15.4.5.2 Constipation Flashcards
Define constipation
- Infrequent passage of hard stools
- May be functional or due to underlying organic disease
- Disease more likely the younger the onset of constipation, especially in neonatal period or early infancy
- Important to distinguish between functional constipation (which must be managed appropriately) and organic disease (which will require further investigation and appropriate specific management)
How many stools are too few?
Slide 4
Bristol stool chart
Slide 7
Define faecal incontinence or soiling or encopresis
involuntary passage of stool usually into underpants and child is unaware of this happening when it occurs = typically constipation with rectal impaction of faeces
Define nonretentive faecal incontinence
voluntary passage of stool into places inappropriate to sociocultural context, typically normal consistency stool = usually due to emotional disturbance triggered by unconscious anger and may be a result of sexual abuse
Constipation causes
- drugs or toxins
- hypothyroidism
- cystic fibrosis
- electrolyte abnormlities (⬇️K; ⬆️Ca; ⬆️Mg)
- spinal pathology
- inflam bowel disease (Crohn’s)
- leiomyopathies, colonic pseudo-obstruction
- Hirschsprug’s disease
- Anaorectal malformation
Anatomical causes of constipation
Anorectal malformations
- Anterior displacement of the anus
Abnormalities of the spinal cord or peripheral nerves
- Sacral dimple, tuft of hair on spine, gluteal cleft deviation {clues that their are spinal abnormalities}
Myogenic causes of constipation
Prune belly syndrome:
- absent or defective abdominal wall muscles (striated)
Leiomyopathy:
- acquired degenerative condition of smooth muscle
- present with massive abdominal distention & constipation
Neurogenic causes of constipation
Hirschsprung’s disease: absence of ganglion cells in myenteric plexus of rectum and distal colon – due to incomplete migration of neural crest cells along intestinal tract
Metabolic disorders as a cause of constipation
- Endocrine e.g. hypothyroidism
- Electrolyte disturbance e.g. ↓K+ ↑Ca2+ ↑Mg2+
Inflammatory bowel disease as cause of constipation
- Crohn’s disease – stricture
- NB: poor growth, perianal disease, blood in stool, extraintestinal manifestations
Other causes of constipation
- cystic fibrosis (constipation very early in life, because meconium is very thick and cannot be passed)
- drugs
Potential Alarm features in constipation
- passage of meconium >48hrs in newborns
- constipation start in 1st month of life
- fam history of Hirschsprungs disease
- ribbon stool (look like stool is coming out of tootpast)
- blood in stool in absence of anal fissures
- failure to thrive
- bilious vomiting
- severe abdominal distention
- abnorm tyroid gland
- abnormal position of anus
slide 18
Functional constipation
- Common time: potty training, when they start going to school (holding of stool -> constipation)
- Diet contributing factors
- Pretensive posturing (fear of defecation)
Epidemiology of functional constipation
- Common problem in children and adults
- Mostly European studies
- Found in up to one third of children
- Peaks around time of toilet training
