All you need to know about Constipation - Dr. Arun Aggarwal

All you need to know about Constipation - Dr. Arun Aggarwal

Constipation is a common problem in children of all ages. A child with constipation may have bowel movements less frequently than normal; hard bowel movements; or large, difficult, and painful bowel movements.

WHY CONSTIPATION DEVELOPS

Pain — when the child does have a bowel movement, it can be painful and lead them to withhold (avoid going) in an effort to avoid more pain.

On occasion, a child may develop a tear in the anus (called an anal fissure) after passing a large or hard bowel movement. The pain from the tear can lead to withholding. Even infants can learn to withhold because of pain.

Unfamiliar surroundings — Children may delay moving their bowels if they do not have a place where they feel comfortable having a bowel movement, or if they are busy and ignore the need to use the toilet. This can happen when a child starts going to school and avoids having a bowel movement because of hygiene concerns or being embarrassed about using the toilet at school.  

Medical problems — Medical problems cause constipation in less than 5 % of all children. The most common medical problems that cause constipation include Hirschsprung disease (an abnormality of nerves in the colon), abnormal development of the anus, problems absorbing nutrients, spinal cord abnormalities, and certain medicines.  

How often should my child have a bowel movement? — It depends on how old he or she is:

●In the first week of life, most babies have 4 or more bowel movements each day. They are soft or liquid.

●In the first 3 months, some babies have 2 or more bowel movements each day. Others have just 1 each week.

●By age 2, most kids have at least 1 bowel movement each day. They are soft but solid.

●Every child is different. Some have bowel movements after each meal. Others have bowel movements every other day.

How will I know if my child is constipated? — Your child might:

●Have fewer bowel movements than normal

●Have bowel movements that is hard or bigger than normal

●Feel pain when having a bowel movement

●Arch his or her back and cry (if still a baby)

●Avoid going to the bathroom, do a "dance," or hide when he or she feels a bowel movement coming. This often happens when potty training and when starting school.

●Leak small amounts of bowel movement into the underwear (if he or she is toilet trained)

Constipation is particularly common at three times in an infant and child's life: after starting cereal and puréed foods, during toilet training, and after starting school. Parents can help by being aware of these high-risk times, working to prevent constipation, recognizing the problem if it develops, and acting quickly so that constipation does not become a bigger problem.

Transition to solid diet — Infants who are transitioning from breast milk or formula to solid foods may experience constipation. An infant who develops constipation during this time can be treated with one of the measures described below.

Toilet training — Children are at risk for constipation during toilet training for several reasons.

●If a child is not ready or interested in using the toilet, he or she may try to avoid going to the bathroom (called withholding), which can lead to constipation.

●Children who have experienced a hard or painful bowel movement are even more likely to withhold, and this only worsens the problem.

School entry — once your child starts school, you may not be aware if he or she has problems going to the bathroom. Some children are reluctant to use the bathroom at school because it is unfamiliar or too "public and this can lead to withholding.

What if my child gets constipated? — In most children with mild or brief constipation, the problem usually gets better with some simple changes. Have your child:

●Eat more fruit, vegetables, cereal, and other foods with fiber

●Drink some prune juice, apple juice, or pear juice

●Drink at least 32 ounces of water and drinks that aren't milk each day (for children older than 2 years)

●Avoid milk, yogurt, cheese, and ice cream

●Sit on the toilet for 5 or 10 minutes after meals, if he or she is toilet trained. Offer rewards just for sitting there.

●Stop potty training for a while, if you are working on it

When should I take my child to the doctor? — You should have your child seen if:

●He or she is younger than 4 months old

●He or she gets constipated often

●You have been trying the steps listed above for 24 hours, but your child has still not had a bowel movement

●There is blood in the bowel movement or on the diaper or underwear

●Your child is in serious pain

Steps of medical management-

1.       Clean out

2.       Maintenance treatment

3.       Rescue treatment

4.       Behavior changes

5.       Dietary suggestions

What is fecal incontinence in children? — Fecal incontinence in children is when a toilet-trained child has bowel movements in places other than the toilet. It happens when a child loses control of his or her bowels. For example, a child might leak a bowel movement into his or her underwear or have a bowel movement while asleep.

Another term for fecal incontinence is "encopresis."

What causes fecal incontinence in children? — Constipation is the most common cause of fecal incontinence in children. Constipation can make bowel movements hurt. A child with constipation might try to avoid having bowel movements. Then the nerves and muscles that control the release of bowel movements stop working as well as they should. This can make bowel movements build up inside the body. But some can leak out anyway. This causes fecal incontinence.

Other causes of fecal incontinence can include:

●Problems with toilet training

●Emotional stress or changes in a child's schedule

●Some medical conditions

Should my child see a doctor? — If your child often leaks bowel movements in his or her underwear or has bowel movements in places other than the toilet, talk to your doctor.

Will my child need tests? — Maybe. The doctor will do an exam and talk with you and your child. Most children don't need tests. But if your child does, possible tests can include:

●An X-ray of the belly – This can show if bowel movements have built up inside the body.

●Blood tests – To check for a medical condition that could cause fecal incontinence.

●Urine tests – Some children with fecal incontinence also have daytime wetting or wet the bed at night. A possible cause of this is a urinary tract infection.

How is fecal incontinence in children treated? — That depends on the cause. For fecal incontinence from constipation, doctors can:

●Give medicines to get rid of bowel movements that have built up – This treatment is sometimes called a "clean out."

●Give medicines to help your child have normal bowel movements – These medicines are called "laxatives." They make bowel movements easier to get out.

●Show you how to help your child develop good bowel habits. Here are some things you can do:

•Have your child sit on the toilet for a few minutes after each meal.

•Give your child rewards for sitting on the toilet, whether he or she has a bowel movement or not.

•Keep track of when your child has bowel movements – This gives you and the doctor more information on any problems.

•Stay positive and calm, even if your child still has fecal incontinence sometimes – Avoid scolding your child. This can be stressful and make the problem worse.

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