Bowel movements have been an important issue in almost every culture throughout history, and regular bowel habits have been accepted as an indicator of good health. On the other hand, historical information about constipation in children could not be reached, and the definition of constipation varied until recent years.
3-5% of children visiting pediatric clinics apply with the complaint of constipation. This rate rises to 35% in those who apply to the pediatric gastroenterology clinic.
Which children are considered constipated?
In practice, children who poop infrequently, hurt while pooping, or both, may be considered constipated. The American gastroenterology community has considered constipation as constipation when the child is infrequent or forced to poop for 2 weeks or more, and this becomes an uncomfortable situation for the family. On the other hand, in a period of 8 weeks, the European community has been affected by situations such as pooping less than 3 times a week, incontinence more than once a week, pooping hard and big enough to block the toilet, poop masses that are palpable in the abdomen or rectum examination, the child’s unwillingness to poop and feeling pain while pooping. Having at least 2 of them describes the condition as constipation.
How does constipation develop in a child?
Most children have no underlying cause. In general, after a painful poop, the child delays pooping, thinking that it will hurt every time he poops. In each delay, the last part of the intestine (rectum) where the poop is collected begins to expand by adapting to this situation, and the feeling of pooping decreases in the child. As this feeling begins to subside, the newly formed poop begins to accumulate even more in the rectum and the rectum begins to expand gradually. This situation, which develops in a vicious cycle, causes constipation to go into advanced stages and over time, poop incontinence begins.
In which period is constipation common?
In infancy, the period in which the transition from breast milk to formula, the addition of solid foods to the diet and the transition from formula to cow’s milk are made.
It is common in children, usually when toilet training starts. In this period, they may develop pain after diaper dermatitis, pain when they poop hard after being dehydrated, or constipation after confrontation with their parents.
In school period, constipation may develop after children do not want to go to the toilet at school.
How is the examination of constipated children done?
The shape and location of the breech are important, if it is in front of or behind the breech, it may be the cause of constipation. The presence of cracks, fistulas or hemorrhoids should be investigated. It will also give information about the sphincter in the way the breech shrinks. The most important examination in these children is the digital examination of the rectum. Normally, it should be enough to allow the little finger to enter, and being narrower causes constipation in children. When the finger reaches the rectum, the rectum may be wide and profuse poop.
Dimple in the sacrum (dimple on the waist) may be an indication of an abnormality in the nervous system.
Which tests should be done in constipation?
The causes of childhood constipation are highly variable. These reasons should be considered one by one and investigations should be planned for suspected diseases.
The main conditions considered in chronic constipation in children without any other practical problem are Hirschsprung’s Disease (congenital megacolon) and functional constipation. Sometimes it is difficult to distinguish between these two situations.
Abdominal X-ray: In addition to giving information about how much poop is in the intestines, it also gives information about the spine. It can be especially useful in children who do not want to have a rectal examination.
Contrast radiographs (medicated film): It is useful for the anatomy of the intestines and for distinguishing Hirschsprung’s Disease.
Anorectal manometry: With this test, which is used to measure rectal and sphincter pressures, functional constipation and Hirschsprung’s Disease can be differentiated.
Rectal biopsy: In prolonged constipation that cannot be treated and functional constipation is definitively excluded, a small piece of the rectum can be taken for pathological examination. With this method, the nerve structure can be examined and Hirschsprung’s Disease can be diagnosed definitively.
How should it be treated?
In children who are diagnosed with functional constipation without underlying diseases and Hirschsprung’s Disease, treatment is mainly carried out in 3 stages. It is to empty the poop that has accumulated in the large intestine, to prevent the child from feeling pain while pooping and to give the child a regular bowel habit.
Emptying hard poop that has accumulated in the large intestines is one of the important steps in treatment. This can be achieved with oral medications, or it can be done with rectal enemas.
The second step of the treatment is that the child does not feel pain while pooping. After the hard poops accumulated in the large intestine are emptied, the painful poop sessions should be ended by ensuring that the child poops softly while pooping in the following days. For this purpose, poop softening drugs can be used orally. In some cases, it may be necessary to use long-term poop softening medications. It is known that these drugs do not cause any side effects and undesirable results in the long term.
Maintaining regular bowel movements is the most annoying step in the treatment of constipation. In general, children do not want to go to the toilet, which puts a strain on families. In the morning, after breakfast and after dinner, the child should be persuaded to sit on the toilet without being intimidated. It should not be overlooked that it will take months to restore order.
What should be considered in the diet?
In addition to consuming whole wheat or whole wheat bread, fruits and vegetables rich in fiber, consuming fruits that contain complex carbohydrates and unabsorbed sugar such as plums, pears, apples and drinking plenty of water will increase the amount of water in the poop and ensure soft poop.
It would be appropriate to exclude cow’s milk from the diet, at least for a while.
Recent studies have shown that the regulation of intestinal flora plays an important role in the treatment of constipation. Therefore, adding prebiotics and probiotics to the diet can help treat constipation.
