3.2 Constipation

Question 1

Is constipation in children common? What must you consider?

Answer 1

• idiopathic or functional is most common
• consider secondary causes

Question 2

5 classic Hx or features of constipation?

Answer 2

Presentation

• stool less <3 a week
• rabbit dropping stools
• retentive posturing
• overflow soiling
• rectal bleed, pain, straining, loss of sensation of need to poop

(Rectum can be repeatedly impacted and desensitised)

Question 3

8 secondary causes of constipation?

Answer 3

SECONDARY:

• Hirschsprung’s disease
• Cystic fibrosis (particularly meconium ileus)
• Hypothyroidism
• Spinal cord lesions
• Sexual abuse
• Intestinal obstruction
• Anal stenosis
• Cows milk intolerance

Question 4

What is encopresis?

Answer 4

Term for faecal incontinence

Question 5

When is encoparesis considered pathological?

Answer 5

Considered pathological once child is 4yr or older

Question 6

Causes of encoparesis?

Answer 6

Usually from chronic constipation, rectum stretched and loses sensation.

Rarer causes: spina bifida, Hirschsprung’s, CP, learning diff, abuse, psychosocial stress

Question 7

8 constipation red flags and possible causes?

Answer 7

• no meconium in 48hrs; Hirschsprungs or CF
• neuro Sx especially in LL; CP or cord lesion
• vomit; obstruction or Hirschsprungs
• ribbon stool; anal stenosis
• abnormal anus; stenosis, IBD, abuse
• abnormal back or buttocks; spina bifida, sacral agenesis
• failure to thrive; coeliacs, hypothyroid, neglect
• acute severe pain and bloating; obstruction or intussusception

Question 8

Management of idiopathic constipation?

Answer 8

Dx can be made without Ix in absence of red flags

• high fibre diet and good hydration
• start laxatives (MOVICOL 1st)
• faecal impaction may need high dose laxative regime to start off
• encourage praise for visiting toilet; schedule visits, bowel diary, star charts.

(continue laxatives longterm and slowly wean off)