Why does Constipation cause Pee and Poo Leaks in Kids?

Did you know one of the main reasons for urinary incontinence in children is constipation?! Yes! It seems odd, but the bowel and bladder are closely linked and are often referred to as bowel and bladder disorder (BBD).  Constipation in pediatric patients can lead to urinary leakage, often due to a condition known as overflow incontinence.  Constipation can also lead to fecal incontinence, also called “encopresis.” 

It is important to note that urinary incontinence and bowel incontinence in children is not their fault.  In fact, in PT we call them pee and poo leaks instead of accidents. Accidents imply that it is the child’s fault, when in fact, they do not have control over the leaks and need further help managing the underlying reason for leaks.

Picture of pink toilet in pink bathroom.

What exactly is functional constipation in children? Functional constipation is defined by a child having two or more of the following in the recent month:

• At least 1 episode of stool leakage per week

• History of excessive fecal retention

• History of painful or hard bowel movements

• Presence of large fecal mass in the rectum 

• History of large diameter stools

• 2 or fewer bowel movements per week

Dry needling of the sacroiliac joint and respective attachments and right gluteus.

The cycle of functional constipation: 

Bowel absorbs water→stool becomes hard→stool becomes retained→rectum becomes distended→loose stool seeps around hard stool resulting in stool leakage→loss of rectal sensation due to stretched out rectum→loss of urge to defecate

Signs and Symptoms of Constipation

• Frequent pee or poo leaks: Involuntary urine leakage and/or liquid stool seeping around impacted/hard stool

• Abdominal discomfort: Pain or fullness in the abdomen.

• Difficulty with bowel movements: Hard stools or infrequent bowel movements.

• Increased urinary urgency: Needing to go to the bathroom frequently.

• Body odor

• Stool plug the toilet

• Loss of appetite

Person holding poop emoji cutout

So what is the connection Between Constipation and Urinary Leakage?

1. Anatomical/Mechanical Pressure: A full rectum can compress the bladder, causing urgency or leakage.  The rectum sits behind the bladder in both males and females and when full, it can press on the bladder and urethra causing difficulty with emptying and incontinence.

2. Nerve Pathway Impact: Chronic constipation may affect the nerve pathways that control bladder function, leading to incontinence.

3. Pelvic floor muscle dysfunction:  The Pelvic floor has difficulty relaxing resulting in difficulty emptying the bladder causing bladder overactivity and urine leaks.

4. Behavioral Factors: Constipation can be painful and thus children may avoid using the toilet leading to retention and withholding which can further worsen constipation.

Management Strategies

1. Dietary Modifications:

• Increase fiber intake (fruits, vegetables, whole grains).

• Ensure adequate fluid intake to prevent dehydration.

2. Regular Toilet Habits:

• Encourage regular bathroom breaks, especially after meals.

• Create a bowel routine to help the child feel the urge to have a bowel movement.

3. Medications:

• Laxatives or stool softeners may be prescribed to relieve constipation.

4. Behavioral Therapy:

• Consider interventions like positive reinforcement for using the toilet.

5. Education:

• Education about the importance of regular bowel habits and the impact of constipation on urinary function.

• Education about bowel and bladder toileting posture.

When to Seek Help

Often times providers will “watch and wait,” however, if your child continues to exhibit irregular bowel habits or urinary leakage during the day, please reach out.  The sooner we can address the underlying issues, the sooner the leakage will resolve.

References:

Hakkak, A., & Yavuz, B. (2019). "The relationship between urinary incontinence and constipation in children: a review." Pediatric Health, Medicine and Therapeutics. [Link to Journal]

  Michelsen, H. C., et al. (2015). "Fecal incontinence in children: a review." Pediatrics. [Link to Journal]

  Chowdhury, A. & Sun, M. (2020). "The interplay between urinary and bowel dysfunction in children." Journal of Pediatric Urology. [Link to Journal]

  American Academy of Pediatrics. (2016). "Constipation in infants and children: evaluation and treatment." Pediatrics, 138(3), e20163003. [Link to AAP Guidelines]

  Gingold, J. & Glickman, S. (2017). "Management of constipation in children." Current Opinion in Pediatrics, 29(5), 654-660. [Link to Journal]