Sometimes the first sign of constipation in a child can be that they begin wetting themselves after being toilet trained successfully, or faecal smearing, “skid marks” in their underwear.
What is Constipation and Why do I Need to Address it?
Constipation is a common childhood condition and can sometimes present in unexpected ways. For some children, the first sign of constipation may be new episodes of wetting after they have already been successfully toilet trained, or faecal smearing (“skid marks”) in their underwear. These symptoms can be distressing for both children and parents, but they are often a sign of an underlying bowel issue rather than behavioural problems.
Parents may find it helpful to explore related concerns in our article on poo problems in children.
What Is Constipation and Why Does It Need to Be Addressed?
Constipation occurs when bowel motions become infrequent, difficult, or painful to pass. It is estimated that up to 25% of children experience constipation at some point during childhood.
When a child is constipated, stools often become hard, dry, and difficult to pass. They may appear as small pellets or be passed in small amounts. Children may experience tummy pain or bloating, cramping or discomfort, painful straining when trying to poo, spending long periods on the toilet with little result, and a feeling of incomplete emptying. Faecal smearing or soiling of underwear is also common.
Soiling often occurs when softer stool leaks around a large, hard stool that has become impacted in the bowel. This is known as overflow soiling and is explained further in our information on faecal incontinence. Importantly, this is not something a child can control.
What Is “Normal” Bowel Function in Children?
Normal bowel frequency can vary widely. For children, passing a bowel motion anywhere between three times a day and three times a week can be considered normal.
Because every child’s digestive system is different, frequency alone does not determine constipation. To accurately assess bowel health, we need to consider stool consistency, pain or straining, time spent on the toilet, changes in routine, diet or fluid intake, and behavioural patterns around toileting.
Establishing good bowel habits early in life plays a key role in long-term bowel and bladder health.
Constipation and Urinary Incontinence in Children
Constipation can significantly affect bladder function and continence. In some children, wetting accidents or urinary urgency may be directly linked to an overloaded bowel.
When the rectum becomes full of hard, impacted stool, it can press against the bladder, reducing the bladder’s ability to expand and hold urine. This pressure may contribute to frequent urination, urgency, daytime wetting, and night-time bedwetting.
You can learn more about this relationship by reading our articles on daytime wetting in children and bed wetting (nocturnal enuresis). In many cases, effectively managing constipation leads to a significant improvement in bladder symptoms.
How Pelvic Physiotherapy Can Help
At Sydney Pelvic Clinic, our specialist pelvic health physiotherapists provide evidence-based assessment and treatment for childhood constipation and continence concerns.
Pelvic physiotherapy may include a comprehensive history to understand bowel and bladder habits, abdominal assessment, and real-time ultrasound assessment of the bladder and rectum. We provide education for parents around constipation management, including diet, hydration, massage techniques, and establishing consistent routines.
We also work directly with children, teaching them how to relax their pelvic floor muscles, particularly when an overactive pelvic floor is contributing to difficulty emptying the bowel. Correct toilet posture and positioning are addressed, and a structured, supportive toileting program is developed.
In some cases, we collaborate with GPs or paediatricians, and laxatives may be recommended when appropriate. For best outcomes, toileting programs are typically followed for six to twelve months, allowing the bowel and bladder time to recover and function normally.
You may also find it helpful to explore our Children’s Health services for an overview of paediatric pelvic health care.
A Supportive Approach Matters
Children should never be punished for accidents. Constipation-related soiling and wetting are not behavioural choices. Positive reinforcement, reassurance, and encouragement are essential for building confidence and supporting long-term success.
With the right education, compassionate care, and professional support, children can regain comfort, confidence, and control.
If you’re concerned about your child’s bowel or bladder health, you can book an appointment online to speak with one of our experienced pelvic health physiotherapists.
