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Constipation in kids
July 13, 2012 by Dr. Mandar V. Bichu
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Constipation in kids

In an age where children’s diet has centered round chips, chocolates, candies, cookies and colas, constipation has become an increasingly annoying problem. Managing constipation is a task which needs the clear understanding of the underlying mechanism and often, it involves changes in life style of the child. Let’s see what exactly goes wrong when your kid is habitually constipated and how to get around that problem.


What is constipation?

Constipation is not just about the reduced frequency of stools. Many a time, babies who are mainly on milk feeds pass stools every 2 or 3 days but till the time their consistency remains soft and normal, this doesn’t constitute constipation.  When infrequent passage of stools is also associated with dry and hard stools that are difficult to pass, then only it qualifies as constipation.


What is encopresis?

Encopresis is involuntary passage of stools beyond the age when bowel control is usually achieved. This kind of day-time or night-time soiling by formed stools beyond the anticipated age of toilet training (4-5 years) is often a complication associated with constipation.


What are other problems associated with constipation?

Passage of very hard stools can lead to injury and cause bleeding and fissure formation in anal region. Abdominal distension, abdominal pain and anorexia are also commonly associated with it. Overflow diarrhea can occur when the accumulating fluid leaks around hard masses of stools. In very severe cases, there can be stool impaction and intestinal obstruction. As the stool- loaded bowels exert pressure on urethra to partially obliterate it, there is an increased risk of developing urinary tract infections.


What are the causes of constipation?

The commonest variety of constipation encountered is called ‘Functional constipation’ where there is no organic abnormality responsible for it. It accounts for 90-95% of constipation cases above the age of 1 month. 

Organic causes include congenital abnormalities of bowel like Hirschsprung disease; metabolic abnormalities like dehydration, hypothyroidism and cystic fibrosis; drugs like iron preparations and painful conditions of anus like an abscess or a fissure. Narrowing of the anal canal as in anal stenosis or anal stricture – which might be congenital or acquired following surgical intervention also can cause constipation and so do spinal cord abnormalities like spina bifida or spinal tumors.

As a rule, constipation in neonatal period and in infancy needs to be evaluated more carefully to rule out these organic causes but later on the functional variety is the more likely cause.


How does functional constipation develop?

Development of this form of constipation has a psychological basis and is mostly related to faulty toilet training. If such training is too vigorous and coercive then passing stools becomes a negative experience for the toddler. Such a toddler then starts voluntarily withholding stools as a method of expressing his rebellion or sometimes simply fearing that the soiling might be punished by parents. Unfamiliar surroundings (hospital, relative’s house, school etc.) often induce reluctance to void stools in later years. Painful passage of stools anytime can cause fear for defecation later on.

This soon develops into a vicious cycle where voluntary holding, stool retention and painful defecation keep on perpetuating each other. This excessive retention of stools distends the rectum and reduces its sensitivity, necessitating even more stool- accumulation to initiate the urge to void stools.

Faulty diet which is low in fiber and inactive life- style with lack of exercise are usually found in such children and they serve only to worsen the situation.


How do we treat constipation?

A thorough physical examination and a good history, mostly provides enough information to paediatrician to rule out serious, organic causes. Investigations like Barium enema and other tests are needed only when such causes are suspected.

For a functional, non-organic type of constipation, the management involves participation of both parents and the child sufferer. All of them should be explained how the constipation develops and should be asked to identify the problem areas in their particular case.

Steadfast parental attitudes about bowel control often need correction. It should be emphasized that this problem is not something which could just vanish by popping in medicines and needs a permanent change in life style to correct itself.


Five things to do to cure constipation:-

Ø  Regular physical exercise, ensuring adequate water/ fluid intake and improving fiber content of food are the cornerstones of treatment.

Ø  Cut down on fast food. Fruits (oranges, ripe bananas), bran, cereals and green leafy vegetables should form the main portion of diet. In infants addition of fruit juices to milk feeds is often necessary.

Ø  Don’t make toilet seat a battle- ground! Pressurising the child about having ‘good’ bowel habits is counter-productive. Explain the things gently and be patient about the result which often takes long (few weeks to few months) to achieve.

Ø  Child should be made to understand that he has to follow a particular toilet timings same time every day. Usually a 10- minute period on a toilet seat is sufficient.

Ø  Laxatives (Lactulose, Magnesium preparations, Bisacodyl), lubricants (Mineral oil, glycerine suppositories) and enemas have only a limited role in management. Only your doctor should decide how these medicines are to be used. Usually these medicines are used to break the ‘retention-pain’ vicious cycle initially but it’s the changes in diet, activity and psychological make-up which finally cure this problem!

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