Constipation in Children

Constipation is a condition where a person cannot pass stools regularly or unable to completely empty his / her bowel. Constipation also causes stools to be hard and lumpy and sometimes very large or small. The severity varies person to person and it can be for a short while or chronic in nature.

Constipation is a very common problem with all children but children with disabilities are the major sufferers. Mostly children with cerebral palsy, autism, spina bifida, arthrogryposis and other locomotor disabilities are prone to get constipation. Due to constipation children with disabilities can have lot of adverse effects such as behavioral problems, poor feeding, pain, rectal bleeding, social-emotional stress, and sometimes serious problems:  megacolon and bowel obstruction, etc.

Children with constipation generally have these signs and symptoms

• Several days without passing stools
•  Poor or loss of appetite
•  Feeling pain or bloating in the abdomen
•  Presence of hard stools that is difficult to pass, mostly painful
•  Sometimes bleeding from the rectum
•  Poor urine control or Urinary incontinence
•  Behavioral disorder like getting cranky

Constipation can be very mild to very severe. Constipation is generally assessed by BRISTOL STOOL SCALE. This scale has seven sub types based on mild to severe.

There are many causes of constipation. The most common are

• Poor or abnormal motility

• Low tone or hypotonia

• Structural anomalies

• Neuromuscular anomalies

• Metabolic/toxic or allergic abnormalities

• Lack of urge to defecate

• Specific Syndrome where constipation is common

• Diet containing poor fluid and poor fiber

• No mobility or poor mobility (Immobility)

• Post surgical procedures

• Consuming medicines such as strong pain killer( narcotics), non-steroidal anti-inflammatory drugs, like ibuprofen, medicines used as an antidepressant, including the selective serotonin reuptake inhibitors, antacids containing calcium or aluminum, iron pills, allergy medications, such as antihistamines, certain blood pressure medicines, including calcium channel blockers, psychiatric medications, anticonvulsant/seizure medications, anti-nausea medications, etc

• Medical and health conditions such as endocrine problems, spinal cord injury, lazy bowel syndrome, etc

Treatment of constipation is a complex method so prevention should be the first goal to manage children who are constipated. Following steps to be taken

• Increase fluid (1500-2000 ml per day)

• Increase fiber slowly (25-30 gm per day)

• Increase exercise

• Safeguard visual and auditory privacy

• Bowel Training (after waking or meals)

•  Squat position or Left side lying while bending knees and moving legs toward the abdomen

Separate exercise programs for all three groups

• For fully mobile, who can walk independently in the community

– 15-20 minutes walking twice per day, five times per week

• For Limited mobility, who can walk under supervision with or without assistive devices

– 50 feet twice per day

• For immobile, who uses wheel chair or no active form of mobility

– Pelvic tilt, low trunk rotation and single leg lift

A new but novel method in the form of massage can be effective also

An intestinal massage consists of circular, clockwise movements along the line of the colon by using the hands, permeating the ascending, transverse, and descending colon, for a period of 5–10 minutes, preferably 30 minutes after a meal, when gastrocolic and duodenocolic reflexes cause mass movements in the large intestine. An abdominal press assists in the expulsion of fecal matter, and it should be performed concurrently with an intestinal massage, by pressing the legs flexed on the abdomen. This maneuver is not indicated for patients with hip dislocation, as it may increase their pain.

Children who are constipated should avoid eating or drinking foods with little or no fiber, such as: ice cream, fast food, chips, cheese, prepared foods, processed foods, excessive amounts of whole milk

Medical and surgical management is necessary for those children where preventive measures are not fruitful.

Medications

Mostly Laxatives are prescribed. Such as

• Fiber supplements
•  Stimulants
•  Osmotics
•  Lubricants
•  Stool softeners
•  Enemas and suppositories

When laxatives are not enough to improve the condition, other medications are included. Such as   Serotonin 5-hydroxytryptamine 4 receptors, etc

Surgery

Surgery is rarely needed to treat constipation. It is recommended if constipation is caused by a structural problem in the colon.

If your child has neurodevelopmental disorder and it is associated with constipation, please contact us for detail assessment and management of this condition. We are here to help you. You can connect us through

Mail: helpicd@gmail.com Whatsapp @ +91-7838809241