The Impact of Constipation on Pediatric Voiding Dysfunction: An Expert’s Guide For Parents

As pediatric urologists, one of the most common patients we see in the office is the child struggling with voiding dysfunction. This umbrella term includes symptoms of urinary incontinence, urgency, frequency, and sensation of incomplete emptying. One of the less obvious but most significant contributors to this is constipation. This can be one of the most surprising findings for parents and the most challenging hurdle during the visit. In this post, we'll review the association between constipation and voiding dysfunction and why we can't make progress until constipation is thoroughly treated.

Constipation and Voiding Dysfunction Travel Together Like Ham and Eggs

The bowel (rectum) and bladder share the same bony space in the pelvis. When the rectum is always significantly dilated with stool, it can press against the bladder, creating a cascade of problems that affect normal urination.

Bladder compression:

A full rectum due to constipation will directly press on the bladder with a few downstream effects:

1. This will directly reduce the bladder's capacity because the bladder has no extra room to expand within the bony pelvis.
2. The bladder will feel a constant stretch sensation, just like a full bladder, giving your child the feeling it is never empty. This will lead to urinary frequency, urgency, and a sensation of incomplete emptying.

Nerve interference:

The colon and bladder share many of the same nerves and centers within the brain for sensation. Studies have shown that chronic constipation interferes with normal signaling of bladder sensation of fullness or appropriate emptiness with voiding.

Behavioral factors:

Children with constipation can develop discomfort in the pelvic or genital area that may make them avoid going to the bathroom. This aversion can lead to a cycle of withholding both stool and urine, which increases pelvic floor muscle tone and worsens the cycle of constipation and urine holding.

Why Do Kids Become Constipated?

Understanding how constipation happens is the first step in prevention. A diet with insufficient fiber can lead to harder stools that are more difficult to pass. Also, physical activity is important for appropriate digestive system motility, so a lack of physical activity can cause the GI system to move more slowly. Finally, kids may ignore or fight the urge to have a bowel movement due to previous uncomfortable bowel movements or feelings of missing out while involved in an engaging activity.

Three Steps to Address Constipation and Improve Voiding

Addressing constipation is the first step in improving voiding dysfunction in kids. Once it's addressed, maintaining regular, soft stooling is key to preventing recurrent urinary symptoms.

1. Start with dietary changes, including increasing daily water intake and encouraging high-fiber foods such as fruits, vegetables, and whole grains.
2. Prompt your child to have a bowel movement after a meal by having them sit on the toilet for 10 minutes. This takes advantage of a normal reflexive colon contraction after a meal.
3. Also, stool softeners or laxatives are commonly used initially or on an ongoing basis in kids with voiding dysfunction and constipation. Proactively addressing any underlying constipation with a stool softener is a key step in addressing voiding dysfunction for the reasons reviewed in this article. Further, it's a step that parents can take that does not rely on their child changing behavioral or eating habits, which can be lengthy.

The Bottom Line

Constipation is a common cause of and often overlooked factor in voiding dysfunction in kids. Understanding the interplay between the bowel and bladder helps parents understand the importance of addressing constipation and, therefore, improving urinary health.

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