Bladder and bowel

Constipation

Constipation is common in childhood, particularly when children are being potty trained at around 2 to 3 years old.

Your child may be constipated if:

they have done less than 3 poos in the last week
their poo is large and hard
their poo looks like "rabbit droppings" or little pellets
they are straining or in pain when they poo
they have some bleeding during or after having a poo, because their poo is large and hard
they have a poor appetite or stomach pain that improves after they poo

If your child is over 1 year old, soiled pants can be another sign of constipation, as runny poo (diarrhoea) may leak out around the hard, constipated poo. This is called overflow soiling.

Constipation in children has many possible causes. Sometimes there's no obvious reason.

Some of the possible causes include:

not eating enough high-fibre foods like fruit and veg
not drinking enough fluids
feeling pressured or being regularly interrupted while potty (or toilet) training
feeling worried or anxious about something – such as moving house, the arrival of a new baby, or starting nursery or school

If your child is constipated they may find it painful to poo, which may mean they do not want to try to poo. This can create a vicious circle; the more they hold back, the more constipated they get.

If you think your child may be constipated, take them to a GP. The treatment for constipation depends on your child's age.

The longer your child is constipated, the more difficult it can be for them to get back to normal, so make sure you get help early.

Laxatives are often recommended for children who are eating solid foods, alongside diet and lifestyle changes.

It may take several months for the treatments to work, but keep trying until they do. Remember that laxative treatment may make your child's overflow soiling worse before it gets better.

Once your child's constipation has been dealt with, it's important to stop it coming back. A GP may advise that your child keeps taking laxatives for a while to make sure their poo stays soft enough to push out regularly.

Treating constipation with soiling (children pooing their pants)

Getting constipated and soiling their clothes is not something your child is doing on purpose, so there's no reason to get cross with them.

You may both find the situation stressful, but staying calm and relaxed is the best attitude to help your child deal with the problem.

A health visitor or GP can offer helpful tips.

Read about soiling (children pooing their pants).

Make sure your child has plenty to drink – offer breastfed babies who are not eating solids yet plenty of breastfeeds. Formula-fed babies can have extra drinks of water between their formula feeds. This must be cooled boiled water for babies under 6 months. See more advice on drinks for babies and young children.
Give your child a variety of foods, including plenty of fruit and vegetables, which are a good source of fibre. See what to feed young children.
Encourage your child to be physically active. For more information, read the physical activity guidelines for children aged under 5 years.
Get your child into a routine of regularly sitting on the potty or toilet, after meals or before bed, and praise them whether or not they poo. This is particularly important for potty-trained boys, who may forget about pooing once they are weeing standing up.
Make sure your child can rest their feet flat on the floor or a step when they're using the potty or toilet, to get them in a good position for pooing.
Ask if they feel worried about using the potty or toilet – some children do not want to poo in certain situations, such as at nursery or school.
Stay calm and reassuring, so that your child does not see going to the toilet as a stressful situation – you want your child to see pooing as a normal part of life, not something to be ashamed of.

If you'd like advice about taking the stress out of going to the toilet for your child, speak to a health visitor.

Find out more advice for children with constipation on ERIC, The Children's Bowel and Bladder Charity website

ERIC, The Children's Bowel & Bladder Charity, is a UK charity for families affected by bedwetting, daytime wetting, constipation and soiling. ERIC has a freephone helpline on 0808 801 0343 (Monday to Thursday, 10am to 2pm), or you can email the service via a webform at www.eric.org.uk/helpline.
Bladder and Bowel UK: child information library has a range of booklets and leaflets covering bladder and bowel problems in children.

Soiling

Soiling is when a child regularly poos their pants. If they're already potty-trained, the soiling is usually because they are badly constipated. Treatment from a GP can help.

You may feel angry or frustrated when your child keeps pooing their pants (soiling). But they are not doing it on purpose and may not even realise it's happening.

Soiling usually happens when a child is so constipated that a large, hard piece of poo becomes stuck at the end of their gut (rectum).

Fresh poo from higher up the gut then runs around the hard poo and leaks out, staining their pants.

See a GP if:

your child is regularly pooing their pants (soiling)

It's important not to try to sort out soiling by yourself.

Ask for an urgent GP appointment or get help from NHS 111 if:

your child is pooing their pants (soiling), has a swollen tummy and is being sick
your child is soiling and has numbness or weakness in both legs

You can call 111 or get help from 111 online.

If your child is pooing their pants (soiling) because they're constipated, a GP can prescribe laxatives to clear out the hard poo and get your child pooing regularly and comfortably again.

This can take a few months to work. The GP will want to see your child regularly to check how they are doing.

The soiling may get worse before it gets better.

A GP may refer your child to a specialist for treatment if they think soiling could be caused by another medical condition.

If your child is regularly pooing their pants (soiling), it can help to:

set up a regular toilet routine for your child – for example, they could sit on the toilet for 5 minutes every day after each meal and before going to bed
be positive and encouraging – you could use a star chart to reward your child for sitting on the toilet (whether or not they do a poo), or leave some toys or books next to the toilet
encourage your child to go to the toilet as soon as they get the urge to during the day
make sure your child is drinking plenty of fluids and has enough fibre in their diet
encourage your child to be physically active

Find out more

Daytime wetting

Encourage your child to drink more throughout the day – at least 1.2 litres for 4-8 year olds, and 1.5 litres for those aged 9 and over

Avoid giving fizzy or caffeinated drinks to your child. Hot chocolate, orange and blackcurrant drinks have also been shown to irritate the bladder. Water is the best option for your child

Water bottles with time trackers and wobble watches can be helpful to remind your child to use the toilet and to drink throughout the day, as well as maintaining some independence

Encourage your child to use the toilet regularly throughout the day. You may need to liaise with his/ her school to ensure that your child can access the toilet

Your child may benefit from ‘double voiding’ – this is when they use the toilet, and when they think they are finished, they should count to 10 and try again to ensure they are fully emptying their bladder

Ensure your child has a change of clothing when at school or out and about in case of accidents

Don’t punish your child if they do wet during the day – it is more important to praise for when they do follow these steps

Please access ERIC via www.eric.org.uk for further advice and support.

Please access via www.bbuk.org.uk/children-young-people

Or contact our service for more support.

Night time wetting

Encourage your child to drink more throughout the day – at least 1.2 litres for 4-8 year olds, and 1.5 litres for those aged 9 and over
Avoid giving fizzy or caffeinated drinks to your child. Hot chocolate, orange and blackcurrant drinks have also been shown to irritate the bladder. Water is the best option for your child
Water bottles with time trackers and wobble watches can be helpful to remind your child to use the toilet and to drink throughout the day, as well as maintaining some independence
Encourage your child to use the toilet regularly throughout the day. You may need to liaise with his/ her school to ensure that your child can access the toilet
Your child may benefit from ‘double voiding’ – this is when they use the toilet, and when they think they are finished, they should count to 10 and try again to ensure they are fully emptying their bladder
Avoid the use of nappies or pull ups for a minimum of two consecutive nights
Ensure your child’s mattress is fully protected
Lifting is not recommended, however if you wish to do this, you must make sure that you vary the time and that your child is awake and walked to the toilet
Ensure the bathroom is accessible at night time
Ensure your child has a change of clothing when at school or out and about in case of accidents
Remember to reward your child for following these steps, even if they do not manage to have a dry night.