Pediatric Gastroenterology

Constipation in Pediatric Gastroenterology

Nurse smiling at a young boy on the exam table

A regular pattern of stool excretion is conceived to be a sign of health in children irrespective of their ages. Particularly during the first months of life, mothers pay close attention to the characteristics and frequency of their kids' defecation. In most cases, a parent may be worried if they noticed that their child's stool is too infrequent, too hard, painful and too large. This may be a sign of constipation.

Constipation can be defined as a diminution in either the frequency of bowel movements or the painful passage of the bowel movements. On average, kids between the ages of 1 to 4 years should have bowel movements 1 to 2 times in a day. Whenever a child is constipated, he may begin to bemire their underwear. This fecal bemiring is commonly involuntary, and the children do not have control over it.

How Prevalent is Constipation?

Constipation prevails in children of all ages, more so in school-aged kids and when potty-training. About 3% of all visits to the pediatrician are in some manner related to constipation. Of all the visits to a pediatric gastroenterologist, 25% are due to problems linked to constipation. Every year, millions of prescriptions are issued for stool softeners and laxatives.

Causes of Constipation

Typically, constipation is defined as functional or organic. For organic constipation, it means there is a distinctive cause such as a neurological problem or colon disease. Fortuitously, most constipation problems are functional. This means there is no identifiable cause. Functional constipation is still problematic, but there is usually no perturbing cause behind it.

In some infants, difficulties and straining in the expelling fecal matter (often a soft one) are because of their uncoordinated defecation and unfledged nervous system. Besides, it is worthy comprehending that even some healthy breastfed babies can go for some days without having a bowel movement.

In children, constipation can commence during toilet training, when there are changes in the routine or diet, or after an illness. From time to time, children could hold ordure when they are loathing using unfamiliar toilet facilities. Summer or school camps with facilities that are not private or clean enough are common initiations for ordure withholding in this age group.

Once a child has constipated for more than a couple of days, the retained stool can fill up the large intestine (colon) causing it to stretch. An overstretched large intestine cannot work properly, and more stools will be retained. Therefore, defecation becomes very afflictive, and as a result, many children will try to withhold the fecal matter.

Some of the behaviors of withholding include crossing the legs or tightening up buttock or leg muscles and tensing up when the urge to urge to pass a bowel movement is felt. In most of the times, these withholding behaviors can be misread as attempts to push the fecal matter out. Retention of the stool will worsen constipation and make the treatment process challenging.

Signs & Symptoms

  • If the child has small or hard stools, which are painful or difficult to pass
  • If the child systematically skips days without experiencing regular bowel movements
  • If the child passes large fecal matter that clogs the toilet
  • Crankiness, stomach pain and/or poor appetite
  • Bleeding because of a fissure (tear in the anus because of passing hard stool)

In most cases, it does not necessitate for testing before treatment for constipation. However, at times, depending on the asperity of the problem, you doctor may demand x-rays or other relevant rests for a better clarification of the problem.

Constipation Diagnosis

A pediatric gastroenterologist may use various methods to diagnose your child with constipation.

Medical History

A thorough medical history of the child is recommendable as part of a full evaluation. Some of the significant information that your doctor may need to know include:

  • The time for the first bowel movement after birth
  • The period for which the condition has been present
  • What the parent or the child defines constipation as
  • The size and consistency of stool
  • The frequency of bowel movements
  • Whether there is pain during defecation
  • Presence of abdominal pains
  • Whether there has been blood in the fecal matter

Some, parents, may mistake soiling for diarrhea. If there is a history of stool withholding, the chances of an organic disorder are reduced. Medications are a significant potential cause of constipation. Abdominal distension, anorexia, fever, weight loss, nausea, and poor weight gain may be signs of an organic disorder.

Physical Examination

For a complete evaluation and diagnosis, a proper physical examination is advisable. It is of the essence to have an external examination of the perineum and perianal area. It is recommended to have at least one digital examination of the anorectum. The anorectal examination helps in assessing any presence of anal wink, the size of the rectum, anal tone, and perianal sensation. A test for occult blood in fecal matter is necessary for children with constipation as well as any kid with intermittent diarrhea, a family history of colonic polyps, failure to thrive, and abdominal pains.

Constipation Treatment

Various factors determine the treatment of constipation in children including personality, age and the source of the problem. Some kids may only require alterations in diets such as increases in fresh fruits intake, water intake per day and fiber. Other patients may need medications such as laxatives and stool softeners.

It helps a great deal to begin bowel-training routine where your child sits on the toilet for about 5 to 10 minutes before or after the evening bath and after every meal. To encourage good habits, it is advisable to do this in a consistent manner. Praise your kid for trying it. If you have not trained your child yet, it is best for you to wait until the constipation is controlled.