Constipation in infants and children; Although it is known as not pooping, it does not just mean the prolongation of the defecation interval. Every baby and child has a defecation pattern that they are used to. Constipation is defined as the disruption of this order, which varies depending on eating habits and age, and the sum of the findings that occur afterwards. Briefly, late (rare) defecation, difficult defecation and hard defecation for more than two months are called chronic constipation.
Problems in the intestinal structure, congenital anatomical problems, familial intestinal slowness and wrong food selection, exaggerating milk consumption, feeding with solid food constantly, not going to the toilet when needed, fear of pain in children are the main causes of constipation in children. Breastfed babies may poop 7-10 times a day in the first days after birth, and then 5-7 times a day. The number of defecations may be less or more.
During this period, poop is watery and soft. However, it should be known that it is natural for babies who take breast milk not to poop, sometimes up to a week. In infants, unless there is excessive or bilious vomiting, significant abdominal distention, and developmental arrest or regression, this should be considered normal and no treatment or intervention should be undertaken. After switching to solid foods, the stool starts to thicken and solidify.
At the same time, the number of defecations decreases. The number of defecations, which is 1-3 per day in a school-age child, reaches the frequency seen in adults during adolescence. Constipation; It can cause hard and painful defecation, tear/crack formation in the anus (anal fissure), blood in the stool, delay hiding and defecation when defecation is needed, abdominal pain especially after meals, irregular eating and deterioration of toilet habits. .
Although these problems are actually the result of constipation, they can also be the cause of the onset of constipation in a child. For example, a tear in the anus for any reason may cause pain during defecation, causing the child to hold his poop and constipating after a while. In case of recurrent constipation despite long-term and applied treatments, some behavioral disorders may occur in the child.
As a result, the most appropriate definition for constipation is a change in defecation habits and the emergence of the above-mentioned findings accordingly.
Problems caused by constipation in children:
1. Long defecation interval: It is the change in the frequency of usual defecation. For example, the frequency of defecation of a child who poops once a day increases to 3-4 days.
2. Change in the quality of defecation: It is the loss of the usual consistency of the stool and its transformation into a harder one. This situation usually changes depending on the change in the diet.
3. Forced and painful defecation: It is the child pushing himself, crying or feeling pain during defecation. These children often have anal fissures (tears) together.
4. Abdominal pain: Shortly after meals (about 10 minutes), the gastrocolic reflex begins and the intestines begin to move. This leads to the need to defecate. In cases of ongoing constipation, these bowel movements manifest as cramp-like abdominal pain.
5. Blood in the stool: It is the condition that occurs due to the hardened stool causing a tear in the anus. It appears in the form of fresh blood smeared in the stool.
6. Stool retention (storage): Constipation can be both a cause and a result. The most important reason is the fear that pain may occur during defecation. It can become a habit after a while. It is one of the most difficult problems to solve in treatment. Waited stool remains hard in the last part of the intestine, and as it stays, more water is absorbed and becomes harder. The child then begins to poop little by little, and this is called ‘fecal incontinence’. It is a manifestation of advanced constipation.
7. Constipation does not give similar symptoms in every child. The severity and effects of complaints vary from child to child. Communicating with these children may not be easy. Therefore, it is useless to apply the general rules directly in the treatment of constipation in children.
Treatment methods that include “multiple approaches” should be applied to each child, based on the findings specific to that child. This is the point where modern treatment has reached today: instead of applying the standard treatment to each patient, applying the treatment methods specific to each patient!
8. However, it should be kept in mind by both physicians, parents and adults that the treatment of constipation in children is a long-term process that requires patience.
No response or discontinuation of treatment because the symptoms have resolved may cause the symptoms to occur more intensely than the first. A diet containing more fiber-containing foods and regular toilet habits are indispensable in the treatment of constipation. • 50% of cases under the age of five recover within one year, and 60-75% within two years. It is known that in one third of school-age children, it extends until adolescence. Is it necessary to research patients with chronic constipation?
• 95% of cases have functional (idiopathic) reasons (cases requiring investigation of organic causes, approximately one in 20 cases). They do not have any structural, endocrine or metabolic problems
• 5% of the cases are of organic origin. These; o If there is a history of constipation that starts in newborns and early infancy o Delayed emergence of meconium o Thin stool, blood in stool, tight anal sphincter, empty rectum on touch o If there is growth and development retardation o Abdominal distention, ileus, biliary vomiting o Lower extremity reflex and tone decrease, anal reflex weakness, pilonidal dimple, absence of cremaster reflex o Anus located anteriorly
Treatment: The aim is to remove the accumulated lumps and prevent re-accumulation. Treatment of functional constipation is long and relapses are frequent. Doctors should work closely with the family when treating a child with constipation. For this purpose, a large number of drugs that increase mass, increase bowel movements and lubricate in many intestines are used. The experience of the physician in this matter is very important, many physicians use the drugs with which they are most satisfied with the results. How should babies and children be treated for constipation?
1. Information about nutrition is important. As a general rule, it is necessary to consume plenty of pulpy vegetables and fruits, and to limit the consumption of bagged foods bought from grocery stores and markets.
2. Toilet training. Sitting on the toilet at appropriate times of the day so that the intestines can catch the cyclical rhythm. Enabling the child to use the toilet seated rather than squatting (use of toilet bowl and potty according to age). Adapter in the toilet, use of steps to keep the feet on the ground. Also in terms of the habit of spending time in the toilet, having objects such as TV, toys, etc. that may attract attention
3. Treating the anal fissure, if any, and taking precautions.
4. Evacuation of the accumulated poop with the help of ready-made enemas
5. Necessary and sufficient poop softening drug supplement to prevent the hardening of the newly formed poop in the intestine. The main point of treatment is adequate continuation of the necessary treatment. It does not mean that the constipation of the child or the baby has passed while the drugs are being used.
Families should patiently continue this long-term treatment. The timing of drug reductions or discontinuation must be given by the doctor. We have to use the emollients that we use in the treatment of constipation for our patients, mostly for 1.5 – 2 years. Mostly, we reduce our medications gradually.
In conclusion:
Most of the applications due to chronic constipation are functional (idiopathic) constipation
•Organic constipation requires diagnostic investigations and treatment for the cause
• Evidence for the efficacy of constipation treatments is weak, treatment is largely based on clinical experience
• Childhood constipation is a long-term problem that requires months or years of treatment
