Potty Talk: Do You Know Squat About Constipation?

There is no shortage of television commercials related to constipation medications. It seems that everyone is constipated these days. Not surprisingly, constipation happens in children too. It is the most common reason why children see a pediatric gastroenterologist; 3% percent of all visits to the pediatrician and a total of 2.5 million physician visits each year in the U.S. relate to this condition.

Not everyone who has constipation is taking medications (nor do they need to). While some suffer in silence, a good number of people are able to control their symptoms with modifications in their daily routine and their diets. Here are some non-pharmacologic interventions:

Gastrocolic Reflex

You have probably had your reflexes tested at the doctor’s office. The doctor hits your knee with a small hammer and your leg extends quickly. Believe it or not, your gastrointestinal tract has a similar involuntary response called the gastrocolic reflex.

When you eat a meal, your stomach (gastro-) stretches out to accommodate it and begins to send signals to the colon (-colic). In response, the colon begins to contract and this often causes a mildly uncomfortable abdominal sensation triggering the need to use the restroom. While your lower leg extends in less than a second, the gastrocolic reflex takes 30-60 minutes to take effect. Therefore, in people who have trouble using the restroom, we recommend trying to go 30 minutes after a meal to accentuate this reflex. Interestingly, just like your knee reflex happens without any control from your brain, so does the gastrocolic reflex. It happens without you even thinking about it.

Foot Support

One often overlooked aspect of trying to use the toilet is the height of the seat. As adults, most of us do not give a second thought to sitting on the toilet and our feet touching the ground. With feet firmly planted, a healthy adult is able to push down against the floor and generate enough force in their abdomen to help eliminate stool. However, most children’s feet dangle in this position. In turn, they are unable to generate enough force to evacuate their colon.

We sometimes meet patients whose parents are embarrassed to tell us their child is prone to standing with their feet on the rim of the toilet, squatting over the bowl. The child does this because over time their body has learned this is a good way for their feet to be supported and it increases the so-called “anorectal angle” in their pelvis. Many commercially available products provide foot support and lead the child to be flexed at the hips while sitting on the toilet. This position is more natural for passing stool. We generally recommend a foot stool or old phonebooks to help our younger patients.

Fiber Intake

Most Americans do not get enough fiber in their diet. Busy families often eat processed food, which rarely meets the guidelines set by the USDA. The fiber in whole-grain breads, oatmeal, fresh fruits, vegetables and brown rice lead to softer, more bulky stools which are generally easier to pass. A rough rule of thumb for children is that a child should have their age in years plus 5 for their daily intake of fiber in grams (for a 7 year old; 7 + 5 = 12 grams of fiber per day).

Click here for more information on constipation and if you are unsure whether your child’s constipation is typical, talk to their pediatrician.

Steven Ciciora, MD, is the director of division educational activities in the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children's Hospital and an assistant professor of Pediatrics at The Ohio State University College of Medicine. Dr. Ciciora’s clinical interests involve all aspects of pediatric gastroenterology, including celiac disease, motility disorders, functional disorders and liver disease. His published research has focused on motility disorders. He has presented his work at national meetings and earned distinguished presentation honors at the American Neurogastroenterology and Motility Society’s Young Investigator Forum. His work in the community led to him being awarded the Down Syndrome Association of Central Ohio’s Commitment to Excellence Award. He is also an author for the American Academy of Pediatrics inaugural pediatric GI review program.

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