’s are caused by the double whammy of holding pee and holding poop. A child who withholds poop harbours extra infection-causing bacteria in the rectum, an organ that is not designed to store poop.
- The rectum’s job is to sense stool is there and to signal that information to the brain. If a child ignores these signals and starts storing poop, the infection causing bacteria venture too close to the outside world.
- These bacteria colonize the perineum (the area between the vagina and anus) and eventually the bladder. The less often the child pees, the more opportunity for the offending bacteria to crawl up to the bladder. Antibiotics will clear up an infection but will not prevent a recurrence.
- The way to make it hard for the offending bacteria to journey to the bladder is to fully treat constipation.
6. Frequent and/or urgent peeing.
7. Infrequent pooping.
- Kids should poop a pile of mush every day.
8. Pooping more than twice a day.
- Extremely frequent pooping means the child’s rectum is stretched and lacks the tone to fully evacuate.
9. Belly pain.
- Children who frequently complain about stomach-aches usually turn out to be constipated.
10. Skid marks or itchy anus.
- Skid marks indicate is that he/she is not fully emptying. A kid who frequently scratches his/her bottom is also not fully emptying.
11. Super loose poop.
- Runny poop may be all that can ooze around the large, hard rectal clog.
12. Continued troubled potty training or hiding to poop in diapers.
- Sure, it can take a few weeks or even a few months for a child to get potty training down.
- However, if a child continues to struggle, that means one of two things:
- The child is constipated.
- Toilet training a constipated kid is an exercise in futility.
- Also, when kids hide to poop, it is not because they are shy; it is because they are in pain.
2 Types of Faecal Incontinence:
- Medical causes of faecal incontinence in children for e.g:
- Repaired anorectal malformations
- Post-surgical Hirschsprung disease
- Spinal cord trauma
- Spinal cord tumours
- Cerebral palsy
- Myopathies affecting the pelvic floor muscle and external anal sphincter
- Functional cause of faecal incontinence namely constipation. The rectum loaded with faeces leading to overflow incontinence due to withholding.
- Withholding leads to megarectum and mega colon and decreased propulsive contractile forces of the rectal musculature
- Rectal sensitivity is blunted due to rectal hyposensitivity or constant accumulation of faeces
- Semi liquid faeces seeps between the faecal mass and rectal wall and escape through the anal canal when sphincter muscle is relaxed
- Incontinence of faeces can occur in day or at night
Or
Children who have regular stools on the toilet with no pain or difficulty but 1x week or 1x month leaks large amounts of poo without knowing it happening-complete evacuation of the bowels.- Usually have leaks in the afternoon due to fatigue of the pelvic floor muscle.
- Child is older than 4 years with no evidence of faecal retention
Pelvic health physiotherapy can be very surprisingly effective at helping your child overcome bowel or bladder challenges. The physical benefits to your child are huge…but the best gifts of all are that of self-efficacy, self-esteem, and self-confidence.