Constipation in Children Flashcards
What is the definition of constipation in children?
A child that defecates less than 3 times per week
or
Significant difficulty passing stool.
What is chronic constipation associated with in children?
Hard pellet like stool that is difficult to pass.
How are most cases of constipation in children described?
Idiopathic or functional constipation
What is functional constipation due to?
Lifestyle factors
What are possible causes of constipation in children?
- Low fibre diet
- Dislike of using toilet
- Pain on passing stool
- Anal fissure
- Not recognising sensation of needing to pass stool
What underlying conditions can constipation be a sign of?
Hirschsprung’s disease (MAIN)
Cystic fibrosis
Hypothyroidism.
What are features of constipation?
- Hard stools that are difficult to pass
- Rabbit dropping stools
- Straining and painful passages of stools
- Abdominal pain
What is retentive posturing?
Holding an abnormal posture
What might you be able to feel on a constipated child?
Hard stools may be palpable in abdomen
What do you need to check for in children before treating the constipation?
Faecal impaction
What is faecal impaction?
Inability to evacuate large hard inspissated concreted stool or bezoar lodged in the lower GI tract
What are symptoms of faecal impaction?
- symptoms of severe constipation
- overflow soiling
- faecal mass palpable in the abdomen
What are red flag symptoms of constipation?
- Not passing meconium within 48 hours of birth
- Neurological signs or symptoms, particularly in the lower limbs
- Vomiting
- Ribbon stool
- Abnormal anus
- Abnormal lower back or buttocks
- Failure to thrive
What is the first line management if faecal impaction is present?
Polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) using an escalating dose regimen
What disease causes chronic constipation?
Hirchsprung’s disease
What is Hirschsprung’s disease due to?
Absence of ganglion cells from myenteric and submucosal plexuses
How does Hirchsprung’s disease occur?
As the baby develops in utero, the distal colon is not innervated correctly.
The resulting aganglionic colon is shrunken and not able to distend properly.
What does an aganglionic colon cause?
Back pressure of stool trapped in the more proximal colon.
How can Hirschsprung’s disease present at birth?
- a delay in passing meconium (>48 hours)
- a distended abdomen
- forceful evacuation of meconium after digital rectal examination
How can Hirschsprung’s disease present later in childhood?
Chronic history of constipation
Poor response to movicol disimpaction regimens
Poor weight gain.
How can the diagnosis of Hirschsprung’s disease be confirmed?
Full-thickness rectal biopsy
What is the initial management of Hirschsprung’s disease?
Rectal washouts initially
What is the definitive management of Hirschsprung’s disease?
Removal of the section of aganglionic colon- Anorectal pull through procedure
