Constipation

Question 1

What are possible secondary causes of constipation?

Answer 1

• Hirschsprung’s disease
• Cystic Fibrosis
• Hypothyroidism

Question 2

How does constipation present?

Answer 2

• less than 3 stools
• Hard stools that are difficult to pass/ rabbit dropping stools
• abdominal pain
• straining and painful passages of stools
• Retentive posturing = holding an abnormal posture
• Rectal bleeding
• Overflow soiling

Question 3

What is Encopresis?

Answer 3

• This is the term for faecal incontinence.
• This is not considered pathological until 4 years of age
• It is a sign of chronic constipation where the rectum is stretched and loose stools are able to bypass the blockage and leak out causing soiling

Question 4

What lifestyle factors can lead to constipation?

Answer 4

• Not opening the bowels
• Low fibre diet
• Poor fluid intake and dehydration
• Sedentary lifestyle
• Psychosocial problems - difficult home problems

Question 5

What is Desensitisation of the Rectum?

Answer 5

• Patients develop a habit of not opening their bowels
• Over time they loose the sensation of needing to open their bowels
• They start to retain faeces in their rectum
• This leads to faecal impaction
• Overtime the rectum stretches as it fills with more and more faeces, leading to further desensitisation

Question 6

What are the Red flags for Constipation?

Answer 6

• Not passing meconium = within 48 hours of birth = cystic fibrosis
• Neurological signs or symptoms = particularly in the lower limbs = cerebral palsy
• Vomiting (intestinal obstruction or Hirschsprung’s disease)
• Ribbon Stool (Anal Stenosis)
• Abnormal Anus
• Abnormal lower back/ buttocks (spina bifida, spinal cord lesion)
• Failure to thrive (coeliac disease, hypothyroidism)
• Acute severe abdominal pain and bloating (obstruction/ intussusception)

Question 7

What are the complications of constipation?

Answer 7

• Pain
• Reduced Sensation
• Anal Fissures
• Haemorrhoids
• Overflow and soiling

Question 8

What is the Managment for Constipation?

Answer 8

• Correct any lifestyle factors
• Start laxatives (Movicol) and continue long term and then weaned off when the child develops a normal, regular bowel habit
• Faecal impaction = disimpaction regimen with high dose of laxatives
• Encourage and praise visiting the toilet, involve scheduling visits, bowel diary and star charts