Constipation

Question 1

Constipation

Answer 1

Delay or difficulty in passing stools for more than 2 weeks

Question 2

Soiling

Answer 2

Involuntary passage of faeces (overflow incontinence)

Question 3

Organic causes

Answer 3

RARE! More likely if onset at birth or associated with faltering growth
Local: Hirschprung’s; Neuromuscular (eg cerebral palsy)
Systemic: Hypothyroid; coeliac; food allergies

Question 4

Clinical features

Answer 4

Usually acute and transient
May follow an acute febrile illness => hard stool => discomfort/pain on passing +/- anal tear => retention of faeces => increased rectal capacity => further accumulation of faeces => discomfort/pain on passing +/- anal tear

Question 5

History

Answer 5

Frequency
Consistency
Pain/blood on defecation
Soiling?
History of delay in passage of meconium

Question 6

Examination

Answer 6

Systemic signs of faltering growth
Abdominal distention, palpable descending colon
Presence of anal fissure

Question 7

Red Flag

Answer 7

Started within first few weeks of life
Meconium >24 hours of life
Faltering growth
Delayed walking or lower limb abnormal neurology
Distension of abdomen
Vomitin
Child protection concerns