As paediatricians, we often hear from concerned parents that their child is not pooing every day. They worry that not having a bowel movement every day means that their child is constipated. Our colleagues who take care of older patients tell us that adults have the same concerns. What are you worried about? Do you secretly fear that your bowels might explode? Or that you will be bunged up for ever if you go too long without going to the loo? You are not alone. When you research bowel health on the web, you can find plenty of people who recommend the importance of moving your bowels at least once a day.
This is only a half-truth at best. While pooing regularly does prevent the discomfort and potential complications of constipation, you will be just fine if you don’t move your bowels every day. A doctor will not define your problem as constipation until you have fewer than three stools a week.
How do we define constipation in adults? Get ready, because this may be more than you ever wanted to know about how much you need to defecate. Doctors say that you have chronic constipation if you have two or more of the following problems for at least twelve weeks of the year: you strain for at least 25 per cent of your bowel movements; you have lumpy or hard stools for at least 25 per cent of bowel movements; you don’t feel like you have completely emptied out your bowels at least 25 per cent of the time when you defecate; you feel like your bowels are blocked up at least 25 per cent of the time when you defecate; you have to use your fingers to get the stool out at least 25 per cent of the time; and finally, you have fewer than three stools a week.
What about children, you ask? Surely doctors must want babies to poo more often. Actually, even small babies don’t need to poo every day. Babies who poo only a few times a week could be just fine. How do we define constipation for a child? There are lots of medical groups that have come up with definitions. One of these definitions is known as the ROME 2 criteria for children, and they say that children with chronic constipation have at least two of these indicators: (1) at least two weeks of having a pebble-like, hard stool for the majority of their stools; (2) firm stools two times or fewer per week; and (3) no other bowel diseases. Another definition comes from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition group: kids are constipated when they delay or have difficulty in defecation for two weeks or more, and this is significant enough to cause the child distress. A final definition is known as the Paris consensus, and it defines constipation as two of the following experiences for a period of eight weeks: defecating fewer than three times a week; losing bowel control because of constipation and leaking more than once a week; passing large stools that clog the toilet; having a stool you can feel in the belly by pressing on the stomach; intentionally withholding poo or not wanting to defecate; or experiencing pain when pooing.
If you or your child meets one of these definitions, you should, of course, talk to your doctor. But clearly none of the experts are worried if you don’t move your bowels every day.