![]() ![]() Lack of a bowel movement in first 48 hours suggests Hirschsprung disease Timing of first bowel movement after birth It is important to see if pain is relieved or affected by defecation (may suggest irritable bowel syndrome) rule out other causes because abdominal pain is often misdiagnosed as being related to constipation May suggest stools that are hard enough to produce fissures or that are associated with an allergy Infants younger than one month with constipation have a relatively greater likelihood of an organic etiology Larger, hard stools may be a sign of withholding normal bowel movement frequency associated with symptoms may indicate irritable bowel syndrome This cycle commonly coincides with toilet training, changes in routine or diet, stressful events, illness, or lack of accessible toilets, or occurs in a busy child who defers defecation.įrequency, consistency, and size of stools Over time, as the rectum stretches to accommodate the retained fecal mass, rectal sensation decreases, and fecal incontinence may develop. ![]() Withholding of stool can lead to prolonged fecal stasis in the colon with reabsorption of fluid, causing the stool to become harder, larger, and more painful to pass. Parents often confuse these withholding behaviors as straining to defecate. To avoid the passage of another painful bowel movement, the child will contract the anal sphincter or gluteal muscles by stiffening his or her body, hiding in a corner, rocking back and forth, or fidgeting with each urge to defecate. 2, 10 Functional constipation is most commonly caused by painful bowel movements that prompt the child to voluntarily withhold stool. Outside of the neonatal period, childhood constipation is usually functional (i.e., there is no evidence of an organic condition). Referral to a subspecialist is recommended only when there is concern for organic disease or when the constipation persists despite adequate therapy. Education is equally important as medical therapy and should include counseling families to recognize withholding behaviors to use behavior interventions, such as regular toileting and reward systems and to expect a chronic course with prolonged therapy, frequent relapses, and a need for close follow-up. An increase in dietary fiber may improve the likelihood that laxatives can be discontinued in the future. ![]() Polyethylene glycol–based solutions have become the mainstay of therapy, although other options, such as other osmotic or stimulant laxatives, are available. Successful therapy requires prevention and treatment of fecal impaction, with oral laxatives or rectal therapies. Further evaluation for Hirschsprung disease, a spinal cord abnormality, or a metabolic disorder may be warranted in a child with red flags, such as onset before one month of age, delayed passage of meconium after birth, failure to thrive, explosive stools, and severe abdominal distension. Often, a medical history and physical examination are sufficient to diagnose functional constipation. Stool retention can lead to fecal incontinence in some patients. Childhood constipation is common and almost always functional without an organic etiology. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |