Constipation is the cause of alllllll the things. Just joking.

No, but really – it’s one of the most common things I see in my office at Willow Park, and it causes strange problems sometimes. Parents often don't believe me when I tell them it's constipation causing the problem. 

What is constipation? It doesn't necessarily mean your child isn't stooling daily. A kiddo can be constipated and poop many times a day. Constipation means hard, dry stools. They’re often painful to push out. And yes, most kids with constipation will go a few days between stools.

I really feel that constipation has become more prevalent over the years because of how our kids' diets have changed. In general, kids are eating less fresh fruits and veggies and depending more on packaged goods for snacks and meals. 

There are lots of medical causes for constipation as well. Did you know that hard poops can cause:

1. Stomach pain
2. Withholding of stool
3. Vomiting
4. Refusal to eat
5. New urinary accidents
6. Wetting the bed
7. Diarrhea
8. Poop accidents 
9. Blood in stools, blood in diaper
10. Fever (yes it can cause fever! mostly lowgrade)

Here's the deal - and let's get down and dirty about it. The things your kids eat affect the quality of their poop. If they eat and drink things that don't have much fiber (think cheese, yogurt, pastas, cookies, white bread, bananas, milk, goldfish crackers), their stools will be harder. 

Also, did you know our bodies absorb water out of our stools if we need it? So if your kiddo isn't drinking enough water, his body will just take it out of the poop, and it will become hard. 

The poop gathers at the “end of the tube” in a child’s body – the rectum and descending colon – and stretches everything out a lot. See the pic. This chronic distension leads to problems with the “valves” inside the rectum. Sometimes, this leads to leaking – soft stools can leak out without the child being able to control it. 

These big bulky stools can also push on neighboring organs, like the bladder, and even push urine out sometimes. And children with chronic constipation tend to develop poor control of their pelvic muscles and can lose control over their bladder, leading to leaking. One study showed that after being treated for constipation, 89% of 250 kids had complete resolution of their daytime wetting problems.

When the stools become hard, they hurt to push out. So kids don’t want to poop. So they hold it in. And the body slowly takes water out of it. And the stools get harder. And more difficult and painful to push out. Thus starts the painful cycle. 

Kids can get constipated anytime, but I find it’s most common 1) when babies start solid foods, 2) when kids start potty training, and 3) when kids start school.

So how do you fix the problem? Well, that depends on the severity of the problem and the age of the kiddo. But some general rules:

1. WATER. LOTS OF IT. Children and teens should drink at least 6 to 8 cups of water a day. 
2. Fresh fruits and veggies! I encourage kids to eat green veggies, prunes and other fruits (but not bananas), bran, whole grain bread. Sometimes those puree pouches with the kale, spinach, and broccoli are a good start for the picky kids.
3. Certain fruit juices – ok, we pediatricians are NOT big fans of juice. But I’ll make an exception in this case – go with prune, or pear.
4. Fiber supplements – flax seeds are great. Fiber gummies and cookies are good, too.
5. Behavioral and schedule changes – encourage a routine for “potty time”. 20-30 min after meals, have your kiddo sit on the toilet for 5 minutes. Encourage your child to listen to his body and stop playing when he feels the urge to “go” (and not hold it in). 
6. Do not punish your child, or get mad, if he has an accident (urine or stool) – remember, this isn’t under his control!
7. Avoid those foods I mentioned before for a few days – bananas, cheese, crackers, milk (if over age 1), breads, pastas.

If there is anything I can’t express enough to parents – it’s BE PATIENT! It takes many months for the intestines to stretch out and constipation to form in toddlers and children, and it takes many months (sometimes even years) to treat it. Sometimes we use safe laxatives or glycerin suppositories to help during the really rough patches – call or come visit us to talk more about that if you think its necessary. 

Hugs,Dr. Poop (er, Diane)

T.J. Oshie, a hockey star, became a national hero after helping Team USA beat Russia in a dramatic shootout. But now the St. Louis Blues player is in the headlines for a different reason, after his fiancé, Lauren Cosgrove, gave birth to a little girl. Their daughter was born with gastroschisis, a condition where the baby is born with the intestines on the outside of the body.

We asked James P. Miller, M.D., a pediatric surgeon for Cook Children’s, to give us some answers about gastroschisis.

Cook Children’s: What causes gastroschisis?
Dr. Miller: No one is really sure what causes it. We think it happens while the baby is developing and the abdominal wall is being formed.  It’s an abdominal wall defect where the intestines protrude through the abdominal wall. Interestingly enough it’s almost always on the right side. In the most basic terms, it’s like having a ruptured umbilical, or belly button, hernia.

Cook Children’s: How rare is gastroschisis?
Dr. Miller: It’s about 1 in every 3,000 births. Sixty percent of babies with gastroschisis are born premature and to mothers of young age. At Cook Children’s, we probably see about 30 or so per year.

Cook Children’s: What are the main concerns for babies with gastroschisis?
Dr. Miller: Getting the bowel back in the baby. Often times, this needs to done in stages over a period of days.  Another concern is that the gastrointestinal tract is slow to function. About 10 percent of babies will have an area of narrowing and some with a segment of bowel missing. When this occurs the recovery is more prolonged. Babies will need to be fed through their veins while the GI tract recovers. 

Cook Children’s: What is the prognosis?
Dr. Miller: Overall, quite good. Usually, babies are here at the Cook Children’s NICU for anywhere between four to eight weeks after delivery and the defect is usually isolated.

Photo of T.J.Oshie courtesy of: Mark Buckner/St. Louis Blues