Poop School Gives Constipated Kids Relief

There are two parts to defecating, each of which can cause problems, Shah explained. First, the body needs to move digested material, aka fecal matter, from the colon to the rectum. Second, we need to coordinate and relax our pelvic floor muscles, which are normally contracted, in order to allow the stool to leave the body. 

It’s possible that medication, diet, or a lack of fiber might explain why someone might have difficulty with the first part, but the pelvic floor can also be a problem zone that requires special investigation. According to Shah, about a third of adult patients with constipation are having problems with their pelvic floor. Patients who’ve endured childbirth, radiation treatment for rectal or ovarian cancers, or spinal cord injuries may have suffered damage to the muscles and nerves in the pelvic floor. 

For others, though, there may be more complicated psychological factors at play, including stress and anxiety. Children, in particular, tend to fall into two categories, said Piorkowski: younger kids who are too distracted to listen to their bodies and older ones who have pooping anxiety. 

“Anxious kids are more prone to withholding,” Piorkowski said. “So if they had a large stool burden or were constipated at one point in their life, they kind of realized, Oh, I can hold it in and I can prevent myself from feeling that again. And then it creates this medical concern because whatever we eat has to come out. It’s this cycle of withholding and unfortunate pain when they go.”

The more that stool builds up, the harder it becomes to pass. Eventually it builds up in the rectum, expanding it like a balloon and damaging its elasticity. 

Shah, the gastroenterologist, said he’s encountered backed-up patients who have come up with workaround methods to assist them with pooping. Some have weekly colonic irrigation or massage appointments, while others have turned to herbal remedies. Others try to rely on laxatives or enemas, but Shah has even had patients tell him they will insert their fingers into their rectums or vaginas to try to stimulate a response. Over time, though, these workarounds prove counterproductive to normal pooping habits. 

“For some of my older patients, it’s been decades, but they’re just sort of doing what they’re doing,” Shah said. “It’s not until somebody says, ‘You know, it’s not totally normal that you go every five days,’ or ‘We did this CAT scan for a whole other reason and you had a ton of stool throughout your entire colon. We could probably do something about that to help you.’”

In order to retrain or assist these patients, a gastroenterologist might simulate defecation by inserting a catheter with electrodes into the rectum, sending signals to the brain and evaluating what level of stimulation finally prompts a bowel movement in a simulated defecation. Alternatively, they can expand balloons inside the rectum to see at what volume a patient’s brain is triggered to poop. These tests are designed to examine whether the rectum is sending the right signals to the brain or if it’s been overstretched.  

If a gastroenterologist suspects a patient has pelvic floor problems, they will likely send them to a physical therapist like Katie Thomas, who works with patients at her clinic in East Grand Rapids, Michigan. As a pelvic floor physical therapist, she’ll work with a typical patient for six to eight visits, leading them in strength and breathing exercises to help them overcome dysfunction that might include constipation or diarrhea, urinary leaking, or pain in sexual activity.