Constipation

Question 1

What is the most common type of constipation in children?

Answer 1

Idiopathic constipation or functional constipation

This type indicates no significant underlying cause other than lifestyle factors.

Question 2

List some possible secondary causes of constipation.

Answer 2

• Hirschsprung’s disease
• Cystic fibrosis
• Hypothyroidism

Question 3

What is considered a normal frequency of bowel movements in children?

Answer 3

Varies between individuals; breast-fed babies may have as little as one stool a week

Question 4

What are typical features in history and examination that suggest constipation?

Answer 4

• Less than 3 stools a week
• Hard stools that are difficult to pass
• Rabbit dropping stools
• Straining and painful passages of stools
• Abdominal pain
• Retentive posturing
• Rectal bleeding associated with hard stools
• Faecal impaction causing overflow soiling

Question 5

What is encopresis?

Answer 5

Faecal incontinence, usually a sign of chronic constipation

It is not considered pathological until 4 years of age.

Question 6

List some rarer causes of encopresis.

Answer 6

• Spina bifida
• Hirschsprung’s disease
• Cerebral palsy
• Learning disability
• Psychosocial stress
• Abuse

Question 7

What lifestyle factors can contribute to constipation?

Answer 7

• Habitually not opening the bowels
• Low fibre diet
• Poor fluid intake and dehydration
• Sedentary lifestyle
• Psychosocial problems

Question 8

Fill in the blank: Patients may develop a habit of not opening their bowels and lose the sensation of needing to open their bowels, leading to _______.

Answer 8

[faecal impaction]

Question 9

What are some secondary causes of constipation?

Answer 9

• Hirschsprung’s disease
• Cystic fibrosis
• Hypothyroidism
• Spinal cord lesions
• Sexual abuse
• Intestinal obstruction
• Anal stenosis
• Cow’s milk intolerance

Question 10

What are red flags that may indicate serious underlying conditions causing constipation?

Answer 10

• Not passing meconium within 48 hours of birth
• Neurological signs or symptoms
• Vomiting
• Ribbon stool
• Abnormal anus
• Abnormal lower back or buttocks
• Failure to thrive
• Acute severe abdominal pain and bloating

Question 11

What are some complications of constipation?

Answer 11

• Pain
• Reduced sensation
• Anal fissures
• Haemorrhoids
• Overflow and soiling
• Psychosocial morbidity

Question 12

What is the first-line treatment for idiopathic constipation in children?

Answer 12

Movicol (laxatives)

A diagnosis can be made without investigations if red flags are considered.

Question 13

What management strategies are recommended for treating constipation?

Answer 13

• Correct reversible contributing factors
• Recommend a high fibre diet and good hydration
• Start laxatives
• Encourage and praise visiting the toilet
• Continue laxatives long term and wean off as normal bowel habits develop