Constipation and incontinence

Question 1

How often do kids usually go to do a poo?

Answer 1

At least every 2-3 days, but breastfed babies might only be once/week

Question 2

When is constipation often an issue?

Answer 2

Transition from breastmilk to solid foods, during toilet training, at school entry

Question 3

What is the most common cause of constipation? Why can this be an issue? What is a long-term outcome if unresolved?

Answer 3

Functional faecal retention. Can lead to positive feedback cycle (faecal retention = bigger, more painful dyschezia = more reluctant to go to toilet). Can cause chronic dilation of rectum, making it less sensitive to changes in stretch and causing overflow incontinence (encopresis).

Question 4

Name 5 organic causes of constipation

Answer 4

Anorectal malformation
Spinal cord lesion
Metabolic disorders (hypothyroidism, hypercalcaemia)
Autoimmune disorders (coeliac)
Genetic (CF)
Cow’s milk allergy
Intestinal neuropathy (Hirschsprung disease)

Question 5

Name 5 red flags for an organic cause of constipation

Answer 5

Delayed meconium passage as infant
Abdominal distension
Failure to thrive
LL neurology
abnormality in anus/buttocks/sacrum
PR blood loss

Question 6

Name 3 other causes of faecal incontinence (encopresis) than overflow incontinence

Answer 6

Psychogenic/psychological
Neurological injury
Infection (causing diarrhoea)
Learning disability

Question 7

Are Ix usually warranted in a child with constipation?

Answer 7

No - trial treatment first

Question 8

Name 3 interventions for a child with chronic constipation

Answer 8

Disimpaction if severe - paraffin oil to lubricate stool, rarely give enemas

Toileting education - encourage regular toileting, reward even if no poo comes out, educate on correct position (footstool to ensure knees higher than hips, legs apart, bulge tummy out), toilet ring over seat if needed (get rid of fear of falling in), keep a stool chart/diary

Long-term laxatives (for months, even if constipation resolves) - paraffin oil, movicol (osmotic softener)

May require stimulants (senna + bisacodyl)