Does Constipation Cause Urinary Tract Infection and Reflux?

The rectum and bladder lie side by side in the pelvis, separated only by a thin layer of tissue. A rectum that is distended and full of hard stool compresses the bladder from the front and above; the bladder holds less urine, gives an earlier sensation of fullness, and cannot empty completely at the end of voiding.

Constipation is not just 'infrequent bowel movements.' A child who has a bowel movement every day can still be constipated if they cannot fully empty the rectum or if their stool is hard and painful. For this reason, physicians look at a set of criteria rather than stool frequency alone.

• Two or fewer bowel movements per week
• At least one episode of fecal incontinence or soiling of the underwear per week
• Stool-withholding behavior: crossing the legs, stiffening, hiding
• History of painful or hard bowel movements
• A large fecal mass in the rectum
• Stool of a diameter large enough to clog the toilet

Constipation treatment has two phases, and the second is often neglected. The first phase is emptying the hard stool that has accumulated in the rectum (disimpaction); the second phase is maintenance treatment, continued for months, to let the rectum return to its normal diameter and its sensory threshold recover.

Medication alone is not enough; if habits do not change, its effect is not lasting. At the same time, diet and behavioral changes alone will not resolve severe constipation either; the two go together.

• 5–10 minutes of toilet sitting after meals, with foot support
• Regular water throughout the day; fluids are not skipped at breakfast or at school
• Vegetables, fruit, legumes, and whole grains; watch the daily amount of milk
• Recording stool consistency and frequency on a simple chart
• Not stopping the medication without the physician's instruction