Constipation with overflow Flashcards
What is constipation in childhood
defined as infrequent stool passing, large stools, and in children often painful defecation
in children often leads to withholding which makes it worse and leads to overflow diarrhoae
usually functional cause - start from acute event, leading to withholding and cycle
diet/low fibre/dehydration/etc
if early in life consider other causes -hirshprungs, atresia, obstruction, malrotation, merkels, etc
absuredely common. -always consider as cause of abdo pain
RF -low fibre diet, low nutrient diet, low fluid intake, infection, stress, obesity
ADHD, autism etc
or idiopathic
Signs and Sx of constipation in childhood
importantly the child is healthy, growing and gaining weight
painful defecation with delay between stools
Abdo pain and PALPABLE mass (often LIF)
hard stools, large volume -
incontinence can appear temporarly after passing a stool
passage of liquid/soft of small volume stool -OVERFLOW diarrhoae
can also find-
anal fissures (sign of abuse as well be careful)
Bladder issues -large stool presses on bladder -causing urgency or enuresis
obtrusction - bilious vomiting very rarely if super impacted
if early in life consider other causes -hirshprungs, atresia, obstruction, malrotation, merkels, etc
Ix of constipation in childhood
baseline -child should be healthy -normal HR, BP, RR, temp, O2 etc
usually no test needed -start de-impaction regime and see if it works
if early in life consider other causes -hirshprungs, atresia, obstruction, malrotation, merkels, etc
if needed –
AXR -stool burden or signs of other causes
AXR with radiopaque marker
Abdo USS-can see softer stools and bladder
Pelvis USS- can see rectal stools and bladder effects
Treatment of constipation in childhood
the main thing is - de-impaction regime for the child with Movicol
dont want to increase peristalsis in case of obstruction
If not impacted –//always first line -DIET
increase fibre intake, increase water intake,
Reward diaries in case of painful movements -encourage child to go to bathroom
impacted–
1st line - osmotic laxative -eg lactulose/movicol
2nd line -stool softners -docusate sodium suppositories
those 2 esp good with witholding behavours -
want to do this for about 2 weeks with a few sachets
then move to maintenance dose
very very persistant -specialist and possible surgery
complications and prognosis of constipation in childhood
anal fissure - very common but also care (abuse)
Overflow diarrhoea
abdo pain
dehydration in result from osmotic laxatives
megarectum -dilation of rectum from stools
obtrusction - bilious vomiting very rarely if super impacted
prognosis is great -most dissapear during childhood
can become persistant if not managed well