Constipation

Question 1

What is a normal frequency for children opening their bowels?

Answer 1

4 per day -1 per week

You want the stool to be soft and relatively easy to pass (aiming for a 4 in the Bristol stool chart)

This also changes depending on age and diet - breast fed babies will open bowels more than formula fed.

Question 2

What symptoms other than not opening bowels/ painful passing of faeces, will a child present with?

Answer 2

Poor appetite
Irritable
Lack of energy
Abdominal Pain or distension
Withholding or straining
Young children who are struggling with passing stools may hind themselves or strain when they need to pass a stool. 

Diarrhoea/overflow incontinence (sooling clothing)
Children with constipation are often miserable.

Question 3

Causes of constipation?

Answer 3

Poor diet e.g. low fibre, excess milk
Potty training or scary school toilet can cause children to put off passing stool and this can cause constipation
Intercurrent illness
Medication- Gaviscon, opiates
Psychological
Organis- e.g. hypothryoidism, lead poisoning

Question 4

Why is it so important to focus on getting soft pain free stool when treating constipation.

Answer 4

If a child has had to pass a hard stool and this was painful, they will want to avoid the painful experience so will hold on to stool. This starts a viscious cycle as this them means the bowel has more time to extract even more water, so the stool becomes harder, when eventually passed this can cause more pain and even an anal fissure. Which leads to them avoiding passing stool again and so on.

It is important to try and making going to the toilet an enjoyable and pain free experinence, so the child can overcome the association with pain.

Question 5

How is constipation treated?

Answer 5

Lots of encouragement and praise
Increase fibre and fluids in diet, decrease milk
Reduce the adverse factors of using the toilet e.g. correct height, not too cold, give step to rest feet on
Soften stool and stimulate defectaion- e.g. laxatives

Question 6

What laxatives are used in children?

Answer 6

Osmotic laxatives - e.g. Lactulose- increase fluid in bowel

Stimulant Laxatives - e.g. Senna - these irritate lining of bowel to make them go

Isotonic laxatives -e.g. Movicol/Laxido

Question 7

What is a possible complication of constipation?

Answer 7

Megarectum- thing can press on other pelvic organs and cause urinary retention

Question 8

How is severe constipation treated?

Answer 8

Empty the impacted rectum and colon

Maintain regular stool passage
Then slow weaning off treatment