When the Bowels Won't Move - The Constipated Child

If a child passes less than 3 stools per week and there is associated difficulty in passing them, then it is called constipation. Some normal breastfed babies pass soft stools every 2nd or 3rd day without difficulty. This is not constipation because there is no associated difficulty in passing stool. A child may pass stool daily but if there is accompanying difficulty in passing it (due to hard consistency or size) then also it is called constipation.

Initial constipation may be due to:

Change in routine diet

Various illnesses

Stressful events

Unavailability of toilets (travel etc.)

Child's busy schedule (morning school)

Leads to large, hard stools

These cause pain during defecation

May lead to fissures or cuts near anus

More pain during every subsequent passage of stool

Stool-withholding due to fear of pain

Stools become drier, firmer, and larger

Further increase in constipation

Most of the cases of constipation (almost 95%) are precipitated and perpetuated by these events. Other causes of constipation in children are:

Spinal cord lesions

Cerebral palsy

Congenital Megacolon (Hirschsprung¡¯s disease)

Anal stenosis

Hypothyrodism

Diabetes insipidus

Hypercalcemia

Codeine containing cough syrups

Anti-epileptic drugs

Anti-psychotic drugs

Once the viscous cycle of constipation ¨C painful defecation ¨C stool withholding ¨Cconstipation sets in the child refuses to sit on the toilet, rises on his toes, holds his legs and buttocks stiffly and often rocks back and forth, holds on to a furniture, screams, turns red until the stool is passed. With time, such withholding behaviour becomes an automatic reaction.

MANAGEMENT:

Most children with constipation will benefit if proper treatment plan is implemented under the guidance of a Paediatrician with active involvement of parents.

1. Disimpaction (Clearing of retained stools)

In a child having constipation a hard mass may be felt in the lower abdomen due to impaction of fecal matter (stool). Sometimes multiple, small, hard, masses may be present. The first thing to do in such cases is to disimpact (remove) the retained stool.