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Column originally published Aug 7, 2012

Constipation And Urinary Retention

Question: Last week, our six-year-old daughter suddenly couldn’t pee. She always pees before going to bed; but that night, after trying for 5 minutes, she couldn’t pee. She did go to bed and fell asleep. The next morning, she woke up in distress and still couldn’t pee. We gave her some juice, thinking that this would help, but it didn’t. Her belly was obviously swollen. We were scared, and took her to emergency room. The nurses scanned her belly, and found that she had over 600 ml of urine in her bladder. Because of her discomfort, they put in a urine catheter and drained over 400 ml of urine. After a lot of questions, the doctor said that constipation was the cause of her problem. We were thinking of something far worse, and it was a great relief. We have always known that her bowels were irregular and she has constipation, but we never anticipated that this could obstruct her bladder. Is it really possible?


The doctor in the emergency room was correct. Severe constipation can cause urinary retention (difficulty in passing urine), with all the symptoms that you have described, as well as a few other problems that many are unaware of.

Let me begin by explaining how stool is formed in the first place. After food is swallowed and entered the stomach, digestion begins with stomach acid and many kinds of digestive enzymes secreted by our pancreas and small intestine. Nutrients from the food, including carbohydrate, proteins, fat, minerals, and all kinds of vitamins are absorbed into the body through the small intestine.

Those things that cannot be digested or absorbed, especially the bulk and fiber in fruits and vegetables, pass into the large intestine to become stool. When stool is first formed, it has a lot of water content and is very loose. As the stool passes through the the large intestine, water is gradually absorbed so that by the time it gets to the rectum (the area just above the anus), there is only a fraction of the water left.

This is how our body uses and conserves water. When we eat, there is always some water in our food. Depending on how much water and other liquids that we drink, our body has a very intelligent and efficient system to make sure there is enough water in our body to keep us healthy. If we drink lots of fluid, we produce a lot of urine which should be light in colour, and less water will be absorbed in the large intestine. If we are not drinking enough fluid for the body’s need, our kidneys will absorb as much water as possible and our urine will be concentrated. At the same time, the large intestines will try to absorb most of the water from the stool that is being formed. As a result, the stool will become more firm and solid.

It is important to remember that we need water for the body to function properly. Water evaporates from the skin in the form of sweat, and it is also lost from our lungs through every breath. There is no fixed amount of water that we need to drink every day; eight glasses of water a day is just a myth. However, if we are thirsty, we need to drink. Some people like to drink milk, but we don’t need excessive amount of milk to have a healthy body. We also don’t need to drink juice; it is regarded as empty calorie with a lot of natural sugars. Soft drinks should be used as treats only, and should not be something that we drink frequently. Water is what our body needs, nothing more, nothing less.

In order to have good bowel movements and prevent constipation, we need to eat good amount of fruits and vegetables, which provide us with lots of essential vitamins, anti- oxidants, natural sugars, as well as fiber and bulk that form the majority of our stool. Without fruits and vegetables, the amount of stool that is produced every day will be less, and frequency of bowel movements will decrease. Too much dairy, especially cheese, can slow down the movement of stool through the large intestine. As a result, there is more time for water to be absorbed from the stool, leading to larger and harder bowel movements — the essence of constipation.

Constipation can creep up on parents without warning. Many children become picky eaters and prefer treats instead of fruits and vegetables. Many love the taste of cheese, and may not drink enough water and other fluids. Once they feel the pain and discomfort associated with the passage of constipated stool, they will hold the bowel movement as long as a little bit of stool is passed, and they feel the relief of pressure in the rectum. Over time, more and more stool gets piled up inside the large intestine.

The most common symptom of constipation is pain. When the hard stool passes through the anus, it can cause a tear and bleeding. Occasionally, loose stool can leak around a large piece of hard stool in the rectum. When the child passes gas, this liquid stool can leak out. This is a very distressing problem because it can stain their underwear.

When enough stool is packed in the rectum, it can block the bladder outlet, and lead to urinary retention that your daughter recently experienced. Although this is not a common problem, we do see that from time to time. Treating the constipation will cure the problem.

I hope you understand the process that led to your daughter’s recent visit to emergency room. It may be necessary to use laxatives and enemas to relief constipation for the short term. However, long-term treatment, including fruits and vegetables, as well as lots of water, is absolutely necessary.