Constipation in Children
Medivia Hospital Pediatric Surgery Specialist, who is also a pediatric urologist. Dr. Hamit Okur stated that the most important issue affecting the success in the treatment of constipation can be provided by the mother, child and physician trio with good interaction.
Constipation can be defined as defecation later than two days, stool being too hard, stool difficulty, stool incontinence at least once a week, painful and hard stools. Children who make stools every day despite painful and hard stools should also be considered constipated. The number of defecation varies with the age of the child. While infants may have defecation between 4-10 days, the number of defecation related to feeding type and diet decreases in older children and in older ages, it returns to defecation once a day.
Your baby must have the first faeces (meconium) within the first 24 hours after birth. If 48 hours have passed since birth, it has not had its first defecation (if it has not removed meconium) and / or if it has had hard and intervention defecation from birth, it is best to have your baby examined by a pediatric surgeon for an underlying organic cause.
Constipation is less common in breast-fed infants. This is due to proteins and oligosaccharides found in breast milk. In addition, breast-fed infants are fed more frequently, which has a positive effect on bowel movements. The frequency of defecation and consistency of the baby are the two most important criteria for constipation.
Causes of Constipation in Infants:
Inadequate fluid consumption during transition from breast milk to supplementary foods
Excessive consumption of milk and dairy products
Lack of fiber in the diet
Breech obstruction that prevents normal defecation, non-normal position of the breech or no neural structure providing normal defecation
How is constipation in infants treated?
First, a full examination should be performed by a pediatric surgeon for the presence of an organic cause that may cause constipation. In the presence of an organic cause, treatment is planned for it.
Breast milk should be given to the baby for as long as possible. Adequate fluid consumption should be ensured during and after the transition from breast milk to additional nutrition.
Care should be taken to ensure that prepared foods are prepared appropriately.
It may be beneficial to have the baby bathe frequently with warm water and massage the belly after bathing.
Fruit puree and vegetable soups may be helpful in keeping with the baby's age.
Medications recommended by your doctor may be used if these do not resolve constipation.
Constipation in Children
Constipation is a very common condition in children and can become chronic if it is not treated properly. The most common cause of breastfeeding is transient constipation and transient occurrence in children during the transition to supplementary foods or adaptation to toilet training. In addition to this, the causes of constipation that require treatment may be organic reasons due to an underlying disease or functional causes, which are the most common conditions.
1. Organic Causes
Congenital anatomic disorders (breech obstruction, etc.)
Congenital intestinal nerve tissue diseases (Hirschsprung Disease, etc.)
Diseases of the gastrointestinal tract
Diseases involving the nervous system
There are a wide range of organic causes, such as connective and muscle tissue diseases, but these are rarely diagnosed as a cause of constipation.
2. Functional Constipation (Habitual Constipation)
Functional constipation can be described as stool holding action. There is no underlying organic cause. It is the most important cause of constipation in children. It is seen in children who voluntarily keep their stool or not. It occurs for familial, environmental, social and cultural reasons. Keeping child excrement due to reasons such as separation from family, going to school, caregiver problems, incompatibility with siblings, incompatibility with friends, school failure etc. for social reasons or not wanting to go to the toilet due to hygienic reasons outside the home, not being able to quit the game, etc. . The feces accumulated in the last part of the intestine, defined as the rectum, harden and solidify over time. Difficult to throw out. In the meantime, cracks (fissure) occur around the breech. These cracks then cause painful defecation and the child is afraid of making feces and the feces accumulated in the rectum become harder and will be discarded. This leads to a vicious circle. The stool accumulated in the rectum involuntarily infects the undergarment from time to time, and involuntary defecation occurs, which we call encompresis. If this condition persists, the nerves and muscles involved in defecation become lazy and the event enters a difficult-to-treat process.
Does Constipation Cause Urinary Problems?
Yeah. Another negative effect of constipation is that the hard stool in the rectum causes urinary problems by compressing the bladder and urinary tract. Urinary problems such as urinary incontinence, urinary tract infection, bladder urinary escape (vesicoureteral reflux), involuntary bladder contractions are also undesirable conditions that may develop as a result of constipation.
How is constipation diagnosed?
A full history of feeding status, stool habit and control, time of onset and course of constipation is taken from birth. Congenital constipation usually suggests an organic cause, such as the underlying Hirschsprung Disease. Constipation that occurs in later ages suggests a functional cause. A complete physical examination is performed for the cause. Breech examination and rectal examination is performed for breech fractures (anal fissure) or breech problems. The abdomen is evaluated by x-ray film. If necessary, a bowel x-ray with barium is taken and if Hirschsprung's disease is considered, a rectal biopsy is performed. In some cases, more detailed tests, called anorectal manometry, can be performed.
