Chronic constipation

Question 1

What is constipation - questions to ask

Answer 1

how often ?
how hard ?
is it painful ?
has there been a change ?

Question 2

Signs and symptoms with constipation?

Answer 2

Poor appetite
Irritable
Lack of energy
Abdominal pain or distension
Withholding or straining
Diarrhoea

Question 3

why do children become constipated? - social

Answer 3

poor diet
Insufficient fluids
Excessive milk
potty training / school toilet

Question 4

why do children become constipated? other causes

Answer 4

intercurrent illness
Medication
dehydration - gaviscon, opiates
physiological 
organic

Question 5

organic causes of constipation ?

Answer 5

normal time - eg during day or night
hypothyroidism
Hirschsprung disease
lead poisoning

Question 6

Treatment of constipation - social?

Answer 6

Explain treatment to parents

Dietary
 fibre
 fruit
 vegetables
 fluids
 less milk

Question 7

Treatment of constipation - Psychological

Answer 7

• Reduce aversive factors
• Make going to the toilet a pleasant experience
• Correct height
• Not cold
• School toilets
• Soften stool and remove pain
• Avoid punitive behaviour from parents

Question 8

treatment can involve

Answer 8

• Soften stool and stimulate defecation
• osmotic laxatives (lactulose)
• stimulant laxatives (senna, picosulphate)
• isotonic laxatives (Movicol / Laxido)

Question 9

megarectum can cause?

Answer 9

soiling and UTI

Question 10

Treatment of severe constipation

Answer 10

Empty impacted rectum - movicol, enemas, manual evactuation
Empty colon
Maintain regular stool passage 
Slow weaning off treatment
Ensure compliance