Constipation is a very common paediatric problem in children, so you are not alone.
For practical clinical purposes, constipation is generally defined as infrequent defecation, painful defecation, or both. In most cases, parents are worried that their child’s stools are too large, too hard, not frequent enough, and/or painful to pass.
Functional constipation that is not due to organic or anatomic causes is encountered most commonly. ‘Encopresis’, also known as faecal incontinence, is faecal soiling that occurs in the presence of chronic functional constipation. Occasionally, a parent will misinterpret the signs of encopresis as diarrhoea.
When the constipation is severe and if it has been a longstanding problem since early infancy, it is necessary to visit a Pediatrician and rule out an underlying organic disorder.
Do check specifically about intermittent large stools, because some children with constipation will have a daily bowel movements but with incomplete emptying and retention of a large stool mass.
The most common causes of Constipation in children are:
— Functional constipation.
— Behavioural/ situational constipation (phobias, abuse, toilet training).
— Milk protein intolerance.
— Irritable bowel syndrome .
— A diet history 🙁 ingestion of large amounts of cow’s milk )
— Metabolic causes:( Hypercalcemia, hypokalaemia lead toxicity, hypothyroidism, celiac disease)
— Anorectal lesions (fissures, haemorrhoids, Hirschsprung disease , abscess, trauma)
— Anorectal malformations (stenosis, anterior anal displacement, ectopic anus, imperforate anus)
— Abnormal abdominal musculature (prune belly, gastroschisis)
— Spinal cord lesions (tethered cord, spina bifida)
— Neurologic (Botulism, cerebral palsy, myotonic dystrophy)
— Connective tissue disorders (SLE, scleroderma).
— Meconium ileus (i.e., small bowel obstruction) appears in the Newburn period in approximately 10% of infants with cystic fibrosis.
How can we establish the actual diagnosis?
— Via proper assessment of history (Excessive cow’s milk intake, Poor diet, Toilet training problems etc.)
— Complete physical examination.
— Consider: Free T4/ TSH, Calcium, Lead, Electrolytes, Celiac panel (TTG) as needed.
— Consider: Abdominal x-ray ,Barium enema ,Referral for rectal manometry/ rectal biopsy as need.
The Medical management:
— Osmotic laxatives : polyethylene glycol, lactulose ,Magnesium hydroxide.
— Lubricants : mineral oil.
— Stimulant Laxatives : Senna , Bisacodyl .
The Surgical Management if needed, is guided according to the underlying cause of constipation.
Mothers and fathers, if your child is suffering from constipation this SHOULD NOT BE NEGLECTED, otherwise the child will suffer from serious complications in the long run.