Should Constipation Be Treated?
Yeah. The aim of the treatment of constipation in children is to ensure that your child defecates normally and regularly. For this, it is necessary to keep the stool soft and prevent painful defecation and stool leakage. When the stool accumulated in the rectum is not thrown out, it hardens in the rectum and becomes a large mass. During the removal of this hard stool, cracks occur around the breech and they cause pain. The child avoids defecation and a vicious cycle table appears. Hard stool may only need to be removed by enema, etc. Hard stools that accumulate in the rectum and are not thrown away can cause lazy sensory nerves and the child may not feel the need to poop. In addition, undesirable conditions such as fecal incontinence are encountered with the effect of pressure. Constipation must be treated first to prevent urinary problems. If constipation is not treated in a timely fashion, treatment may become very difficult in the future.
Motivation is important in treatment. Constipated children should not be blamed, should be motivated in a positive way. It should be noted that constipation is a treatable condition, but it can be overcome by good dialogue and patience between the family, the child and the physician.
First of all, if there are crack-like conditions in the rectum due to constipation, they should be treated. If hardened feces are present in the rectum, it may be necessary to empty the rectum and intestines by enema. If Hirschsprung's Disease, breech obstruction or other organic causes, which may be the cause of constipation, have been identified, the cause-related treatment is planned.
If your child does not have an organic cause, the social and psychological condition that may cause functional constipation should be corrected. Good information should be given to both the family and the child.
There are three basic principles in the treatment of constipation:
1. Diet Treatment:
What should be done?
Fiber foods should be given weight and adequate fiber intake should be provided. For this, whole wheat bread should be consumed, vegetable dishes should be given weight and plenty of fruit should be consumed. Fruit such as apples should be eaten without peeling their skin, and fiber fruits such as apricots, grapes and figs should be provided according to the season.
Regular eating habits should be provided. Especially breakfast should not be neglected and the habit of eating three meals should be provided.
A glass of warm water should be placed on the hungry stomach in the morning.
Don'ts:
Excess tea, coffee and cola drinks should not be consumed.
The consumption of ready-to-eat foods called fast-food should be minimized.
The intake of foods such as biscuits, crackers, wafers and chocolates should be restricted, especially between meals.
If your child is older than one year, he should not consume more than half a liter of milk per day.
Consumption of rice, pasta and bananas should be reduced.
2. Restoring Toilet Habits
Due to constipation, the intestines became lazy and sensory nerves were weakened. Therefore, in order to regain the toilet habit, it is aimed for your child to go to the toilet after every meal and especially after breakfast, even if there is no need for defecation and to activate the sensory nerves by sitting in the toilet for at least 5 minutes. It is important to put steps under your feet and keep your knees slightly above the hip level to allow young children to sit comfortably in the toilet. If your child tells you that it hurts toilets, remove them from the toilet and then put them back in the toilet. When you need defecation during the day, let him go to the toilet without waiting. Warn your child not to keep his feces, especially when he is in school and have him go to the toilet. The goal is to regain the habit of defecation once or twice a day. For this, the “Defecation Diary” can be kept and your child can be motivated.
If your child has fecal incontinence, never punish them.
Pay attention to genital and anal cleansing.
3. Drug Treatment
Stool softening drugs, enemas and creams may be recommended to keep the intestines working, to prevent stool accumulation and to make painless defecation, but they should not be used unconsciously unless recommended by the doctor.
Sample Treatment for Chronic Constipation:
Start the appropriate diet and intestinal regulator medication as recommended by your doctor.
When you wake up in the morning, drink a warm glass of water. Then have your normal breakfast. After breakfast, apply the cream recommended by your doctor around the rectum and apply suppositories or enemas.
After five minutes, have your child sit on the toilet and wait five minutes for defecation. If there is no defecation, remove it from the toilet. You can continue this treatment for 5-10 days. If defecation does not occur at all, consult your doctor. If defecation occurs, discontinue the administration of suppositories and enemas, and continue the bowel regulator for one month. Follow the nutritional advice during this process and check with your doctor again at the end of one month.
4. Biofeedback Treatment
Biofeedback teaches the use of sphincter muscles. It can be recommended in cases of resistant constipation that do not respond to other treatments.
As a result,
Constipation in children is a condition that must be treated. Treatment should not be late. If left untreated, growth retardation, psychosocial problems, adaptation problems caused by fecal incontinence, breech fractures caused by hard stool and breech bleeding due to these may cause serious problems in the treatment of urine; The doctor, family and child should always be in touch.
26AXX
Dulcolax Laxative Suppositories, 28 Count, Fast, Reliable, and Gentle Relief from Constipation and Hard, Dry, Painful Stools Within 15-50 Minutes, Comfort Shaped Medicated Suppositories
