It’s an oddly dignified question, from a chiropractor to a paediatric practice member: “Tell me about your poo”. And don’t kids love an excuse to talk about such things? But toileting is a big indicator of gastrointestinal function and nervous system function alike. It’s also a common childhood issue. Constipation is one of the most common gastrointestinal complaints in childhood, with prevalence estimates varying between 0.5% and a massive 32% of children globally. [1] Other epidemiological studies report similar ranges, reinforcing that this is a routine clinical issue rather than a rare presentation. [2,3]  Alongside conventional medical care, many families explore complementary or manual therapy options as part of managing their child’s health. These include, among other modalities, chiropractic care. In children with ongoing or chronic conditions, reported use is often higher, ranging from 20% to over 50% in some settings [4]. This suggests that seeking additional, non-pharmacological support is not unusual, particularly when symptoms persist or affect quality of life.
This is where chiropractic enters the picture for many people. A growing number of case reports have shown that constipation and other related complaints have responded well to chiropractic care. Constipation in children is frequently associated with stool withholding behaviours, painful defecation, and in some cases, encopresis. Beyond gastrointestinal symptoms, it has been linked to emotional distress, behavioural challenges, reduced social participation, and increased family stress. [1] For many families, this creates a cycle that can be difficult to resolve.
Standard management approaches typically include dietary modification, behavioural strategies, and pharmacological interventions such as laxatives or stool softeners. These strategies can be effective, particularly in the short term. However, not all children respond fully, and while many a chiropractor will have seen improvements in paediatric patients under care, documenting these improvements so that other parents know that chiropractic may help remains an area for improvement.
At present, chiropractic literature addressing paediatric constipation consists primarily of case reports and small case series’. These have described improvements in bowel function following chiropractic care, particularly where attention is directed to the lumbopelvic and sacral regions [5,6] While such evidence does not establish causation, it raises a clinically and practically relevant question: Does subluxation-based chiropractic care supporting nervous system function influence bowel regulation in some children? A recent case series appearing in the Asia Pacific Chiropractic Journal explored a case of three children, from three different families, all presenting at the same chiropractic practice and seeing significant improvements in constipation.
The case series
This case series describes three paediatric patients presenting with constipation, with or without encopresis, who received chiropractic care. Each child came from a different family context, with varying diets, developmental stages, and health histories. All were assessed and managed using a subluxation-based chiropractic approach by the same practitioner. The first case was a six year old male, who was previously toilet-trained and continent. This child developed intermittent constipation and encopresis over a 6 to 12-month period. Episodes occurred several times per week, primarily at school. Medical and psychological assessments were unremarkable.
Examination findings were largely within normal limits, aside from minor reflex asymmetry. He was checked and adjusted using gentle care, including activator methods. Very early in the course of his care, reductions in encopresis were observed, followed by improved awareness of bowel urge and voluntary toileting. Over time, accidents resolved almost entirely, with only occasional episodes during periods of emotional stress. Improvements in focus, behaviour, and school engagement were also reported. This was with no additional changes in his diet or lifestyle, making the findings significant.
A second patient was a four-year-old male. He presented with a history of significant food allergies and prior anaphylactic reactions. He experienced prolonged stool withholding, sometimes lasting up to one week, followed by overflow diarrhoea. He was using laxatives at the time of presentation. Again, no other changes were introduced, and after the introduction of chiropractic care, bowel movements became more frequent and predictable. He also developed improved awareness of the need to defecate and progressed to independent toileting. Bowel habits stabilised to daily or near-daily movements. While symptom relief was a major benefit of his care, the improved body awareness was notable, as it contributed to his ability to regulate his body functions. This is a core element of subluxation-based chiropractic care, even if we are usually speaking about more sophisticated issues like nervous system function, sensorimotor function or other high-level body functions.
The third patient was a two year old female who had experienced constipation for six months, with bowel movements occurring every four to five days. Behavioural cues suggested awareness of the need to defecate, followed by withholding. She was described as unsettled and frequently distressed. Initial changes were gradual, but within several weeks, bowel movements became more regular. She began indicating the need to use the toilet and transitioned to daily bowel movements. Concurrent improvements in mood and social engagement were reported.
Across all cases, care consisted of low-force, paediatric-appropriate chiropractic adjustments, including Activator methods and drop-piece techniques. In one case, modified manual adjustments were used where clinically indicated. In all cases, care was modified to suit the age and tensile strength of the patient (as is the standard for paediatric chiropractic care). Parents were asked to maintain bowel diaries documenting frequency, consistency, and behavioural observations. Families were also encouraged to continue any concurrent medical care and maintain supportive toileting routines. Care was initially provided weekly, progressing to fortnightly as improvements were observed, with a consistent focus on the lumbopelvic and sacral regions.
Despite differences in presentation, several consistent patterns emerged. In all cases, there were findings consistent with lumbosacral subluxation. Improvements in bowel regularity followed the introduction of care in all cases, and increased awareness of bowel urge was reported. Also noted across all three individuals were broader observations of behavioural and emotional improvements.
These findings are consistent with previous reports in the chiropractic literature, though they remain exploratory.
Possible Mechanisms
Chiropractic care is about adjusting the subluxation so that the nervous system can operate free from interference. We aren’t an “adjust here and X will happen” profession. With that said, basic science research shows that the lumbosacral spine is important in bowel function. This region is closely associated with autonomic and somatic pathways involved in defecation. From a chiropractic perspective, care directed at improving spinal function may influence how these pathways are coordinated. There is also growing interest in the broader role of the nervous system in regulating stress responses and behaviour and improving sensorimotor integration. More research would be beneficial, but the findings we have so far are encouraging indeed. In children who demonstrate stool withholding or heightened stress, these factors may be relevant and are well-worth exploring.
This case series is limited by its small sample size, lack of a control group, and reliance on parental reporting. Baseline data were not fully standardised, and interruptions in care occurred in some cases. As such, causation cannot be established. However, the timing and consistency of observed changes suggest that further investigation is warranted.
The chiropractic approach does not focus solely on symptoms, but on supporting nervous system function. When this system is operating more effectively, changes may extend across multiple domains of a child’s health and development. Further research, particularly larger and controlled studies, is needed to better understand these relationships and their potential clinical implications. But for these three little ones, and the people who care for them, it is significant indeed.
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ReferencesÂ
- Koppen, I. J. N., Vriesman, M. H., Saps, M., Rajindrajith, S., Shi, X., van Etten-Jamaludin, F. S., Di Lorenzo, C., & Benninga, M. A. (2018). Prevalence of functional defecation disorders in children: A systematic review and meta-analysis. The Journal of Pediatrics, 198, 121–130. https://doi.org/10.1016/j.jpeds.2018.02.029
- Mugie, S. M., Di Lorenzo, C., & Benninga, M. A. (2011). Constipation in childhood. Nature Reviews Gastroenterology & Hepatology, 8, 502–511.
- Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., & Benninga, M. A. (2014). Evaluation and treatment of functional constipation in infants and children. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266
- Lim, A., Cranswick, N., Skull, S., & South, M. (2005). Survey of complementary and alternative medicine use at a tertiary children’s hospital. Journal of Paediatrics and Child Health, 41(8), 424–427.
- Alcantara, J., Alcantara, J. D., & Alcantara, J. (2011). The chiropractic care of infants with constipation: A case series and selective review of the literature. Complementary Therapies in Clinical Practice. https://doi.org/10.1016/j.ctcp.2013.10.008
- Miller, J. E., & Benfield, K. (2016). Chiropractic management of pediatric constipation: A case report. Journal of Clinical Chiropractic Pediatrics, 15(1), 1196–1201.
