Constipation

Question 1

What is functional constipation?

Answer 1

No known medical cause, clinical Dx w/o need for labs/imaging to confirm it

Question 2

What defines constipation?

Answer 2

Stools that are hard or difficult to pass, can be associated w/ abdominal pain/discomfort and/or encopresis

Question 3

What is encopresis?

Answer 3

Leakage of liquid stool around a hard ball of stool

Question 4

How common is constipation?

Answer 4

Very common, affecting about 1/3 children

Question 5

Common times of onset of constipation

Answer 5

1. Introduction of solids (e.g. rice cereal), 2. Toilet training (e.g. different situation, child might start withholding), 3. School age (e.g. child doesn’t want to use bathrool)

Question 6

What symptoms are common?

Answer 6

Stools hard or difficult to pass, abdominal pain, poor appetite, watery stools

Question 7

Red flags for a different/worrisome Dx

Answer 7

1. Bilious vomiting, 2. persistent distension, 3. wt loss, 4. urinary incontinence, 5. bloody diarrhea, 6. thin “pencil like stools”

Question 8

Other questions to think of another etiology for constipation

Answer 8

1. Delayed passage of meconium (CF, Hirschprung’s disease), 2. Developmental problems, 3. Growth problems

Question 9

PE, major categories to check for?

Answer 9

1. Anatomic abnormalities, 2. Neurologic problems, 3. Chronic disease, 4. Metabolic disease

Question 10

What should you include in PE?

Answer 10

Sacrum, anus, lower extremity tone, lower extremity reflexes. Digital rectal exam usually not needed

Question 11

Common triggers for constipation

Answer 11

Milk, psychosocial factors (e.g. new member of the family, change home, etc)

Question 12

Do dietary changes matter?

Answer 12

Can be helpful to prevent constipation, for treatment this is less clear

Question 13

is fiber intake helpful to treat constipation?

Answer 13

No. It has not been shown to be effective to treat moderate to severe constipation: Insoluble fiber can increase stool size making it more difficult to pass

Question 14

is drinking more water helpful to treat constipation?

Answer 14

No. It has not been shown to be an effective tx: drinking more water will not prevent water reabsorption in the colon

Question 15

Management

Answer 15

ALL ABOUT TRAINING THE BOWEL
1. Reduce constipating foods (5): milk (dc if necessary), white bread, white rice, white pasta, bananas, 2. Scheduled toilet sitting 10-15 min after meals (breakfast, dinner), 3. Child to use a stool to put the feet so knees are up towards the chest

Question 16

Management for infants < 1 y

Answer 16

Juices (helpful, sufficient to relieve symptoms): pear, prune, apple ones, use them as a “medication” once or twice daily

Question 17

Why can juices be effective?

Answer 17

Sugar acts like an osmotic force, pear/prune/apple juices have sorbitol as well

Question 18

What is infant dyschezia?

Answer 18

Infant grunts, pushes, changes color, strains to pass stools. This is NOT constipation. Common in infants 4 to 6 weeks of age