Bladder Bowel Dysfunction

As many as 40% of children consulting for urologic concerns have symptoms related to constipation.
What are these symptoms? They can range from the mildly bothersome, like frequent urination, to the serious, like urinary tract infections (UTIs) with fever and illness.

• Recurrent urinary tract infections (UTIs) with or without fever

• Painful urination

• Too-frequent urination

• Bedwetting or urine leaks during the daytime, specially in a child who was previously potty-trained

”My child poops every day.

How can she be constipated?”

What does constipation look like in kids?
Constipation is not always obvious, and can happen even when kids are seen to have daily bowel movements.

Constipation in toilet-trained kids can manifest as:

needing to strain or exert effort on the toilet
hard, lumpy, or painful stools. (See the Bristol Stool scale; the ideal stools are 3 to 4.)
history of clogging the toilet bowl
pooping “accidents” or presence of stool streaks in the underwear

Why does this happen?

There are many reasons that constipation is thought to cause bladder issues.

• It may be a space issue: The bulk of stool in the rectum can compress the bladder in a child's small body. Stool can also compress the outlet for urine. This means that the bladder may not empty urine completely or effectively.

•The bowel and the bladder are controlled by the same nerves from the spine. This means that sensations and contractions of the bowel can have the same effect on the bladder, and vice versa.

•Having more stool staying longer in the rectum is thought to increase the amount of bacteria near the urethra, triggering UTIs.

What DO we know?

We DO know that treatment of chronic constipation in these children leads to:

Improvement in how often kids can have UTIs
Improvement in peeing symptoms, including bedwetting and daytime incontinence
Lower rates of UTI in children who have other inborn risk factors for infections

Loening-Baucke V. Urinary incontinence and urinary tract infec-tion and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997;100(2 Pt 1):228 – 32.

Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, Patel M, deBerardinis R, Parker A, Bhatnagar S, Haralam MA, Pope M, Kearney D, Sprague B, Barrera R, Viteri B, Egigueron M, Shah N, Hoberman A. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics. 2015;136(1):e13–21.

What can we do?

Improve hydration! Ask your pediatrician how much fluid your child should be getting in a day.
Encourage a high-fiber diet.
Many children need help with stool softeners (PEG3350, lactulose). They may need to be on these for 3-6 months consistently so that symptoms can resolve
Some children with very bad constipation may need help to “unblock” the bum by using stronger agents at the start (“cleanout phase”), before transitioning to regular stool softeners (“maintenance phase”).
Depending on your child’s needs, they may benefit from pelvic floor physiotherapy to assist in helping them learn to control and coordinate their muscles.

What are the red flags?

Some signs can stand out to your urologist or pediatrician as “red flags”, which could lead them to advise more testing or refer to other specialists.

Repeated UTIs with fever
Poor ability to have bowel movements since birth
Bladder-bowel dysfunction after 6 months
Other symptoms like excessive thirst, urinating extremely high amounts, or unintended weight loss
Findings on the skin of the lower back over the spine like dimples or hair tufts
Other neurologic findings, like weakness, numbness, or tingling of the limbs or changes in walking

Above all: Patience.

Parents and caregivers are recommended to be patient and encouraging!

Patience is key, as the maintenance phase of treatment may take several months, and it may take time before you and your doctors are able to come up with the best constipation regimen for your child.

You may be asked to keep a diary of the child’s urination and bowel movements for a few days.

It is important to not blame the child for any daytime or nighttime accidents.

The information in this infographic is for general information purposes only.

We encourage you to seek an individualized consult for the most appropriate management. You may book an appointment with us or with your preferred pediatric urologist or pediatric surgeon.

Please feel free to send us a message for questions on pediatric urologic health!

For interested health practitioners, we have had the privilege of co-authoring an update on BBD diagnosis and management. Please feel free to view the article via the button below.