The Constipation Cycle

How does constipation develop, and why is it so hard to fix? This video explains the constipation cycle, and how to break the cycle. We suggest that you watch “Elimination Basics” and “Could it Be Constipation” before this video.

A full transcript of the video appears below.

Hello. My name is Kelly Savitri and I’m a nurse with the Vermont Continence Project. In the videos called Elimination Basics and Could it be Constipation?, we talked about how constipation interferes with toilet learning and some of the signs that this might be a problem for your child. In this video, I’m going to describe some of the causes of constipation and why treating it is an essential step in gaining continence skills.

In Elimination Basics, I introduced you to this graphic, where the green part of the cycle represents the physical changes that interfere with a child’s ability to recognize and respond to their body’s signals about peeing and pooping. If you haven’t watched that video yet, I suggest you go back and watch it now.

Today I’m going to describe the triggers that cause constipation and the emotional and mental consequences that affect our children’s toileting behavior, which is represented by the yellow parts of this graphic. Some children are more affected by the green part of the cycle and some are more affected by the yellow part, but either way, the treatment is the same. So please keep watching to see what information is most relevant to your situation.

So first, how did we get here? Constipation is extremely common. About 15% of children experience constipation at some point and the most common time that it happens is around the age of toilet learning. It frequently goes undiagnosed. Often, children first exhibit constipation when there’s a big change, like transitioning from a home daycare to preschool, a new housing situation, or a change in their family situation. Children also become constipated after traveling. It might have to do with changes in their routine or being in unfamiliar bathrooms. There are lots of ways that travel can cause a disruption to a child’s elimination patterns. Finally, diet plays an important role in bowel function. We’re going to go into this in a lot more detail in future videos, but we know that many young kids are picky eaters and the foods that they usually prefer are not leafy green vegetables. If your child lives off mac and cheese and chicken nuggets, there is a high likelihood that this is a factor. Finally, some children are just so interested in playing or doing whatever activity that they’re engaged in that they don’t want to stop to use the bathroom. They learn to ignore the signal that their body needs to poop, and eventually it goes away.

One of the reasons that constipation is so common around the age of toilet learning is because this is a time when children gain the ability to control their bowel movements. Usually there’s a trigger, like I just mentioned. They go on a big trip or move to a new school and they get constipated. This causes them to have a hard, painful bowel movement. It creates an association for them that pooping hurts. When a child has a painful association with pooping, they will try to avoid that experience. We call this withholding. It can be conscious or unconscious, but the underlying motivation is trying to avoid pain. Eventually, the feeling of needing to poop will go away.

Of course, that poop continues to sit in the large intestine. It becomes harder and drier and they become more constipated. When they finally do poop, it hurts again and the cycle continues. Children who are withholding often exhibit posturing, which is when they put their body in a certain position to try to avoid pooping. This can be squatting, holding onto a table or shelf, standing on their tiptoes, or even lying flat on the floor. This is a sign that your child has a painful association with pooping. If your child used to exhibit posturing and doesn’t anymore, it doesn’t mean that they are no longer withholding. It just means that they can’t feel it anymore.

It only takes one painful pooping episode for a child to associate poop as a scary and painful experience. We see this a lot when kids have major resistance to using the toilet. Sometimes they refuse to even go into the bathroom. This can be so frustrating for parents and it can set you up for major power struggles. It’s helpful to remember that the emotion underlying the behavior is fear rather than stubbornness or defiance.

So how do we break the cycle? The easiest and most successful place to disrupt this cycle is to make poop so soft that it doesn’t hurt. Children also have a hard time withholding poop that is very soft. This is why constipation is usually treated with laxatives. Using a laxative will help erase your child’s negative associations with toileting. When your child no longer associates pooping as a painful experience and they learn that they don’t need to avoid it, you can focus on helping them with the other skills associated with toileting. Also, laxatives are necessary to clear impacted stool and help the rectum fully empty on a regular basis, which will allow those overstretched muscles and stretch receptors to return to their normal function.

We have other videos that talk more specifically about constipation treatment, but for now, just know that using a laxative now doesn’t mean that your child is going to have to be on it forever. There will be an opportunity to wean away from laxative use when the cycle is broken and your child is feeling successful with their ability to recognize and respond to their body’s signals.

If your child is struggling with toilet learning, I hope that these videos about constipation have given you some insight into what might be going on for your child. I hope that you will use this information along with our resources, such as the bowel symptom checklist, to talk to your child’s healthcare provider about formulating a constipation treatment plan that is right for them.

Thank you for taking the time to watch this. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider.