Constipation with overflow

Question 1

What is constipation in childhood

Answer 1

defined as infrequent stool passing, large stools, and in children often painful defecation

in children often leads to withholding which makes it worse and leads to overflow diarrhoae

usually functional cause - start from acute event, leading to withholding and cycle
diet/low fibre/dehydration/etc

if early in life consider other causes -hirshprungs, atresia, obstruction, malrotation, merkels, etc

absuredely common. -always consider as cause of abdo pain

RF -low fibre diet, low nutrient diet, low fluid intake, infection, stress, obesity
ADHD, autism etc
or idiopathic

Question 2

Signs and Sx of constipation in childhood

Answer 2

importantly the child is healthy, growing and gaining weight

painful defecation with delay between stools
Abdo pain and PALPABLE mass (often LIF)
hard stools, large volume -
incontinence can appear temporarly after passing a stool

passage of liquid/soft of small volume stool -OVERFLOW diarrhoae

can also find-
anal fissures (sign of abuse as well be careful)
Bladder issues -large stool presses on bladder -causing urgency or enuresis
obtrusction - bilious vomiting very rarely if super impacted

if early in life consider other causes -hirshprungs, atresia, obstruction, malrotation, merkels, etc

Question 3

Ix of constipation in childhood

Answer 3

baseline -child should be healthy -normal HR, BP, RR, temp, O2 etc

usually no test needed -start de-impaction regime and see if it works

if early in life consider other causes -hirshprungs, atresia, obstruction, malrotation, merkels, etc

if needed –
AXR -stool burden or signs of other causes
AXR with radiopaque marker
Abdo USS-can see softer stools and bladder
Pelvis USS- can see rectal stools and bladder effects

Question 4

Treatment of constipation in childhood

Answer 4

the main thing is - de-impaction regime for the child with Movicol
dont want to increase peristalsis in case of obstruction

If not impacted –//always first line -DIET
increase fibre intake, increase water intake,
Reward diaries in case of painful movements -encourage child to go to bathroom

impacted–
1st line - osmotic laxative -eg lactulose/movicol
2nd line -stool softners -docusate sodium suppositories
those 2 esp good with witholding behavours -

want to do this for about 2 weeks with a few sachets
then move to maintenance dose

very very persistant -specialist and possible surgery

Question 5

complications and prognosis of constipation in childhood

Answer 5

anal fissure - very common but also care (abuse)
Overflow diarrhoea
abdo pain
dehydration in result from osmotic laxatives
megarectum -dilation of rectum from stools

obtrusction - bilious vomiting very rarely if super impacted

prognosis is great -most dissapear during childhood
can become persistant if not managed well