🧲📆 Sitz Marker Study in Children: A Parent-Friendly Guide

✅ A Sitz Marker Study is a simple, low-risk X-ray test that shows how stool moves through your child’s colon over several days.
It helps doctors understand why constipation is happening and how best to treat it.

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Test name: Sitz Marker Study
Common names: Colon transit study, marker study, bowel transit test

Plain-language summary (2–3 lines):
Your child swallows a capsule containing tiny markers that show up on X-ray. Pictures taken on specific days show whether stool moves normally, slowly throughout the colon, or gets stuck at the outlet. This guides targeted treatment.

Who it affects (typical ages):
Most often school-age children and teens with chronic constipation or stool accidents that haven’t improved with standard treatment.

✅ What parents should do today:

• Understand the purpose of the test
• Follow medication instructions exactly (some meds may need pausing)
• Keep normal routines during the study

⚠️ Red flags that need urgent/ER care (not caused by the test):

• Severe belly pain with hard, swollen abdomen
• Persistent vomiting
• Fever with severe constipation

🟡 When to see the family doctor/clinic:

• Long-standing constipation
• Stool accidents despite laxatives
• Need to tailor treatment based on transit pattern

2) 🧠 What it is (plain language)

The Sitz Marker Study shows how fast or slow stool travels through the colon.

It answers questions like:

• Is constipation due to slow movement throughout the colon?
• Is stool getting stuck at the rectum/outlet?
• Is transit actually normal (suggesting behavior or muscle coordination issues)?

What part of the body is involved? (small diagram required)

Common myths vs facts

• Myth: “It’s dangerous radiation.”
  Fact: Radiation exposure is low and carefully minimized.
• Myth: “My child will feel the markers.”
  Fact: The markers are tiny and not felt.
• Myth: “It replaces all other tests.”
  Fact: It complements history, exam, and sometimes anorectal manometry.

3) 🧩 Why it’s done (indications)

Common reasons

• Chronic constipation not improving with appropriate laxatives
• Stool accidents (fecal incontinence/soiling)
• Unclear constipation pattern
• Deciding between medical, behavioral, or pelvic floor therapy

Less common but important reasons

• Suspected slow-transit constipation
• Distinguishing outlet obstruction from whole-colon delay
• Planning next steps after other tests

4) 👀 What parents might notice (symptoms leading to the test)

• Constipation for months or years
• Large, painful stools
• Infrequent bowel movements
• Stool accidents despite treatment
• Abdominal bloating
• Minimal urge to poop

What’s normal vs what’s not

✅ Common:

• Occasional constipation with good response to laxatives

⚠️ Concerning:

• Persistent constipation despite correct dosing
• Daily stool accidents in a toilet-trained child
• Poor response to standard plans

5) 🏠 Preparing for the test (step-by-step)

✅ Preparation is simple but important.

Before the study

• Your clinic will tell you:
  • which laxatives to continue or pause
  • which day(s) X-rays are taken (often Day 3 and/or Day 5)
• Your child should:
  • eat normally
  • drink normally
  • keep usual activities

Day 0 (marker ingestion)

• Child swallows a capsule with markers
  (If unable to swallow, some centers open the capsule and mix markers with food—ask your clinic.)

6) ⛔ What NOT to do (common mistakes)

• Don’t change diet drastically during the study
• Don’t add new laxatives unless instructed
• Don’t skip scheduled X-ray days
• Don’t assume “normal stool that week” invalidates results

7) 🚦 When to worry: triage guidance

🔴 Emergency (unrelated to the test)

• Severe abdominal pain with distension
• Persistent vomiting
• Signs of bowel obstruction (rare)

🟡 Call clinic

• Missed X-ray appointment
• Capsule not swallowed
• Questions about meds during the study

🟢 Normal during the study

• No symptoms from the markers
• Regular daily activities

8) 🩺 How the test is done (what to expect)

Step-by-step

1. Day 0: Swallow marker capsule
2. Day 3 (or 4): Abdominal X-ray
3. Day 5 (or 7): Repeat X-ray (protocol varies)
4. Radiologist counts markers and notes location

Sedation?

• Not needed

Pain?

• None from the test itself

9) 📊 Understanding results (simple explanations)

Typical result patterns

1) Normal transit

• Few or no markers remain
• Suggests stool moves normally
• Focus shifts to behavior, routines, or muscle coordination

2) Slow-transit constipation

• Markers scattered throughout colon
• Indicates globally slow movement
• Treatment focuses on medical therapy and routines

3) Outlet obstruction pattern

• Markers cluster in rectum/sigmoid
• Suggests difficulty emptying
• Pelvic floor therapy or biofeedback often helps

10) ⏳ What happens after the test

Next steps depend on results

• Adjust laxatives (type, dose, timing)
• Add pelvic floor physiotherapy/biofeedback
• Reinforce toileting routines
• Combine with anorectal manometry findings (if done)

Return to school/sports

• No restrictions

11) ⚠️ Complications (rare)

• Minimal radiation exposure
• Missed appointments affecting interpretation
• No direct physical complications

12) 🛡️ How results help prevent future problems

• Avoids trial-and-error treatment
• Targets therapy to the cause
• Reduces long-term stool accidents
• Improves confidence and quality of life

13) 🌟 Special situations

Children with anxiety

• Reassure that X-ray is quick and painless

Neurodevelopmental differences/autism

• Visual schedules help
• Allow familiar caregiver present

Severe constipation

• May be combined with other motility tests

14) 📅 Follow-up plan

• Review results with GI team
• Start or adjust treatment
• Follow up in 4–8 weeks
• Track stool frequency and accidents

15) ❓ Parent FAQs

“Will my child feel the markers?”

No.

“Is radiation safe?”

Yes—exposure is low and medically justified.

“Do laxatives affect results?”

They can—follow instructions carefully.

“Does this mean surgery?”

Rarely. Most children improve with targeted therapy.

“Is this the same as anorectal manometry?”

No—this checks movement through the colon, not muscle coordination.

16) 🧾 Printable tools (high-value add-ons)

🧾 Printable: Sitz Marker Study Prep Checklist

• Medication instructions followed
• Capsule swallowed
• X-ray days scheduled
• Normal diet maintained

🧾 Printable: Results & Plan Sheet

• Transit pattern: _______________________
• Plan recommended: _____________________
• Follow-up date: ________________________

🧾 Printable: “Red Flags” Fridge Sheet

⚠️ Urgent: severe abdominal pain, vomiting, distension, fever with constipation.

17) 📚 Credible sources + last updated date

Trusted references:

• Pediatric gastroenterology society motility testing resources
• Children’s hospital constipation and transit study pages

Last reviewed/updated on: 2025-12-30
Local practices may vary.

18) 🧡 Safety disclaimer

This guide supports—not replaces—medical advice. Seek urgent care for severe pain, vomiting, or abdominal distension.

---

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings. To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca In the email subject, please write: New Assessment Appointment with Dr. Hussein Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP