Alrighty.

I know it's been a while since I posted. Forgive me! But BIG things are happening in our little family, and we're expecting our first little one this fall! We're first time parents, and there's a lot going on. We're doing lots of reading, preparing, and most importantly prioritizing – our family comes first, and lately, our family has needed a bit more attention. Thanks for your patience!

So now for the bowel and bladder thoughts…

Lately I've been doing a lot of talking about urine leaks in my day to day practice. Many parents insist that their child has difficult staying clean and dry to urine, but no difficulty pooping. Please let me be clear when I say, that often the perception is that the bowel habits are 'fine,' when in reality those bowel habits are insufficient for that particular person. Urinary leaks largely occur due to constipation, and so when a family tells me their child struggles only with urinary leaks, I never dive right into urinary questions and skip bowel related items.

This is where many parents put up their hands and won't listen to anything further related to the topic. But please, hear me out.

The rectum is the storage facility for stool. It does stretch and can accommodate larger stool burdens. Think about the largest bowel movement you've had – the rectum does stretch to be able to hold this larger poop! So, we know that the rectum stretches. What you also need to know is that the rectum is very near the bladder. So, if the rectum stretches to a large capacity on a regular basis, as it does in constipation, what do you think happens to the bladder?

It gets squuiiiiissshed.

And a squished bladder means the volume of urine inside is more likely to get pushed out, and leak. Especially when a kiddo is jumping, running or playing, when gravity and that activity help the urine escape through the urethra and the strength of the pelvic floor muscles.

So how do we know if a person is evacuating their bowels appropriately? Here are some questions that can give you a good idea…

The rectum is about the size/volume of your own individual fist. So, does your child have poops that are about the volume of their own fist? If their bowel movements are typically smaller, that is an indication they may not be evacuating everything.

• Does your child strain, hold their breath, tense their body up, or perform "toilet Olympics" with lots of movements?
• Does your child have pain before, during or after a bowel movement?
• Does your child ever have abdominal pain?
• Does your child ever have poop smears in their underwear? A full bowel movement? Just a "smear?" Just a color stain?
• Does your child ever demonstrate signs of withholding such as sitting on their foot or feet? Raising up on tiptoes for an extended period of time (think 5-10 seconds)? Hiding and sustaining any position for a period of time?
• Does your child leak poop only at night?
• Does your child have any symptoms (belly pain, behavioral changes, decreased appetite) that resolve after they have a poop?

If you answered yes to ANY of these questions, your child may be insufficiently emptying their bowels. They may be pooping on a regular basis, but a "yes" to any of these questions indicates they may not be getting a sufficient amount of stool that their body needs evacuated on a regular basis. Up to three bowel movements per day is within the 'normal' range. So you really can't compare any person to another when it comes to the number of bowel movements they have. One sibling may need to poop every other day, while their sibling needs to poop 2-3 times per day – even though they may typically eat the same foods at the same time of day! Our bodies are very unique, including our bowel habits!

If your child has had some symptoms that you haven't been able to figure out where they are coming from, consider these questions. Their bodies may be deceiving you, and they may need to be pooping more! So, before you completely attack the urologist with questions, and wonder why your child can't stay dry to urine, make SURE – I'm talking 100% – that your child isn't any magnitude of constipated! If they are, you can address the urine system all you want, but it very likely won't improve, unless you address the bowels and poop first!

Dr. Keller hopes that through this site, conversation, and community, kids and their families can experience positive progress towards improved health. See the 'about me' section for more about Dr. Keller!