Constipation in Pediatrics

Constipation in children is very common—research shows that about 1 in 20 pediatrician visits relate to constipation. It often begins around major life transitions, such as starting solid foods, potty training, or beginning school. Many parents may not realize their child is constipated because the child is still passing stool occasionally, and sometimes the stool remains soft.

Red flags for constipation include passing stool fewer than twice a week, but can also involve pain during bowel movements, holding their breath and straining to poop, frequent abdominal pain, or leaking feces.

Pediatric constipation is typically treated with a combined approach involving both medical providers—such as pediatricians or gastroenterologists—and pelvic floor occupational or physical therapists. This teamwork is important because medical providers can manage medications to help soften stools and make them easier to pass, while pelvic floor therapists work on muscle coordination to reduce pain during bowel movements.

Sometimes, when pooping has become painful, children develop a fear of passing stool. They may stand upright, lie flat, or squeeze their rear muscles tightly, avoiding the squat position because they fear passing large, hard, or painful stool.

After months of irregular bowel movements, the nerves and muscles in the child’s digestive tract can become less effective at moving stool through and instead become better at storing it. Since this change happens gradually, treatment also requires time and involves lifestyle and dietary changes, increased awareness of bodily signals for needing to poop, and muscle coordination exercises to ensure full stool elimination.

Therapists can support families at any stage of this journey—both when starting treatment and when medical providers have cleared the child to begin weaning off medication. Sometimes, complementary techniques like cupping or abdominal massage can be helpful alongside muscle-based therapy to support bowel motility.