While it may seem a bit confusing at first, one of the most common reasons why kids experience bladder leaks (aka urinary incontinence) is because of constipation. Constipation occurs when not all of the poop leaves our bodies on a regular basis and poop starts to build up. This backup causes the rectum (that last part of our gut pathway before it leaves the body) to stretch. When a rectum is stretched it prevents it from being able to sense the urge to poop as it otherwise would and it makes it much much harder to know we have to go. Also, when the rectum stretches it starts to push towards the bladder. The bladder is not a fan of this added pressure. It can no longer fill with as much pee as it used to. When it is under pressure, the bladder is also much more likely to “panic”. It thinks it is more full than it actually is and causes the big muscle on the top of the bladder (the detrusor) to squeeze and push pee out when you don’t want it to.
For kids, it will seem as though your bladder has a mind of its own. Everything is nice and calm in bladder world, and then wham! You have to go right now, or worse, you ARE going right now. You may also notice a belly ache frequently throughout the week and your gas may smell worse than normal (and I mean extra deadly). As for pooping, it’s really important to keep a diary of when you go and what your poops look and feel like.
We have a handy chart with 7 types of poops we use to make keeping track of your poops easier. It’s called the “Bristol Stool Chart” and the type we want to see the most is type 4. When you’re constipated, you will likely see hard poops (type 1 and 2) frequently. Sometimes watery poop (type 6-7) will sneak through the cracks of the poop that is stuck inside your body too. Also keep track of when your poops hurt, if they are very wide and tend to clog the toilet, if you have to push hard to get the poop out, and if wiping is difficult. You may also notice streaks of poop in your underwear even if you felt like you wiped well. All of these findings are signs of constipation.
If your detective work shows that you are constipated, it’s important that we work on fixing this before we start working on the bladder leaks. The good news is that a lot of time the bladder leaks go away once we start pooping regularly! If we’re not 100% sure of whether your body is constipated, we can take pictures with an x-ray (we call these pictures “KUBs”) to see how much poop is backed up inside and how wide our rectum has stretched.
More good news! Pediatric pelvic health providers have lots of great strategies to get the constipation and the bladder leaks to stop. With a team effort from you, your family, and your pelvic health provider, you can reach the goal of having no leaks and easy poops!