Bowel
The primary functions of the digestive system are:

- 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.

To fully empty poop, the following things are required:

- 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

Investigating Tools
Puborectalis during defecation
Constipation in Babies & Toddlers

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.

Constipation in Children

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
Toilet Refusal Syndrome

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

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.