Paediatric Upper & Lower GI Disorders - Chronic Constipation Flashcards
what is constipation?
Infrequent passage of stool
- how often ?
- how hard ?
- is it painful ?
- has there been a change ?
What is normal stool frequency?
(4 per day to 1 per week)
- depends on age
- depends on diet
Wide range of normality
what can be used to assess stool
what are Other Signs and Symptoms of constipation?
- Poor appetite
- Irritable
- Lack of energy
- Abdominal pain or distension
- Withholding or straining
- Diarrhoea (or is it liquid overflow incontinence)
Child not very well
Feel better after passing stool
Why do children become constipated?
Social:
- poor diet - Insufficient fluids, Excessive milk
- potty training / school toilet (not wanting to do at school and if holding on it becoming harder)
Physical:
- intercurrent illness
- Medication (Gaviscon, opiates)
Psychological (secondary)
Organic (hypothyroidism, and more but organic causes very rare)
what is the vicious circle of constipation?
Something makes child have hard stool
Usually children of 2/3 toddler and they have a great instinct so if something is painful then they wont do it
What is the Treatment of constipation - Social
- Explain treatment to parents
- Dietary
increase fibre
increase fruit
increase vegetables
increase fluids
decrease milk
(Sort it right at the start)
what is the Treatment of constipation - Psychological
Reduce aversive factors:
- Make going to the toilet a pleasant experience - Correct height, Not cold, School toilets, Soften stool and remove pain
- Avoid punitive behaviour from parents (Help parents understand why child doing it)
Reward ‘good’ behaviour:
- General praise
- Star charts
what is the Treatment of constipation - medical
Soften stool and stimulate defecation:
- osmotic laxatives (lactulose)
- stimulant laxatives (senna, picosulphate) (Stimulant irritate lining of colon to make child go)
- isotonic laxatives (Movicol / Laxido) (Isotonic maybe best)
what are the advantages of using laxatives?
- non invasive
- given by parents
what are the disadvantages of using laxatives?
- non compliance
- side effects
constipation causes megarectum, what is it?
Get a big dilated rectum
Pushes on urethra – doesn’t empty urine fully
Child can leak stool as they have a rectum full of stool holding external sphincter open
Give adequate treatment - how much and how long?
how much?
enough to make them go and to make sure stool always soft & never painful
Overdo the treatment
how long?
- until no longer required
- related to duration of problem
However long you have had the problem is how long your gonna need to take treatment
key points:
give adequate treatment
Explanation & __________ is critical to success
understanding
what is the Treatment of severe constipation?
- Empty impacted rectum
- Empty colon
- Maintain regular stool passage
- Slow weaning off treatment
- Ensure compliance
Different shapes you take on different days
