Constipation: Useful and practical tips
Constipation is common in children and adolescents and in most cases is due to natural causes.
Usually, constipation leads to infrequent visits to the toilet with bulky and sometimes painful stools. Defecation is associated with discomfort and constipation is maintained as the child voluntarily or involuntarily inhibits the defecation reflex. The rectum (final part of the large intestine) is stretched by stool and the defecation reflex weakens or disappears.
A vicious cycle is thus created that can be broken with timely treatment and regular visits to the toilet.
Diagnosis
Symptoms of constipation can be difficult to interpret because children may have daily or soft bowel movements but still be constipated. In some cases, treatment may be required to make a diagnosis.
To make a diagnosis of constipation, at least two of the following symptoms are required each week for at least one month (according to the Rome IV criteria):
- Two or fewer bowel movements per week in a child with a developmental age of 4 years or older
- At least one episode of fecal incontinence per week
- Characteristic body position where an attempt is made to delay defecation and excessive voluntary retention of feces
- Painful defecation or hard stools
- Presence of a large fecal mass on palpation of the abdomen or rectum
- Large diameter stools that potentially block the toilet bowl
Other symptoms of constipation may include are:
- Abdominal pain during or after meals
- Irritability, change in behavior
- Floating (bloated belly)
- Feeling nauseous or decreased appetite
- Foul-smelling stools or passing foul-smelling gas
- Alternating hard and watery stools (overflow diarrhea)
- Small-diameter stools several times a day due to incomplete defecation
- Blood and pain when wiping with paper due to anal fissures
- Urine leakage and frequent urination
When is treatment with laxatives necessary?
In difficult cases constipation with excessive abdominal pain or when the child’s general condition is affected, it may be necessary, in consultation with the doctor, to administer enema therapy. Enema therapy can be unpleasant for both the child and the parent and is not a first-line treatment.
When the general condition of the child or adolescent is relatively good, oral therapy for a few days is preferably given before administering an enema to soften the stool. Oral therapy should follow the enema.
Many children with a history of constipation may suffer repeatedly and therefore need regular medical monitoring and counseling.
Stool Patterns – Bristol Stool Chart
The Bristol Stool Chart is a reliable clinical tool that assesses stool consistency and transit time. It is useful in recording bowel movement frequency and describing stool consistency in patients. The clinician can draw conclusions about the patient’s bowel transit time and diet, as well as evaluate the patient’s treatment and any underlying conditions or bowel disorders that may be present.
Types 1-2: Tendency to constipation
Types 3-4: Normal stools
Types 5-7: Tendency to diarrhea and urgent bowel movements
Contact the doctor immediately in cases where there are:
- Vomits of green, red or brown/black color
- Severely distended abdomen
- Blood-tinged stools
- Poor weight gain, poor growth
- Stools of very small diameter
- Ulcers, fissures or change in the appearance of the anal ring
In cases with an affected general condition or severe acid abdominal pain, urgent clinical evaluation is recommended.
Treatment
Treatment of constipation takes time. Treatment is associated with:
- A varied and balanced diet with insoluble and soluble fiber
- Sufficient water intake
- Physical exercise
- Regular bowel habits
- Medication
The goal is soft stools without accompanying discomfort or leakage – EVERY DAY!
Bowel habits- Toilet routines
It is recommended to try to defecate for 5-10 minutes , 2-3 times each day. Preferably at set times related to the main meals in order to benefit from the gastrocolic reflex activated by the meal (stimulates intestinal motility). Recommended:
- Stable and at the same time relaxed body position. High stool for support under the feet.
- Children wearing diapers should be helped by parents in a squatting position on the lap or in a lying position with the knees drawn up to the chest.
- Urinating in a sitting position – stimulates the defecation reflex
- Do not postpone a visit to the toilet!
Every effort should be encouraged, even if it is not effective. Parents should set routines and supervise to ensure they are followed.
Medication
Common drug categories:
- Oral osmotic laxatives: Macrogol 3350, Lactulose, Milk of Magnesia
- Stool softeners: paraffin oil
- Stimulant laxatives: bisacodyl, senna, castor oil, sodium picosulfate
- Enemas: bisacodyl, sodium phosphate, paraffin oil
Early initiation of treatment improves the long-term outcome, creates less fear of pain during defecation and facilitates the feeling of the need to defecate. The intestine regains its normal function.
Most oral medications:
- need to be taken daily
- need fluids to work properly
- remain in the intestine, are excreted with the feces and do not affect other systems
- are not addictive and do not have serious side effects
- sometimes create a temporary feeling of discomfort when bowel movements increase
-The correct dose for daily and soft bowel movements may differ from child to child. Once the correct dosage is found, it is good to maintain it.
-After 3-6 months with regular bowel movements, the dose of medication can be slowly reduced after consultation with the doctor. In case of recurrence of constipation symptoms, the dose should be increased.
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