Constipation

Question 1

Constipation doesnt really have a set clinical definition - but roughly what does it mean

Answer 1

Infrequent passage of stool that is likely:

• painful
• difficult
• hard

Question 2

What signs may there be of constipation - other than constipation?

Answer 2

Poor appetite

Irritability

Lack of energy

Abdominal pain and/or distension

Withholding or straining

Diarrhoea - in the case of overflow incontinence

Question 3

What are the reasons a child can become constipated?

Answer 3

Social:

• poor diet (insufficient fluids, excess milk)
• difficulty with potty training or dislike of school toilets

Physical:

• intercurrent illness
• medications - eg gaviscon, opiates

Psychological

Organic causes - rare but important

Question 4

An infant has constipation - which you believe to be due to poor diet

What advice should you give to the parents?

Answer 4

­more fruit

more fibre

more veg

more fluids

less milk­

Question 5

A child is suffering from constipation which you believe to be down to psychological factors

What advice & treatment should you give?

Answer 5

Reduce adversive factors:

• Make going to the toilet a pleasant experience
  
  • Correct height
  • Not cold
  • School toilets reassurance
• Soften stool and remove pain
• Avoid punitive behaviour from parents

Tell parents not to be arseholes about it

Question 6

What medical treatments are available to soften stool?

Answer 6

Osmotic laxatives - lactulose

Stimulant laxatives - senna, picosulfate

Isotonic laxatives - movicol / laxido

Question 7

What GI risk is there to a child if they dont empty their bowels for ages / are constipated?

Answer 7

Megarectum

This can lead to UTIs as well

Other risk:

Impacted rectum