Constipation
Constipation in children:
What is constipation?
Constipation is when the stool frequency of a child is reduced than normally he/she does or the child has very hard stools which are difficult to pass. It is a very common GI (gastrointestinal) problem in children.
What are the signs which help parents to identify constipation in their child?
- Having fewer than normal bowel movements. Constipation is usually defined as stool frequency less than 3 times in a week. Parents should remember that number of bowel movements may be different in each child. But a change in what is normal for your child may indicate there is a problem.
- Passing hard and sometimes large stool
- Bowel movements that are difficult or painful to push out
What causes constipation in your child?
Stool gets hard and dry when the colon (large intestine) absorbs too much water. Normally as food moves through the large intestine water gets absorbed and stool is formed. Normal colonic contractions move the stool down towards the rectum. While stool gets into the rectum, most of the water has been absorbed. Thus stool is now solid.
If your child has constipation, colonic contractions are too slow. So, the stool movements become very slow through the colon. The colon absorbs too much water. This makes the stool very hard and dry.
Once your child becomes constipated the thing gets worsened quickly. A child faces difficulty to push out hard and dry stool. So the child may stop going to the bathroom because causes pain. So stool gets accumulated in the rectum. Over the times rectum will not able to sense that stool is there and the rectum gets dilated.
There are many reasons for childhood constipation. Some of the common diet and lifestyle causes are:
Diet:
- High fat and low fiber diets like fast foods, soft drinks, and junk food
- Not drinking adequate water
- Recent changes in the diet. This includes breast milk to formula, semisolid to a solid diet.
Lack of outdoor activities (exercise):
- Spending a lot of time with TV, playing a video game and android phones
Busy children:
Children sometimes don’t pay attention to the urge of defecation and voluntarily hold the bowel movement. This can happen while the child is busy in school or playing and forget to go to the washroom. Nowadays early morning school schedule is an important cause. Children get up late in the morning and rush to school without going to the washroom.
Emotional issues:
- Not wanting to use a public bathroom or bathroom in the school. So, the child may hold bowel movements, causing constipation.
- Mental stress – because of school, friends, or family
There may be an underlying physical problem:
In the majority of children with constipation, no underlying causes are found (90% of cases) but in 10% of cases, there may be underlying causes that need to be diagnosed.
This includes:
- Problems of the intestinal tract, rectum, and anus
- Nervous system problems, like cerebral palsy (CP), tethered cord
- Endocrine problems – hypothyroidism, hypercalcemia
- Drugs – iron supplements, antispasmodics (used commonly for pain abdomen), narcotics (codeine in cough syrup)
What are the usual symptoms of constipation?
- Not having motions for a few days
- Passing hard and dry stools with difficulty
- Abdominal bloating and pain
- Not feeling hungry
- Small liquid or soft stool staining the underwear
- Showing signs of trying of holding a stool (withholding maneuver) like clenching teeth, crossing legs, squeezing buttocks together, and turning red in the face. Sometimes children hide self behind the door or under the cot when they feel the urge for motion.
The symptoms of constipation can be like other health problems. So, make sure that your child is evaluated by your doctor for a diagnosis.
How is constipation diagnosed in your child?
Your doctor will ask about your child’s symptoms and will examine them clinically in detail. Depending on your child your doctor will ask you the following questions –
- How old was your child when he or she had constipation?
- When did your baby pass meconium (first stool after birth)?
- What is the stool frequency in a day?
- Does your child have pain while passing stool?
- Does your child have vomiting or abdominal distension?
- What food does your child eat?
Your doctor may ask for a few tests after detailed evaluations.
These tests may include:
- Digital rectal examination – your doctor puts a lubricated gloved finger into the child's rectum to look for any abnormality.
- Abdominal X-ray – this test will detect how much your child's large intestine (colon) is loaded with stool.
- Barium enema – this is a special X-Ray of the rectum, done after administration of radiological dye (barium solution) into the rectum. This test is done to detect narrowed (stricture), blockage (obstruction), or other problems in the rectum and colon.
- Anorectal manometry – this test will check the strength of the muscles and nerve of the rectum. It is also the test to detect Hirschsprung’s disease which is one of the causes of constipation.
- Colonic transit study – done with special markers (a special type of pills) which your child will be instructed to take orally X-ray abdomen will be taken periodically (at 12 hours, 36 hours, 60 hours, 90 hours). This X- rays will detect the movement of the pills through the colon.
- Lab testing – this includes thyroid testing, celiac disease testing, metabolic problems.
All tests are not required in a particular child. It depends on the clinical scenarios of your child.
Treatment of constipation:
Treatment of constipation will depend on your child's age, symptoms, and general health. It will also depend on the severity of constipation that means the child having constipation with fecal loading or without fecal loading.
Treatments include the following –
- Diet changes – your child diet needs to be modified. It should include plenty of fiber-rich foodstuffs and plenty of water. Junk food should be restricted
- Lifestyle changes – a child should be engaged in outdoor activities, screen times should be restricted.
- Toilet training- It should be started after 2 ½ -3 years of age. A child should be asked to sit in the toilet for the motion after a major meal.
- Medication – depending on the severity and age of your child your doctor will advise Polyethylene glycol (PEG), a laxative which you have to give your child on regular basis for sometimes. Sometimes your child may need hospitalization for a day for treatment if your child is young below 5 years with impacted fecolith (stoolball in the rectum).
These medications should only be used if recommended by your doctor. Do not use it without taking consultation from a doctor.
The underlying cause of constipation, such as celiac disease, thyroid problems if detected, need to be taken care of.
What are the complications of constipation?
- Anal fissures: Hard stools can tear the lining of the anus (anal fissures). It causes very painful bowel movements and bleeding. Child may avoid passing stool. It further worsens the condition.
- Fecal incontinence – it means passing a small amount of semisolid to liquid stool intermittently which soils child underwear. This causes psychological impacts on the child as well as parents especially when a child started going to school. It occurs when your child having constipation for a long time or because of inappropriate treatment.
When you should call your child’s gastroenterologist for constipation?
You should consult your pediatric gastroenterologist if your child:
- If your child constipated for more than 2 weeks
- Can’t do normal activities for constipation
- Has liquid of soft stool leaking out of the anus and soiling the underwear
- Has a small tear on anal mucosa (anal fissures)
- Has red, swollen veins in the rectum (Piles)
- Pain abdomen, abdominal distension, or vomiting
