Paeds: Constipation

Question 1

Definition

Answer 1

Painful passage of hard infrequent stools

Question 2

Causes

Answer 2

organic common
Organic uncommon
Psychological

Question 3

Organic common

Answer 3

Following acute febrile illness or transient superficial anal fissure

Question 4

Organic uncommon

Answer 4

Hypothyroidism
Hypercalcaemia
Hirschsprung’s disease

Question 5

Psychological

Answer 5

• Forceful potty training
• use of uncomfortable lavatories
• Psychological family stress

Question 6

Psychological children may:

Answer 6

1. Refrain from defeacation due to fear of associated pain
2. Rectum becomes full and over-distended
3. With time sensation of needing to defaecate is lost
4. Involuntary soiling

Question 7

Signs

Answer 7

• Abdominal mass

- Stool present down to anal margin

Question 8

Management from mild to severe constipation

Answer 8

• Dietary fluid and fibre
• Stool softners (lactulose or docusate).
• Stimulant laxatives (sodium picosulphate or senna).
• High volumes of oral polyethylene glycol solutions (Klean-prep) given ofd until stools are liquid
• enemas or manual evacuation under anaesthetic