Constipation in children is a common cause for parents to take them to see a doctor. Constipation in children is a source of much anxiety for parents. Fortunately, constipation is often correctable once the cause is determined. Indeed, many cases of constipation in children go away on their own.

How is constipation defined?

Dr. Brett Hodge

In many Caribbean countries, including Anguilla, there are many definitions of constipation. In order to understand what constipation is, it is important to realise that how often a child has a bowel action varies tremendously. Some children have a bowel action once a day, others once a week without any difficulty whatsoever. Individuals tend to have their own patterns of bowel movement frequency. Constipation may be defined as the difficult passage of hard or firm stools, and does not necessarily involve an alteration in the frequency of defecation. If the interval between the passage of hard stools is prolonged, the condition is termed extreme constipation or obstipation. Constipation is often accompanied by painful defecation or faecal impaction.

Constipation in babies
Babies have to learn to pass stool and during the first few weeks they may grunt, seem fussy or even seem to be straining before passing stool. This is often a sign that they are learning to pass a stool rather than constipation. A baby is considered to be constipated only if the bowel movements are hard, painful and/or associated with signs of discomfort such as abdominal pain or crying while passing a stool. Stool-frequency in breast fed babies can vary even more, for example, from 8-12 per day to one bowel movement every few days. This does not mean the baby is constipated.

What are some of the causes of constipation in children?
The causes of constipation can be either functional or organic. In functional constipation, the bowel is anatomically normal but its function is altered. In organic constipation there are obvious anatomical and obstructive lesions of the bowel causing obstruction.

Causes of functional constipation include the following:
• Dietary manipulation
• Malnutrition with underfeeding
• Excess feeding on cow’s milk or mixing of formula with insufficient fluid
• Habitual
• Metabolic and endocrine disturbances
• Mediations including over the counter drugs
Causes of organic constipation include the following:
• Stricture or stenosis of the bowel
• Painful conditions of the anus (anal fissure, abscess, and fistula)
• Neuromuscular abnormalities
• Local intrinsic factors

Constipation commonly occurs when the child doesn’t drink enough water, milk or fruit juices or if the child does not eat a healthy diet that includes enough fibre.

Children often ignore the urge to have a bowel movement and may become constipated. The child may be too busy playing or having fun to go to the bathroom and this could lead to constipation.

How is constipation diagnosed?
Diagnosis relies on history and physical examination. A detailed drug history is needed as many drugs, such as anticonvulsants, diuretics (water tablets), antacids and supplemental iron preparations, are associated with constipation. In some cases other investigations may be needed; for instance X-ray of the abdomen and other special tests.

Are there problems associated with constipation?
Constipation commonly causes abdominal pain and discomfort. It can also cause small tears known as fissures in the anal area. These should be treated as they can cause pain with the child refusing to have a bowel movement because of fear of further pain, thus making the constipation worse. In a very small number of cases a child may be born with an abnormality in the muscles of the bowel which can cause constipation. This condition is called Hirschprung’s disease which can be corrected surgically. It is very rare in Anguilla and most of the cases of constipation in children in Anguilla are not associated with bowel abnormalities.

Treatment
This will obviously depend on the underlying cause. The correction of associated anatomical or metabolic abnormities is essential. In cases where no organic causes are found, various conservative approaches are used. These include the following:

Diet - Increasing the amount of fluid a child drinks everyday can help prevent and treat constipation. Prunes or prune juice can also help constipation. A high fibre diet is very important. Children who have poor fibre intake tend to be more constipated. High fibre foods include: fruits, vegetables, brown bread, cereals and popcorn.

Bowel habit training - Your child should be taught not to wait to have a bowel movement. Have your child establish a regular bowel habit. Ask him/her to sit on the toilet for at least 10 minutes at about the same time every day, preferably after a meal.

Oral medications - You should ask your family doctor about the use of various medications for constipation.

Suppositories and enemas are available over the counter but they should only be used on prescription by, and under the care/supervision of a doctor.

If you think your child has constipation and does not improve with conservative measures you should consult a health care provider as he/she may need further evaluation.

Conclusion
Constipation is very common in children and can be the cause of much anxiety for parents. Children vary in the frequency of bowel actions and each child often develops his/her own pattern. Parents must be aware of this. The definition of constipation is based mostly on the presence of symptoms of discomfort rather than the frequency of passing stool. The vast majority of constipation in children is functional, that is there is no underlying anatomical problem in the bowel. The majority of cases of constipation in children can be successfully treated once the cause is determined. Parents are encouraged to pay special attention to the eating patterns of their children as lack of adequate fluids and poor intake of foods high in fibre content are associated with constipation.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

| Printer-friendly page | Send this article to a friend |

World News