Constipation in Children

Constipation is a common problem in children. Roughly1 in every 20 visits children make to a doctor are because of constipation.

Definition:Constipation is delay or difficulty in passing stools that is present for 2 or more weeks . And associated with passing hard stools associated with severe pain while passing .

What is normal pooping?

An important milestone in the life of a child is learning to poop in the toilet.

Different children poop different amounts and number of times each day.

Some poop one time a day and others may go after every meal (three or so times per day).

The most important aspect of pooping is the character (or 'softness') of the poop. You can use the Pediatric Bristol Stool Form Scale for Children (see below) to determine if your child's poops are the correct softness. The goal is to poop a Type 3 or a Type 4 on the scale.

Types of constipation in children

Organic constipation

Organic constipation occur because of underlying disease. Associated with celiac disease, thyroid problems or other disorders.

Functional constipation

• Most common type of constipation.
• Not associated with any disesae.

Some of the reasons for functional constipation are Stool with holding .

• Because of fear to pass stools as they may be hard .
• Previous episode of passing hard stool and some insult happened in the anus like small cut or tear.
• While playing they dont want to go so they withhold
• And when they are in school .

Post infectious cause : After a viral gastroenteritis

What are the symptoms of constipation?

• Prolonged on and off severe abdominal pain , Mostly happens in the evening times .
• Bloating of abdomen
• Decreased appetite.
• Nausea and reflux.
• not interested in school and doing things.
• Pain while passing urine.
• Soiling of the underwear which is called encoperesis.
• (Encoperesis is over flow of stool when constipation happens ).

Others are lethargy and excessive sleeping can be seen .

• Because of passing hard stools.
• Blood in stools
• anal fissures
• rectal prolapse.
• Fecal streaking can be seen .

How is constipation treated?

1. Medications

2.Life style modification.

When ever child is constipated or not passed stools for more than 3-4 days and this happening since 1-2 weeks or passing little stools, Most of the stools stays back in the large intestine and make them to get hard .

Mechanism of becoming hard stools.

Child not passed stools for 1 days------ water from the stools wil be absorbed into the body from the large intestine ---- and stools become hard --- they get impacted in the intestine .

• 1 st step is deimpaction
• 2nd softening the stool
• 3 rd regularise the bowels

Before that child should have lifestyle modification . This include :

• Not to give milk in the morning.( give some hot water instead)
• Giving breakfast daily.
• Encoraging the child to pass stools in the morning and not evening preferably fixed time daily .
• Making the child to sit and do the motion rather than standing and doing ( for this buy as small fancy potty and make them intresting ).
• Parents or grand parents should sit with the child and teach them how to strain the motion .
• Parents should start toilet traning from the age of 9m-1 year.
• Giving high fiber diet .( Leafy vegetables , greens , riped banana,dates , prunes ).
• Avoid fried items , juck foods and packed foods .
• Encorage child to drink plenty of fluids and water .
• Giving whole fruits and vegetables with skin is preferable over fruit juices.

POTTY STOOL : Improve toileting posture by promoting the relaxation of the puborectalis muscle and straightening of the 'ano-rectal' angle to make passing a poop easier. A recent study showed that the potty stool is safe and effective (when used with medicines) to treat functional constipation in toilet-trained children.

MEDICATIONS :

• Laxatives -Osmotic laxatives (PEG),Stimulant laxatives
• Stool Softners.
• Rectal suppositories,
• Rectal enema.
• Deimpaction therapy and maintainance

How long does my child need to take their medicines for constipation?

Deimpaction :The initial cleanout removes the backed-up poop from the body. course of 1-4 days before going to a lower daily dose.to produce diarrhea…. The diarrhea will stop when the cleanout is completed.

Maintenance (daily) therapy:Lower dose of laxative … encorage to pass stools….. remove the fear in the child …. Change withholding behavior and allowing the colon to return to its normal shape and muscle tone. During this step, it is important to encourage regular bowel movements in the toilet. Medications for 2-3 months .

Counseling and behavior modifications: may help children who are embarrassed or feel they are 'bad' because of the soiling. A counselor can help structure the treatment plan and help the child cooperate.

What if all of these options fail?

If above medication fails then Child need to be evaluated for any organic cause. Ultasound abdomen ,Thyroid profile ,Abdominal Xray and Anorectal manometry