What is constipation?

Constipation is the inability to consistently pass stools or the passage of stools that are very hard. Constipation is said to as chronic if it persists for longer than 8 weeks. If there are no structural or functional causes, it is referred to as "idiopathic constipation."

What causes this problem, and how common is it?

Constipation is a common problem in children. In routine Paediatric practice, ~ 10% of children present with constipation. It is noted in the first year of life in 17-40% of cases, 95% of cases of constipation are functional, and only 5%are due to organic reasons.

Recent years have seen a considerable decline in outdoor playtime due to a sedentary lifestyle brought on by the internet, television, and mobile devices. In this way, the child tries to delay urination. Changes in infant formula, bottle feeding, weaning, and insufficient intake could cause it in a child under a year old. Toilet training in toddlers, as well as acute occurrences like infections, moving, starting nursery or school, fears and phobias, significant family change, anticonvulsants, antacids, and cold drugs, can all cause constipation. This has caused the prevalence of functional constipation to rise.Hirschsprung's disease, hypothyroidism, nerve system issues, and lead toxicity are just a few examples of the organic causes.

What are the symptoms?

  • Having fewer than two bowel movements per week.
  • Having stools that are hard, lumpy, or dry, or having stools that are painful or
  • difficult to pass,
  • Expressing to you that they feel some stools have not yet passed.
  • Altering their posture to prevent or delay a bowel movement, such as standing
  • on tiptoes and then rocking back on their heels.
  • Experiencing a large stomach or bloating
  • Having daytime or nighttime wetness
  • Having what appears to be diarrheal excrement in their underwear.

When to see your doctor?

  • Persistence of constipation beyond 8 weeks
  • When the child is standing to pass stools or straining significantly to defecate
  • Child is afraid to evacuate or cries while passing stools
  • Pain or Bleeding while
  • passing stools
  • 'Ribbon stools’ (more likely in a child younger than 1 year)
  • Abdominal distension
  • with vomiting accompanied by constipation
  • Urinary tract symptoms like retention of urine, urine infection or incontinence
  • Failure to pass meconium/delay (more than 48 hours after birth in a full-term baby)

How is it diagnosed?

Primarily by gathering medical history and performing a clinical examination that includes a rectal exam. The abdomen is swollen and the perineum appears abnormal in cases of pathological diseases. The lower abdomen or the area around the navel may feel sore. Asymmetry or flattening of the spine, discoloured skin, naevi, or hairy patches may all be signs of abnormality. Lower limb deformity could be connected.

To confirm and determine the precise cause of constipation, a plain x-ray of the abdomen and a contrast enema is performed.

What are the treatments available?

Home remedies include an increase in dietary fibre, e.g. green leafy vegetables, fresh fruits and drinking plenty of water. Isabgol husk also adds dietary fibre. Sitz bath and application of a moist, warm cloth to the anus gently help in pain relief and relaxation. For relief of hard stools, medicines like oral Lactulose, Sodium Picosulfate, Polyethylene glycol with Electrolytes, Bisacodyl, and Docusate Sodium may be required. A doctor usually prescribes these. Glycerine Suppository could be inserted or a simple enema may be necessary if the stools are impacted. Suppose the child does not settle with conservative management. In that case, surgical diseases, e.g. Hirschsprung’s disease and other organic disease cases, should be looked for and referred to higher centres with Paediatric surgical services.

Are there any alternatives to surgery?

Yes. Functional constipation does not require surgery. Adequate liquid and fibre consumption, along with lifestyle modifications, may cure the problem.

What does the operation involve?

If the child does not settle with conservative management, then surgical treatment is necessary. A manual disimpaction of stools may need to be done through the anus, quite often under a general anaesthetic. For the diagnosis of Hirschsprung’s disease, a rectal biopsy is necessary. Further surgical requirement entails the removal of the defective intestine and the joining of the upstream normal intestine to the anus.

What are the possible complications / what happens after the operation?

After the surgery for Hirschsprung’s disease, most of the children start passing normal stools. However, some children present with post-operative complications like abdominal distension, vomiting, faecal mass in the abdomen and diarrhoea, which is due to overflow incontinence of stools. Rarely, constipation may persist or recur.

What is the outlook or future of these children?

The majority of the patients having constipation do well with medical management and appropriate dietary management. Recurrence depends on the patient’s long-term compliance with therapy. Post-treatment, these patients often experience a greatly improved quality of life

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