Guide to Managing Constipation in Children

Guide to Managing Constipation in Children: Parent’s Guide

Constipation in children is common, and it almost always has a functional cause. Some patients may experience fecal indigestion due to stool retention. A medical history and physical exam are often enough to diagnose functional constipation. If a child has red flags such as onset before the first month of life, delayed passage after birth, failure of growth, explosive stools and severe abdominal distension, further evaluation may be required for Hirschsprung’s disease, spinal cord abnormality or metabolic disorder. Oral laxatives and rectal therapy are required for successful treatment. The mainstay for therapy is polyethylene glycol-based products, but there are other options available, including osmotic laxatives or stimulant laxatives. Increased dietary fibre may increase the likelihood of laxatives being discontinued shortly. Education is as important as medical treatment and should include counselling families on how to recognize withholding behaviours, use behaviour interventions such as regular toileting, and reward systems, and expect chronic therapy with frequent relapses and the need for close monitoring. A referral to a specialist is only recommended when the organic disease is suspected or constipation persists after adequate treatment. 

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Children with constipation cost the healthcare system three times as much as children without constipation. Children with constipation are three times more expensive to the health system than children without constipation. The negative impact on quality of living can last into adulthood.

Normal Defecation Patterns

Many parents worry that their children’s bowel movements occur too rarely. In the first week of life, an infant has three to four stools a day. This decreases as they age until it reaches adult frequency in preschool. In the first few weeks of life, an infant will have three to four stools per day. This decreases to two stools per day during infancy and toddlerhood, and then once to twice a week after preschool.

Etiology of Pathophysiology

Functional Constipation can be caused by painful bowel movements, which cause the child to withhold stool. The child may contract the gluteal or anal sphincter muscles to avoid another painful bowel motion. This can be done by hiding in a dark corner, fidgeting, or rocking backwards and forwards. These withholding behaviours are often mistaken by parents for straining to urinate. The prolonged stasis of feces in the colon can cause the stool to be harder, bigger, and more difficult to pass. As the rectum expands to accommodate the retained mass of feces, the rectal sensation will decrease over time. Fecal incontinence can develop. This cycle is often triggered by toilet training, a change in diet or routine, stress, illness or a lack of toilets.

Fecal Incontinence

Incontinence female is the involuntary or voluntary passage of feces into the underwear of a child who has reached the developmental age of four years. It affects 1% to 4 % of children in school and is almost always caused by constipation. Urinary incontinence can also be linked to fecal incontinence.

Pathophysiology is not well understood in fecal overflow incontinence. Families may mistake fecal overflow for diarrhea or lack of attention. Fecal incontinence is often improved when stool retention has been treated.

Encopresis and Impaction

Encopresis

Constipation Treatment

1. Diet Changes

• Increased fibre intake will increase the bulk of the stool, making it easier to pass.
• Constipation can be relieved by drinking more fluids.

• Regular Exercise Regular exercise helps to strengthen the abdominal muscles, which help move stool out of the large bowel. Constipation can be relieved by regular exercise such as walking, playing tag, jumping rope, riding a bicycle, or swimming.
• Bowel Habits Training It’s important to teach your child to use the bathroom as soon as they feel the urge. This can be taught by having regular “toilet time.”

• Children who have soft, regular bowel movements often need medicine.
• Every day, daily medicines are taken.
• Clean-out medications are only used when a child’s stool is large and hard to pass.

• To help prevent constipation, teach your child to go to the toilet whenever he or she feels an urge. This is best taught by having a set time each day for your child to use the toilet. After your child becomes accustomed to sitting on a toilet, he might be able to relax the muscles that hold the stool. Your child will be less likely to hold in the stool if you set aside a regular time each day. The colon will return to normal size when a child stops holding in the stool.

How to schedule a daily sitting time at the toilet:

1. You and your child will benefit from patience. It is difficult to teach new skills.

2. Begin by teaching your child how to sit on a toilet even if they do not have a bowel motion.

• Start slowly with 1-2 min. Gradually increase to 10-12 minutes.
• Use a timer for your child to know how long they should sit.
• While your child is on the toilet, provide quiet activities for them to do. You can include books as ideas.
• Drawings, handheld computer games, music and books on cassette.
• Save special activities to use while on the toilet.
• Small improvements deserve praise
• Do not force or hold children on the toilet, unless they are in a medical situation.
• A behaviour specialist can guide you through this process.

3. Choose a time each day for your child’s bathroom visit.

• Regularity will help your body to develop a regular bowel pattern.
• Routines are often important to children with autism. Toilet sitting can be a part of a child’s normal schedule.
• Reduce resistance.
• Create a schedule with pictures that include bathroom time.
• Plan the toilet time according to your child’s regular bowel movements.
• Most people enjoy the morning, but children who are getting ready for school may be rushed.
• school.
• Some children enjoy the time after school.

4. Comfortable clothing for your child

• Choose a toilet that will be comfortable for your child.
• If the toilet seat is too big for your child, use a child’s seat.
• If the child’s toes do not touch the floor, use a stool.

How to teach Stooling in the Toilet

1. Make sure that your child sits on the toilet at least 1-2 times a day.

2. Empty dirty diapers or underwear in the toilet to teach “poop goes on the toilet”.

3. When you believe your child may have a stool, try to time the toilet sitting with that.

4. Try to stimulate your gastrocolic reaction before you go to the toilet. This reflex occurs after drinking or eating. This reflex allows the colon to empty the bowels immediately after eating. Try the following to stimulate your child’s reflex:

• Enjoy a meal or snack
• Warm Drink

5. Be aware of your child’s signals. Take your child to the toilet when you notice signs that he or she may need to urinate. You might see:

• Changes in facial expression
• Going to a quiet area of the house
• Straining