How'd you score? Here's an explanation of the answers.

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1. A, B, C and D.

XXL stools, skid marks, rabbit pellets, and the urgent need to pee are all signs of constipation. For a more comprehensive list of the common signs, download our free infographic, "12 Signs Your Child is Constipated," available on our free Downloads.

 

2. C and D.

Abdominal x-ray and anorectal manometry are both reliable methods of detecting constipation whereas

two methods commonly used by pediatricians — feeling a child’s belly and asking about the child’s pooping frequency — are highly unreliable.

 

A tiny, wiry body can harbor a huge mass of hardened stool that a doctor can’t feel, and many severely constipated children poop every day, as I explain in Even Severe Constipation Goes Undiagnosed in Bedwetting Children. Here’s Why. For these reasons, I x-ray all my enuresis patients. I discuss the safety and benefits of x-raying for constipation in The M.O.P. Anthology. It is helpful to measure the child’s rectal diameter. A measurement exceeding 3 cm indicates constipation.

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Anorectal manometry is an even more precise, though more invasive, way of detecting constipation, by measuring how stretched the rectum is. A balloon is inserted into the child’s anus and then gradually inflated while a machine records the rectal contractions. In chronically constipated children, the rectum is so stretched out and floppy that the child may not be able to sense the balloon even when it’s fully inflated. Anorectal manometry was used by Dr. Sean O’Regan in the studies that provided the basis for the Modified O’Regan Protocol.

 

3. A.

Children should poop every day. It is a myth that pooping every few days is “normal” for some kids. Every person who eats every day should poop every day. After all, any day that a child does not poop is a day that stool piles up in the rectum. Eventually, if enough stool accumulates, the child may experience pooping and/or peeing problems.

 

4. D.

Pooping multiple times a day is a red flag for constipation — not a sign of “regularity.” It means the child is not fully emptying when he or she poops. In the M.O.P. Anthology I explain why many kids have trouble fully evacuating.

 

5. A, C, and D.

A child has an elevated risk of becoming chronically constipated if the child toilet trains before age 2, has a family history of constipation, and/or eats a highly processed diet. I find that a child's temperament plays a large role, too — perhaps more so than the child's diet. Many children with stellar eating habits nonetheless become chronically constipated, even before they start toilet training. It’s important for parents to be aware of the signs of constipation and treat this condition early and aggressively.

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Parents who train their children at a young age — to meet preschool deadlines, to save landfills from diapers, or because other cultures train early — should know there can be serious repercussions, as I explain in The Pre-M.O.P. Plan: How to Resolve Constipation in Babies and Toddlers.

 

Many children who train “late” (after age 3) do have high rates of constipation, but that is because they were already constipated when training began, as explained in Children Toilet Trained Before Age 2 Have Triple the Risk of Wetting Problems as well as The Problem With Preschool Potty Deadlines.

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6: A, B, C and D.

Chronic constipation can lead to bedwetting, daytime pee accidents, poop accidents, and chronic urinary tract infections.

 

In fact, chronic constipation is almost always the root cause these conditions. (There are a handful of medical conditions that trigger wetting in the absence of constipation, but these are extremely rare, as I explain in the M.O.P. Anthology.)

 

When a child regularly delays pooping, stool piles up in and stretches the rectum, which, in turn, presses against and aggravates the bladder nerves. If the child's bladder is sensitive enough, this will lead to enuresis (daytime and/or nighttime wetting). In the case of encopresis, the rectum can become so stretched and floppy that it loses tone and sensation and stool just falls out of the child’s bottom, without the child even noticing. The constipation-UTI connection is explained in Why 1 Million Girls a Year Get UTIs.

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7: B, C, and D.

Poop shaped like cow patties, thin snakes, or a frozen yogurt swirl suggest a child is not constipated (although in some cases, soft poop can ooze around a hardened rectal mass, so you can't rule out constipation simply based on the consistency of a child's stool).

 

There's no such thing as "nice" big log — firm logs are a sign of constipation. A child who has watery diarrhea may also be constipated; it may mean the child has a hardened mass of stool in the rectum and all that’s coming out is watery stool that oozes by the mass.

 

Our free How’s Your Poop? chart offers helpful visuals! Thumbs-up poop: thin snakes, mushy blobs, frozen yogurt; thumbs-down: rabbit pellets, logs, turkey sausages.

 

8: A, B an D.  

In a chronically constipated child, the rectum stretches and commonly loses tone and or sensation, and the bladder nerves may become aggravated.

 

However, while stool can accumulate in other parts of the colon, the stretching and loss of sensation is typically confined to the rectum.

 

9: B.

Toilet training too late is not a cause of constipation.

 

While toilet training before the child is ready can cause constipation, there is no such thing as “toilet training too late.” When a child has difficulty toilet training, parents are often blamed for “waiting too long,” but the waiting isn’t the problem; it’s the fact that the child was already constipated.

 

In the population as a whole, high rates of childhood constipation are linked with a highly processed diet. However, many individual cases can be linked to early toilet training, a genetic and/or temperamental predisposition toward constipation, and restrictive school restroom policies, as I discuss in Why Is Your Child Constipated? Because We Live in the 21st Century.

 

In a small minority of children, dairy intolerance can contribute as well.

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10. A, B, C, an D.

Stomach ache, frequent peeing, hiding to poop, and chronic urinary tract infections are all red flags for constipation. 

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Further reading: The Real Reason Some Kids Pee All the Time (No, Not to Get Attention), Why 1 Million Girls a Year Get UTIs,

12 Signs a Child is Constipated.