GI - constipation

Question 1

define Faecal impaction

Answer 1

chronic constipation causing large build-up of hard stools in the rectum and bowel.

The stool blocks the rectum, and the child stops being able to open their bowels.

The only stools that can get past the impaction are very loose and tend to be smelly.

It can lead to overflow soiling with smelly loose stools.

Question 2

define constipation

Answer 2

An extremely common condition affecting children characterised by decreased frequency, increased harness of the stool and painful defecation.

Question 3

what is idiopathic or functional constipation

Answer 3

when there is no underlying physical cause other than lifestyle and environmental factors

Question 4

what are some lifestyle and environemntal factors that cause idiopathic constipation

Answer 4

Reduced fluid intake
Reduced fibre intake
Reduced physical activity
Psychosocial issues (e.g., toilet training problems, stress or abuse)

Question 5

secondary causes of constipation

Answer 5

Hirschsprung’s disease
Cystic fibrosis (particularly meconium ileus)
Hypothyroidism
Medications (e.g., antihistamines or opiates)

Question 6

sx of constipation

Answer 6

• Reduce frequency of bowel movements
• Hard or large stools that are difficult to pass
• Rabbit-dropping stools (small round stools)
• Straining
• Painful passage of stools
• Overflow soiling (incontinence of particularly smelly loose stools)
• Rectal bleeding associated with hard stools
• Abdominal pain
• Holding an abnormal posture, referred to as retentive posturing

Question 7

how does constipation present on examination

Answer 7

Hard stools may be palpable on abdominal examination

Inspection of the anus is required to look for abnormalities such as infection, fissures, fistulas or bruising.

no DRE in kids

Question 8

what is a cause of infectious constipation

Answer 8

Perianal group A streptococcal infection

causes pain and erythema (redness) at the anus and surrounding skin.

treat with abx

Question 9

what are some red flags that indicate a serious underlying condition and require prompt referral

Answer 9

• 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 10

complications of constipation

Answer 10

Pain
Anal fissures
Haemorrhoids
Overflow and soiling
Psychosocial morbidity

Question 11

how is idiopathic constipation diagnsoed

Answer 11

clinically

Question 12

Behavioural and lifestyle interventions for constipation

Answer 12

Sufficient fluid intake
Sufficient fibre intake
Sufficient physical activity
Regular attempts to open the bowel (e.g., after each meal)
Bowel movement chart
Encouragement systems (e.g., star charts)

Question 13

medical treatment for constipation

Answer 13

1. Macrogol laxatives (e.g., Movicol paediatric)
2. Stimulate laxatives (e.g., Senna) second-line

Question 14

how do paediatrc macrogol laxatives work

Answer 14

by drawing water into the stool, making it softer and easier to pass. T

Question 15

how to maintain regular bowel movements after constipation meds

Answer 15

Disimpaction regimen may be needed with high dose of laxatives at first followed by half the disimpaction dose as maintenance