Constipation

Question 1

What questions do we use to assess passage of stool?

Answer 1

• how often ?
• how hard ?
• is it painful ?
• has there been a change ?
• Breast fed babies tend to have more poos

Question 2

What is normal stool frequency ?

Answer 2

4 per day to 1 per week)

• depends on age
• depends on diet: Vegans/vegetarians tend to go more often then meat eaters

Question 3

SSx for constipation?

Answer 3

• Poor appetite
• Irritable
• Lack of energy
• Abdominal pain or distension
• Withholding or straining – usually toddler, actually they’re trying to stop poo coming out. Because of pain.
• Diarrhoea due to outflow obstruction - so overflow

Question 4

Why do children become constipated?

Answer 4

• A lot of it is social – poor diet, not enough ruffage or fluid: Insufficient fluids, Excessive milk – become iron deficient
• Physical: intermittant illness, medication
• FH
• Psychological (secondary): once scared to go, wont let it out, get’s hard
• Meds can cause constipation: opiates (codeine), gaviscon
• Fast colon vs slow colon

Question 5

What is the vicious cycle of constipation? What effect does this have on rectum?

Answer 5

• Hard poo that was painful
• Doesn’t want to push out next poo
• So withhold poo
• Kid clenches external sphincter
• Then bowel sucks out more water
• Poo get’s bigger and harder: next time they go it is more painful
• Megarectum: rectum get’s stretched – soiling is caused by megarectum that has too much stool in it

Question 6

What is the first part of constipation treatment?

Answer 6

• Explain to the parents
• Increase dietary fibre: more fruit, veggies, fluids, less milk

Question 7

What are the 4 intrinsic parts of Rx for constipation?

Answer 7

• Clear out rectum
  
  • osmotic laxatives (lactulose) – she never uses this!
  • stimulant laxatives (senna, picolax): issue is stomach ache
  • isotonic laxatives (movicol) – crux of getting them better
• Make sure poo is never ever hard again
• Make sure stretched back passage is kept empty
• Retrain brain to recognise when back passage is full
  
  • Make going to the toilet a pleasant experience
  • Avoid punitive behaviour from parents
  • Reward good behavior
  • Remove pain

Question 8

What are the advantages and disadvantages of laxatives?

Answer 8

Advantages

• Non invasive
• Given by parents

Disadvantages

• Non compliance
• SE

Question 9

How long and how much laxatives?

Answer 9

• enough to make them go! (aim is 3 sloppy stools a day)
• until no longer required
• related to duration of problem

Question 10

What Ix for constipation?

Answer 10

• Do a colonic marker study – these will show up on xray
• Normal gut transit is 24 hrs
• Abdo examination – may feel pelvic mass

Question 11

What are v important for childhood constipation?

Answer 11

• Need to manage early as toddlers, so doesn’t progress to teenagers
• Need extensive explanation to adults