Constipation (paeds) Flashcards
What is the definition of constipation?
Infrequent passage of stool associated with pain and difficult, or delay in defecation
What is encopresis?
involuntary faecal soiling or incontinence secondary to chronic constipation
If you continue to drink water whilst you are impacted, this will eventually leak out
How does bowel habit change from infancy to childhood?
95% of infants > 1 stool/day
95% of school children > 3 stools/week
c. 5% school children = constipated
Encoporesis/soiling oneself is only considered abnormal once a child has gained full bowel control - c.4yrs
What is the pathogenesis of functional constipation?
Painful defecation - voluntary withholding - prolonged faecal stasis and increased absorption of fluids leading to greater faecal size and harder consistency - more pain (cycle repeats)
What is the ROME IV criteria for functional constipation?
At least 2+ of the following for 3m:
Straining for >25% of defecations
Lumpy/hard stools - 1-2 on Bristol stool chart for >25% of defecations
Sensation of incomplete evacuation for >25% of defecations
Sensation of anorectal obstruction/blockage for >25% of defecations
Manual manoeuvres to facilitate defecation (digital evacuation, pelvic floor support) for >25% of defecations
<3 spontaneous bowel movements/wk
What are some non-functional causes of constipation?
Hirschprung's Anorectal malformation Hypothyroidism Spina bifda Coeliac Food allergy/intolerance CF Child sexual abuse Drugs
What are some red flags associated with constipation?
Delayed passage of meconium Fever, vomiting, bloody diarrhoea Failure to thrive Tight empty rectum with presence of palpable faecal mass Abnormal neuro exam
What are the consequence of constipation?
Acute - no sequelae
Chronic - acquired megacolon, anal fissure, overflow incontinence, behavioural problems
How do you investigate constipation?
Usually a clinical Dx
Only investigate if suspected underlying organic cause or non-responsive to treatment
Bloods: T4/TSH, Ca, coeliac screen; CF sweat test; AXR, spinal imaging; rectal biopsy etc.
How do you manage functional constipation?
Diet, fluid and exercise advise - enough fibre, 2L+ water, keep moving
Toilet training/behavioural rewards - star charts for sitting on toilets etc.
What are some medications for constipation?
Advise on fluids + lifestyle
Non-absorbed laxative irrigative - movicol
Softeners - lactulose, liquid paraffin
Stimulant - Senna, dulcolax
Bulking agents - Fybogel
Enema
Klean-prep (strong stuff)
