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Constipation can present in many different ways. There’s an easily Google-able chart called the Bristol Stool Chart. You can use this to compare what your child’s stools look like compared to that chart. If they are type one to three, you should generally worry about constipation. These will range from small, hard pebbles to large stools with lots of lumps in them. And this can confuse people because when they have small, hard pebbles, often they will go to the bathroom every day. So parents think, “Oh, you can’t be constipated. You’re going.” Again, it’s really more about the consistency and the texture that you’re looking at. The other thing that can happen is sometimes you have, like I said before, normal texture stools, but they’re very large and they clog the toilet. And this happens because the colon has gotten stretched out, like we talked about. What’s even more confusing is that you’ll see alternating patterns.
So sometimes kids will have a hard stool. They’ll pass that and then they’ll have a bunch of diarrhea. And this happens because after you pass the hard stool, there’s a big space and there’s a rush of fluid that comes down. And so you end up having a loose stool afterwards. And this confuses people because they think, “Oh, it can’t be constipation. It’s an alternating hard and soft,” but that’s actually a pretty common pattern. Another thing that’s somewhat difficult that can occur if you have really bad chronic constipation is something called oncoparesis. What this is is that you form those little hard balls or pebbles. And when liquid stool comes down, because what’s flowing through our intestines is liquid until almost the very end, it can actually just flow around that and leak out, which is a little bit icky, but something that does happen unfortunately to a fair amount of kids.
