Ten Signs of Constipation Every Potty Training Parent Should Know

Ten Signs of Constipation Every Potty Training Parent Should Know

Straining And Struggling

If I asked you to guess at the signs of constipation in little kids, you would probably mention straining on the potty, days between poops and tummy aches. Possibly also large hard poops or a few dense rabbit droppings.

These are all signs of constipation, but they're NOT the signs of chronic constipation that ring alarm bells for me.

When we think of constipation caused by potty training, this is the kind of constipation we imagine. We reason something along the lines of:

But chronic constipation isn't like that.

That kind of constipation can lead to chronic constipation, but chronic constipation itself comes with a completely different of symptoms.

In fact, you might not see any of the classic symptoms as your child becomes chronically constipated. You can move from frequent and easy potty use to severely constipated so smoothly that you never see it coming.

Your child might even have been chronically constipated before you started potty training.

What is Chronic Constipation?

When a child is chronically constipated, a mass of poop builds up in the rectum or colon, stretching the bowel. Fresh poo moving through the bowel gets trapped behind the blockage and 'builds up' filling and stretching the bowel behind the impaction.

When that soft poo finally squeezes around the blockage, some will stick to it, building the block like an internal stalagmite. The rest of the 'overflow' poo reaches the rectum very soft because it hasn't been processed into a solid stool.

Babies and children who potty train early are at risk of chronic constipation because their bowel control can exceed their social confidence. If they feel the urge to poo at a time when it's inconvenient to do so, they hold on.

But sometimes, if they hold on that bit too long, when they finally poo not everything comes out - and that can be the beginnings of a blockage - without any classic constipation warning signs. (It can also be the beginnings of a holding habit, and that's even harder to deal with.)

Uh-Oh, That Looks Familiar...

Chronic constipation often builds up 'invisibly' but there are signs that you should look out for in your ec'd / potty trained child. I've listed those that I learned from experience. Having battled chronic constipation in one of my children I now watch for these signs without even realising I'm doing it.

Here I've deconstructed what feels like instinct to work out exactly what triggers that sense of foreboding. These are the signs that cause alarm bells to ring in my head.

Disclaimers and "Don't Panic!" Warnings:
1) These are the signs that I personally look for. I'm not a medical doctor - this is personal experience.
2) Although I say constipation can build 'silently' that doesn't mean that your perfectly happy, healthy, regularly pooping toddler is ticking time bomb. If you don't see signs of a problem - there is no problem :) Please don't panic.
3) If you're looking at my list and wondering if a particular sign applies to you, then it probably doesn't! Give it a fortnight, try to remember to look out for it, and see what you think then.
4) Remember that full blown chronic constipation is a condition that builds over a long period of time. Some of these signs give me a vague unease, others make me take action and still others have me thinking 'Ugh! How did we end up here?!' I've included the signs that hint at trouble to come, as well as the 'if you find yourself here get help!' clangers. I'll try to make it clear which is which.

Recognising Constipation: What To Look Out For

1. Saying they need to poop, going and finding the potty, sitting down, but then not doing anything.

   If the 'false alarm' happens once, it's nothing. If it happens twice in a day, or twice in two days, or several times over a week, that's suspicious. Can you explain it? Is your child unwell? Are they getting confused in a toddler kind of way? If not... then maybe there's something else going on.

   If you've dealt with constipation before, assume you have the beginnings of a backup (i.e. stool backing up in the rectum/colon) and flush to be safe. If you've never been here before, keep an eye on it and see whether any of the flushing recommendations appeal to you.

   In the mean time, introduce regular 'sits' at bedtime or around your child's preferred time to go. If you've had a false alarm and your child hasn't pooped by bed time, sit them on the pot for a few minutes to give them a chance.

   Try not to give them anything too absorbing to do during this time. Read them a story. Let them play with their usual potty things. Don't resort to bribery with the ipad unless you have to because if they're too distracted they might not poop.

   Buuuuut... if the ipad is the only way to get them to sit and give their bowels a chance, use it. Getting the poop out trumps parenting technique when you're faced with possible constipation in a potty trained child.

2. Two-tone poops / dual consistency poops.

   If the start of the poop is hard and well formed, but the end is very soft or even sloppy - that can be an early warning sign.

   If you can see a hard section and there's obviously a soft section behind that has started to move past it in places - that can also be an early warning sign.

   Having said that, poo is going to depend on diet, so if you can immediately explain what you're seeing, that's just fine. Poop should be universally soft, yet formed, but every deviation isn't a disaster waiting to happen.

   (Remember, chronic constipation can lead to very soft poops all the time, so if every poo is a cowpat of soft poop, that might not be so good...)

   Keep an eye on your diet and watch for other signs. If in doubt, flush (because, really, there's no harm in a bit of extra fruit and water). If your child has a tendency towards constipation, flick that switch in your brain that puts you into 'monitoring mode'.

3. The stink.

   Yes, poo smells. But if it reeks so badly you want to puke, that's not a good sign.

   If your child's poop falls into this camp, you'll know it… and it will probably have been happening for some time. The odd smelly poo is neither here nor there, but every time - doctors office for you - you're beyond orange juice and watermelon.

4. Gritty soft poops or very sticky poop.

   If you see gritty piles of poo (especially if you're doing a DIY flush), that is not a good sign. If you see grit and it stinks... get thee to your doctor.

   Likewise stickiness. If you're scraping poo off the base of the potty, that's not good. If the smell means you're gagging while you're about it, that's not good at all.

