Constipation Flashcards
What is the most common type of constipation in children?
Idiopathic constipation or functional constipation
This type indicates no significant underlying cause other than lifestyle factors.
List some possible secondary causes of constipation.
- Hirschsprung’s disease
- Cystic fibrosis
- Hypothyroidism
What is considered a normal frequency of bowel movements in children?
Varies between individuals; breast-fed babies may have as little as one stool a week
What are typical features in history and examination that suggest constipation?
- Less than 3 stools a week
- Hard stools that are difficult to pass
- Rabbit dropping stools
- Straining and painful passages of stools
- Abdominal pain
- Retentive posturing
- Rectal bleeding associated with hard stools
- Faecal impaction causing overflow soiling
What is encopresis?
Faecal incontinence, usually a sign of chronic constipation
It is not considered pathological until 4 years of age.
List some rarer causes of encopresis.
- Spina bifida
- Hirschsprung’s disease
- Cerebral palsy
- Learning disability
- Psychosocial stress
- Abuse
What lifestyle factors can contribute to constipation?
- Habitually not opening the bowels
- Low fibre diet
- Poor fluid intake and dehydration
- Sedentary lifestyle
- Psychosocial problems
Fill in the blank: Patients may develop a habit of not opening their bowels and lose the sensation of needing to open their bowels, leading to _______.
[faecal impaction]
What are some secondary causes of constipation?
- Hirschsprung’s disease
- Cystic fibrosis
- Hypothyroidism
- Spinal cord lesions
- Sexual abuse
- Intestinal obstruction
- Anal stenosis
- Cow’s milk intolerance
What are red flags that may indicate serious underlying conditions causing constipation?
- Not passing meconium within 48 hours of birth
- Neurological signs or symptoms
- Vomiting
- Ribbon stool
- Abnormal anus
- Abnormal lower back or buttocks
- Failure to thrive
- Acute severe abdominal pain and bloating
What are some complications of constipation?
- Pain
- Reduced sensation
- Anal fissures
- Haemorrhoids
- Overflow and soiling
- Psychosocial morbidity
What is the first-line treatment for idiopathic constipation in children?
Movicol (laxatives)
A diagnosis can be made without investigations if red flags are considered.
What management strategies are recommended for treating constipation?
- Correct reversible contributing factors
- Recommend a high fibre diet and good hydration
- Start laxatives
- Encourage and praise visiting the toilet
- Continue laxatives long term and wean off as normal bowel habits develop
