Chronic Constipation Flashcards
What is constipation?
Infrequent passage of stool
What do you want to know about the child presenting with constipation?
- How often they pass stool?
- How hard is it?
- Is it painful?
- Has there been a change?
What is normal stool frequency?
4 per day to 1 per week
What does stool frequency depend on?
- Age
- Diet
What are the components of the Bristol stool chart?
- Type 1= separate hard lumps
- Type 4= smooth sausage like
- Type 7= entirely liquid
What are some signs and symptoms of constipation?
- Poor appetite
- Irritable
- Lack of energy
- Abdominal pain or distension
- Withholding or straining
- Diarrhoea
- Urinary issues
- Pale with bags under their eye
Why do children become constipated?
- Poor diet (lack of fluid, excess milk)
- Potty training or school toilets issue
- Intercurrent illness
- Medications (opiates and Gaviscon)
- Family history
- Sacred to go (psychological)
- Anatomical issues
- Hirshsprungs
- Lead poisoning
- Hypothyroidism
What is the vicious cycle of constipation?
- Large hard stool
- Leads to pain and fissuring
- Child withholds stool
- Becomes constipated
How does overflow diarrhoea develop?
- Child enters the vicious cycle of constipation
- Rectum tells them they need to go but the child clenches the external sphincter
- Poo continues to be dehydrates by bowel becoming harder
- Back passage begins to stretch and creates a mega rectum
- Soiling occurs when the mega rectum holds the internal sphincter open and the child is unable to clench the external sphincter
What social treatment of constipation is there?
Explain treatment to parents
Dietary
- Increase fibre
- Increase fruit
- Increase vegetables
- Increase fluids
- Decrease milk
What psychological treatment of constipation is there?
Reduce the aversive factors by making going to the toilet a pleasant experience
- Correct height
- Not cold
- School toilets
Avoid punitive behaviour from parents
Reward good behaviour
- General praise and star charts
- Encourage child to try going to the bathroom after every meal
What medical treatment is there for constipation?
Soften stool and stimulate defecation
- Osmotic laxatives (lactulose)
- Stimulant laxatives (senna, picolax)
- Isotonic laxatives (movicol)
What are the advantages of laxatives?
- Non invasive
- Given by parents
What are the disadvantages of laxatives?
- Non compliance
- Side effects
How much treatment should a child receive?
Enough to make them go
