Constipation in children is a very common problem.
Physiotherapy techniques for overcoming constipation in children and toddlers include practical positioning for bowel emptying and the brace and bulge1 “Moo to Poop” technique.
This Physiotherapy video outlines the practical ways to help your toddler or child overcome constipation and empty their bowel completely without straining.
Scroll down for more information below this video.
Timestamps for Constipation in Children Video
0:42 Correct setup for bowel movements
1:54 Positioning for bowel emptying in kids
3:34 Moo to Poop remedy for constipation in kids
5:38 Best times to use this practical constipation remedy
Setup to Remedy Constipation in Children
Children and toddlers can be fearful of falling into adult toilets or becoming stuck in the toilet seat. As a result they brace and support their body with their arms as shown below.
This bracing action can cause them to contract their abdominal and pelvic floor muscles to stop themselves falling into the toilet. Constipation and incomplete bowel emptying can result simply from poor set up and positioning.
There are 2 key set up strategies to implement to facilitate bowel emptying in children.
A. Toilet Seat Insert or Potty
Use an insert for the toilet seat for older children (shown above). A seat allows the child or toddler to sit and relax their muscles rather than being fearful of falling.
Use a potty for constipation in toddlers (shown above). Sitting on a potty allows the toddler to feel safe and relax their pelvic floor muscles and empty their bowel.
B. Foot Support
Good stable foot support is essential for bowel emptying and overcoming constipation in children. The child’s feet hang in the air unsupported when sitting on an adult toilet seat. This is an unnatural position for bowel emptying compared with the natural squatting position and the child’s abdominal and pelvic floor muscles can’t relax when the feet are unsupported.
Use an over the seat ladder (shown above), footstool or potty to provide the child or toddler with a firm base of support underfoot to promote complete bowel emptying.
Toilet Positioning and Posture for Constipation in Children
Encourage the child or toddler to use the correct bowel emptying position shown below.
The correct bowel emptying position involves:
- Sitting upright with both hands or elbows on the thighs supporting the trunk.
- Discouraging the child from leaning too far forward during bowel emptying
- Sitting with a straight back and leaning slightly forward.
This positioning allows the correct dynamics (technique) for successful bowel emptying without straining.
Moo to Poop Technique for Constipation in Kids
Physiotherapy techniques for overcoming constipation in children and toddlers include practical positioning and the brace and bulge1 “Moo to Poop” technique can be taught to your child as follows. Ensure that the child eats stool softener foods in their diet to promote a soft, well formed stool.
How to play the moo to poop game with your child
1. Start out by encouraging the child to take 2-3 deep breaths and watch for their belly to move forward to promote pelvic floor relaxation.
2. Ask the child to say “Mmmm” which uses the muscles that wrap around the waist. These muscles generate pressure within the abdomen for bowel movements and avoiding straining.
3. Say “Oooo” to bulge the tummy forwards which relaxes the anal sphincter for bowel emptying.
4. Say “Mmmm” to push again if further pushing is required.
Never encourage the child to push down through the anus to empty their bowel. Doing this can stretch and strain the pelvic floor and create poor emptying patterns long-term.
Best times of the day for Bowel Emptying in Toddlers and Children
- Immediately following a meal (eating stimulates the bowel)
- When the child demonstrates the need to empty the bowel
- Provide the child with a reward for successful bowel emptying
- Allow 3-5 minutes maximum sitting time on the toilet for children (and for adult bowel emptying) to reduce the risk of pelvic floor strain.
Markwell, S. Physical therapy management of pelvi/perineal and perianal pain syndromes. World J Urol 19, 194–199 (2001). https://doi.org/10.1007/PL00007097