   'Gritty' or 'sandy' poo it will be a normal kind of poo colour - maybe a bit darker - but will form more of a pile than a hotdog. The grit is bits of old poo washing off the big blockage. You won't see this kind of grit in the absense of other signs. If your child has eaten something that will produce granular poo - nuts maybe? - that's not what I'm talking about here.

5. Poop with girth.

   A child's poo should be about half the width of their wrist. If it's thicker than that, the bowel has stretched.

   You won't believe me that this is a serious enough symptom to start a cleanout, but it should be on your radar. At least go mad on the natural laxatives for a bit and encourage drinking water.

6. Varying quantities that you can't explain.

   If your toddler eats pretty consistently, but they don't poop consistently, take that as a warning and try to clean them out.

   Flush, flush flush - either from above or below.

   (Yes, you do need to monitor what is going in and what is coming out. Until you're actually in dire straights, you don't need to monitor this with precision, but you should be generally aware of what's going on. Pebbles one day and a potty filled with stinky slop the next: not good! Same sized smooth sided hot-dog poop every day: probably nothing to worry about here.)

7. Change of bowel movement timing or frequency.

   For example, if your child used to poo at 7am every morning like clockwork and they stop doing that, start to pay attention.

   Are they still pooping every day? Or does the odd day slip by without a poop? Has that once-a-day routine become once-every-two days? Are there particular days that go by without a poop? Nursery days? Grandparent days?

8. Unexpectedly pooping in pants.

   If your potty trained child suddenly has dirty underwear, pay attention.

   Even if it's just a liiiiitle bit - either soft or crumbly or skid marks.

   They're probably denying all knowledge of having done it. This is not laziness. It's physical. And they really don't have any idea that it's happened. Believe your child. Doctor's office for you.

   (If they're old enough to wipe themselves and you can explain it - relax. A sloppy poo that they didn't wipe properly. A hurried poo on the way out of the door so they barely wiped at all. Not a big deal. But if it's happens once a week. Then twice a week. Or there's too much poo for a wipe-gone-wrong. Or you have a history of this kind of thing. Then it's worth getting checked out.)

9. Change in self initiation.

   If your child always used to self initiate (independently sit on the potty to do their poo, or deliberately signal their need using speech or sign language) and now you mostly send them based on body language - you're probably noticing a holding behaviour.

   What happens if you don't send them when you see that holding behaviour? Do they wait 5 minutes then go by themselves? Or does the urge pass and not return for a few hours? If it's the latter, that is not a good sign. Book yourself in to the doctor (and know what to say when you get there).

10. Obvious holding.

    This is the kind of holding where you can tell your child is holding but they will deny it until they're blue in the face.

    Whether they're 30 months or 4 years old, if they've stopped what they're doing and focussed all their energy into trying to hold while swearing blind they don't need to wee or poo, and this happens every time, you have a problem.

    You might notice this in their mood if you don't pick up on classic holding behaviours (e.g. clenched bottom or frantic racing). If they've been a horror for hours but finally wee/poo and come off the potty a changed child - all delight and giggles - that can indicate a holding behaviour too. You'll recognise this pattern if it's been going on a while.

    Book in with your doctor.

Any signs related to wee?

Ah! You've noticed that these signs only relate to pooping.

There are also many signs related to peeing that can mean your child is invisibly constipated - and sometimes to an incredible degree. Night wetting, daytime accidents having previously been potty trained, urgency (no apparent warning and then suddenly a flood), frequency (forever needing to do a wee), recurring UTIs, holding while denying needing to go....

If you have any of these signs, you'd do well to make sure your child isn't backed up (i.e. chronically constipated) before you explore other possible causes.

Anything else

Reduced appetite (nowhere for the food to go because everything is moving so slowly in the gut), stomach aches, irritability (can be caused by the constipation or by the holding if you've got that going on as well).

Pop belly. If a child has a very large mass of poop growing inside them they can have quite the pop belly - but lots of toddlers are pot bellied and it has nothing to do with constipation, so this might be one to analyse with hindsight!

Nappy/Diaper rash. If your child doesn't wear nappies/diapers and suddenly has nappy rash - that might be related to chronic constipation. If very small quantities of poop leak out unexpectedly, they can cause irritation. Rubbing between the bum cheeks can cause redness and soreness, or the child might scratch themselves and end up with spots.

Getting The Right Help

If any of those sound familiar enough that you're about to call your doctor, make sure you read my doctor's appointment cheat sheet before you walk through the surgery door.

Knowing what to say at that first appointment can save you months of frustration and wasted time. (This cheatsheet is not about undermining your doctor or questioning their knowledge - but it is about understanding their recommendations and knowing how to get them to stand by their treatment plan. It can take months to successfully treat chronic constipation and you will want to be in this together - it's not like picking up antibiotics and never going back.)

Treatment often involves the long term use of laxatives and length of treatment is proportional to the time a child was constipated, so if you delay seeking help by 6 months, that might add 6 months to your laxative treatment time. Don't hang about.

Home Cleanouts: Flush Madly!

If you're at the 'suspicion' stage and don't think you need to get a doctor involved, there are two ways to treat mild constipation. The idea is to flush out the backup and keep the stool soft so that it's easy to pass every day.

1) Flush from above: with natural laxatives (lots of water plus pears, prunes, apples, pineapple, kiwi fruit, melon) or medical laxatives if you've been here before and are comfortable using them.

2) Flush from below: with glycerol suppositories to fix short term problems, or micro enemas to treat chronic problems. If you're familiar with these, you'll know which you prefer and why.

If you're not familiar with the different kinds of laxatives, suppositories or micro enemas, take a look at my doctor's office cheatsheet where I explain the different treatments for chronic constipation, encopresis and chronic holding. I also outline the pros and cons of each from a parent's perspective.