Chronic Constipation Flashcards
What is normal stool frequency?
4 per day to 1 per week
What does stool frequency depend on?
Age and diet
What are some signs of constipation?
Poor appetite Irritable Lack of energy Abdominal pain or distension Withholding or straining Diarrhoea - overflow incontinence
What are the social reasons for child constipation?
Poor diet
- Insufficient fluids
- Excessive milk
Potty training/school toilet
What are the physical reasons for child constipation?
Intercurrent illness
Medication
What are 2 other causes of child constipation?
Psychological (secondary)
Organic - extremely rare
What is the vicious cycle of constipation?
Constipation –> large hard stool –> pain or Amal fissure –> withholding of stool –>
the more they withhold, the harder it gets
What are the treatments for social constipation?
Explain treatment to parents
Increase: fibre fruit vegetables fluids
Reduce:
milk
What are the treatments for psychology constipation?
Reduce aversive factors
Make going to the toilet a pleasant experience
- Correct height
- Not cold
- School toilets
- Soften stool and remove pain
Avoid punitive behaviour from parents
Reward ‘good’ behaviour
- General praise
- Star charts
What are the pharmacological treatments of constipation?
Soften stool and stimulate defecation
- osmotic laxatives (lactulose)
- stimulant laxatives (senna, picosulphate)
- isotonic laxatives (Movicol/Laxido)
What are the advantages and disadvantages of treating constipation pharmacologically?
Advantages:
Non-invasive
Given by parent
Disadvantages:
Non-compliance
Side effects
What are the fundamentals of treating constipation pharmacologically?
How much? -enough to make them go and to make sure stool always soft & never painful How long? -until no longer required -related to duration of problem
What are the fundamentals of treating constipation pharmacologically?
How much? -enough to make them go and to make sure stool always soft & never painful How long? -until no longer required -related to duration of problem
How is severe constipation treated?
Empty impacted rectum Empty colon Maintain regular stool passage Slow weaning off treatment Ensure compliance
Summary
Treat early and effectively
Recognise impaction (impossible to get out)
Choose the most patient friendly treatment
All stages of diagnosis and treatment can be done safely and effectively in the community
Explanation & understanding is critical to success
