Constipation is tricky and not always as easy to detect as one would think. We have to be vigilant, because remember that constipation is the enemy! First, let’s talk about why constipation occurs. The food and drinks we consume travel through the digestive track to the last stop, the large intestine–also called the colon or bowel. The colon’s job is to convert our waste into stool by absorbing water from it. The colon squishes the stool downward toward the rectum, absorbing water the whole time. The problem comes when the colon doesn’t squish very well due to nerve damage. Stool sits in the colon far longer than it should, more and more water is dried up, and we are left with a colon full of hard stool.

Here’s a lovely chart that shows the different types of stool.

Here are some constipation signals that tip off us parents and adults with SB:

Stool consistency. As you see in the chart, balls of poop mean constipation every time. Also look for dark, grainy, mucousy, especially smelly, hard, or bloody stools.

No stool for more than 24 hours. We know that some babies/kids/adults don’t poop every day. But with SB, assume constipation until proven otherwise. It’s best to see a sizable bowel movement daily.

Distended/hard belly. It should feel soft and squishy (unless you have a six pack?).

Leaking urine. If you are usually continent or socially continent with meds/cathing, but you’re having accidents, first assume either UTI or constipation. For babies and little kids, if they are soaking through diapers way before that should be possible, it’s very likely constipation. Others say urine retention is a problem when backed up. What’s clear is that when the colon is full, it presses on the bladder and causes problems there too.

Loss of appetite/nausea/vomiting. When the colon is so backed up, there’s nowhere else for food to go. (Note: If someone vomits something that looks like poop, go to the emergency room immediately.)

Multiple bowel movements daily. Many people assume this means they are emptying “too well,” but in actuality it probably means they are full of stool. It’s just getting pushed out in little bits at a time. “Skid marks” can also be a sign of constipation, when only loose stool can seep down past a blockage.

Slow Transit Times. You can do what we call a “corn test” or “poor man’s motility test” by looking in the stool to see how long it takes for food to pass through the body. Corn is a great tool for this because it’s easily seen in stool. Others are blueberries, broccoli, and blue, purple and green dyes. Ideally, you’ll see food come out about 24-36 hours later.

Diarrhea. It seems counter intuitive, but sometimes all that can get past a blockage is liquid stool.

Urinary Tract Infection. UTI’s can happen because the colon is pressing on the bladder, which then cannot do it’s job well. Or it can occur due to the resulting blowout after a bout of constipation that gets bacteria in every nook and cranny. If someone is experiencing repeated UTI’s, do consider whether constipation is a contributing factor. Many people see a dramatic decrease in UTI’s after starting a bowel program.

Shunt Malfunction. Many shunt malfunctions are due to constipation. If you start seeing slight signs of a malfunction, you may consider the last good poop you saw and start working on solving the constipation problem to see if that helps. (And obviously consult with your neurosurgeon and take appropriate measures.) A clean out can sometimes prevent a surgery.

Bowel program problems. Even when someone is on a bowel program, constipation can still sneak up. Watch out for cramping and vomiting with enemas, less or no output with enemas, water coming out around the cone enema, or leaking from the MACE stoma.

Sometimes the only way to know for sure if a person is constipated is to ask for a belly X-ray. Your doctor should be able to tell if it’s constipation, but if you get a chance to take a look, remember that gray stuff is poop, black is air. Those X-rays are pretty fascinating.

Next: Clean Outs