Think you understand constipation—and how to fix it—when it comes to your kids? You may be surprised.
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Toddler on potty
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For something that's so incredibly common (it's a top cause of belly pain in kids!), constipation is also misunderstood, says Dr. Steven Hodges, a pediatric urologist at Wake Forest University School of Medicine and the coauthor of It's No Accident and Bedwetting and Accidents Aren't Your Fault. If you think constipation is a pretty minor problem—and that eating more fruits and veggies can usually take care of it—you need to check out these four common misconceptions (and the must-know facts):

Myth: Constipation is no big deal.

Truth: Most everyone experiences constipation from time to time, and it's not always serious. But constipation can also become chronic. When it does, a child's rectum can become packed, and a large, hard mass can form, explains Dr. Hodges. That's not only uncomfortable, but it also stretches out the rectum and presses against and aggravates the bladder—which in turn can cause an intense urge to pee and trigger bedwetting and daytime wetting accidents. Over time, a stretched rectum also can lose tone and sensation, causing poop accidents. "Chronic constipation is also the major cause of recurrent urinary tract infections in young girls," he adds.

Myth: You'll know when your child is constipated.

Truth: Plenty of parents don't realize their child is constipated and may even have a serious, chronic problem. "I X-ray my patients who present with bedwetting or accidents, and more than 90 percent are shown to be severely constipated. Yet only about five percent of parents realize it," says Dr. Hodges, who adds that even many pediatricians miss it. Check out his fact sheet, "12 Signs Your Child is Constipated."

Myth: Kids who poop every day aren't constipated.

Truth: Kids should go every day--but even kids who poop daily can be constipated because they don't fully empty. Turns out, the size and consistency matter more than the frequency, says Dr. Hodges, who notes that the biggest red flags of constipation are extremely large poops and poops shaped like pellets or logs. Get a free "How's Your Poop?" download with illustrations that will help you and your kids spot constipation.

Myth: Eating more fiber will relieve constipation.

Truth: It's true that fiber can naturally keep the system running smoothly. And the typical Western diet (for kids, think chicken nuggets, pizza, and mac-n-cheese) is way too low in it. But although getting more fiber-rich foods is a healthy step for anyone to take, adding more fiber doesn't always fix constipation. "When a child is constipated to the point of having persistent discomfort or accidents, a dietary overhaul isn't enough," says Dr. Hodges. For chronically constipated children who don't have accidents, a daily osmotic laxative (like Miralax or lactulose) can help. For children who have accidents, Dr. Hodges recommends a regimen combining laxatives with enemas (laxatives keep poop soft while enemas clear out the rectum and allow it to shrink back to size). Talk to your child's doctor, and read Dr. Hodges' advice on treating constipation for more details.

Sally Kuzemchak, MS, RD, is a registered dietitian, educator, and mom of two who blogs at Real Mom Nutrition. You can follow her on Facebook, Twitter, Pinterest, and Instagram. She collaborated with Cooking Light on Dinnertime Survival Guide, a cookbook for busy families. In her spare time, she loads and unloads the dishwasher. Then loads it again.