chronic constipation

Question 1

what is constipation

Answer 1

infrequent passage of stool

• how often
• how hard
• is it painful
• has there been a change

Question 2

what is normal stool frequency

Answer 2

• 4/day-1/wk
• depends on age and diet

Question 3

other signs and symptoms associated with constipation

Answer 3

• poor appetite
• irritable
• lack of energy
• abdo pain/distension
• withholding (scared of passing stool) or straining
• diarrhoea

Question 4

why do children become constipated

Answer 4

social:

• poor diet - insufficient fluid, XS milk
• potty training/school toilet - unpleasant/scary experience

physical:

• intercurrent illness
• medication - gaviscon, opiates, ondansetron

psychological (2y)

organic - did the child pass meconium at a normal time, Hirschsprung’s disease, hypothyroidism

Question 5

cycle of constipation

Answer 5

• need to break cycle to ease constipation

Question 6

treatment of constipation - social factors

Answer 6

• explain treatment to parents
• diet - increased fibre, increase fruit and veg, increase fluids, decrease milk

Question 7

treatment of constipation - psychological factors

Answer 7

reduce aversive factors - make going to the toilet a pleasant experience (correct height, not cold, school toilets, soften stool and remove pain), avoid punitive behaviour from parents

reward good behaviour - general praise, star charts

Question 8

treatment of constipation - soften stool and stimulate defecation

Answer 8

increase fluids

osmotic laxatives - lactulose (non-digestible sugar → increased gas and effects of sugar on teeth)

stimulant laxatives - senna, picosulphate

isotonic laxatives - movicol, laxido

Question 9

advantages of using laxatives to treat constipation

Answer 9

non-invasive

given by parents

Question 10

disadvantages of using laxatives to treat constipation

Answer 10

non compliance

side effects

Question 11

what is megarectum

Answer 11

• child holds onto poo
• rectum dilates
• rectum pushes forward on urethra
• children then don’t completely empty bladder → UTI
• megarectum also leads to soiling: faecal mass holds internal sphincter open, external sphincter is only thing holding stool in; every time the bowel squeezes the strong internal sphincter can lead to leakage of stool

Question 12

key points to treating constipation

Answer 12

give adequate treatment

• enough to make them go and make sure stool is always soft and never painful
• treat until no longer required
• expect to treat for ~ same length as hx of problem e.g. 1wk hx - 2-3wks treatment

explanation and understanding is critical to success

Question 13

treatment of severe constipation

Answer 13

empty impacted rectum

empty colon

maintain regular stool passage

slow weaning off treatment

ensure compliance and regular follow up