Bowel Management Program Improves Urinary Symptoms Associated with Pediatric Functional Constipation

Bowel Management Program Improves Urinary Symptoms Associated with Pediatric Functional Constipation 150 150 JoAnna Pendergrass, DVM

A one-week bowel management program can significantly improve urinary symptoms in children with functional constipation, possibly eliminating the need for extensive urologic testing.

Molly Fuchs, MD, a urologist at Nationwide Children’s Hospital, and her research team recently demonstrated that a bowel management program (BMP) significantly improved urinary symptoms in children with functional constipation.

Functional constipation is a common pediatric condition characterized by impaired storage and emptying of feces, with no underlying anatomical or structural anorectal malformation. In addition to causing fecal incontinence, the fecal accumulation places mechanical pressure on the bladder, leading to urinary issues such as urine urgency, frequency, accidents and even recurrent urinary tract infections.

Concomitant lower urinary tract symptoms and constipation are collectively known as bowel and bladder dysfunction (BBD).

Urinary problems are a common presenting complaint for constipation. However, notes Dr. Fuchs, children with functional constipation may go years with infrequent stooling and often remain unbothered by their symptoms until they develop urinary or fecal accidents. These accidents can have profound psychosocial effects, including bullying, teasing, and social withdrawal.

Families of patients with functional constipation often do not seek medical help until accidents occur.

“Unfortunately, by this time, the constipation has often been present for years and the new urinary symptoms feel like an urgent crisis for the family,” she says, “creating a difficult situation for the clinician because BBD treatment requires time and consistency to resolve symptoms.”

A one-week BMP is recommended for children whose constipation and fecal incontinence have not been resolved with standard medical therapy. BMPs are individualized and include dietary changes, oral laxatives and rectal enemas.

Until this current study, the effectiveness of a BMP in improving urinary symptoms in children with functional constipation had not been evaluated. Study results were published in Pediatric Surgery International.

“This study highlighted that urinary and bowel symptoms are intimately related,” says Dr. Fuchs.

Dr. Fuchs and her research team conducted a single-center, retrospective study of 241 patients aged 3 to 18 years with functional constipation. The patients received BMP therapy at Nationwide Children’s from April 2014 to August 2020.

The research team evaluated improvement in urinary symptoms by having the patients’ parents complete three patient-reported outcomes measures: Vancouver Symptom Score for Dysfunctional Elimination Syndrome (VSS), Baylor Continence Scale (BCS) and Cleveland Clinic Constipation Score (CCCS).

Questionnaires were completed before the BMP and 1 and 3 months after the BMP.

VSS is used to diagnose BBD in children and assess urinary incontinence. BCS measures social continence in children with surgically-corrected anatomic anorectal malformations. CCCS, currently validated only for adults, assesses constipation severity. For each scoring system, symptom severity increases with the score.

Most study patients (91%) were potty trained. Thirty-four percent of the patients had at least one behavioral disorder, such as ADHD or autism. “Behavioral problems can cause functional constipation,” explains Dr. Fuchs.

Approximately 72% of patients received one BMP, with the remaining patients receiving 2 to 4 BMPs.

Patients undergoing one BMP had significantly improved scores in each scoring system. Those undergoing more than one BMP had significant improvements in VSS and CCCS but not BCS.

Multivariate statistical analysis revealed that BMP significantly improved VSS, BCS and CCCS.

In the publication, the researchers suggested that future studies analyze the long-term effects of BMPs in patients with functional constipation.

For patients with urinary symptoms such as urgency and accidents, Dr. Fuchs advises working up these patients for constipation. “If the constipation can be managed,” she says, “urinary symptoms often improve, avoiding unnecessary urinary testing and allowing for resolution of the underlying problem, rather than just treating symptoms.”



Knaus ME, Ahmad H, Bourgeois T, Dajusta DG, Wood RJ, Fuchs ME. Improvement in bladder function in children with functional constipation after a bowel management program. Pediatric Surgery International. 2022 Oct;38(10):1473-1479.



About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.