Constipation/Faecal Incontinence Flashcards Preview

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Flashcards in Constipation/Faecal Incontinence Deck (17):
1

What is the first bowel action a neonate has?

Meconium passed within first 24h

2

Outline the number of stools a child has in:
- first weeks
- first months
- ~ 2yo

- First weeks: 4 to 8 stools/day (breastfed more)
- First months: breastfed infants 3 stools/day, vs about 2 stools/day for formula-fed infants
- By 2 yo: < 2/day

3

At which time points in a child's life is constipation more common?

- Esp. common during intro of solid foods, toilet training, school entry, illness

4

What is the most common cause of constipation in childhood? Outline how it occurs.

Functional constipation (95%):
Painful defaecation leads to apprehension, retention, passage of hard stool and a cycle of withholding and passage of hard stool. Young children may ignore the urge to defaecate, causing a build-up of large hard bowel actions.

5

What are some less common, medical causes of constipation?

Cow milk allergy
Coeliac disease 
Hypercalcaemia, hypothyroidism
CF

6

What are some less common, surgical causes of constipation?

Hirschsprung disease
Meconium ileus
Anatomic malformations of anus   
Spinal cord abnormalities

7

In infants <6mo, what is a common ddx for constipation?

Dyschezia:
• Healthy infants (<6mo) can strain and cry before passing soft stools
• This is caused by inability to co-ordinate the increase in intra-abdominal pressure with pelvic floor relaxation
• Unless the stools are also hard, this is not constipation and will self-resolve

8

What is meconium?

= earliest stool passed my a mammalian infant, composed of things infant ingests in womb e.g. bile, cells, amniotic fluid

9

What are some behavioural signs of witholding patterns?

- Toilet refusal
- Hiding while defaecating
- Crossing legs

10

Dx criteria for constipation

Two or more of the following characteristics within the previous 8 weeks: 

• < 3 bowel motions/week  
• > 1episode of faecal incontinence/week  
• Large stools in the rectum or on abdominal examination  
• Passing of stools so large that they obstruct the toilet  
• Retentive posturing and withholding behaviour  
• Painful defecation 

11

What kind of oral laxatives can you trial for children?

○ Children: Stool softener (paraffin oil - Parachoc or Agarol) or osmotic laxative (Movicol or Osmolax)
○ Infants 6-12mo: Coloxyl drops or Lactulose
○ Infants <6months: Coloxyl drops

12

At what age can you officially diagnose faecal incontinence?

>4yo

13

Most common cause of faecal incontinence and how it occurs.

• Constipation most common cause
• Withholding → Increased volume and pressure in rectal ampulla → chronic stretching of rectal ampulla → rectal hyposensitivity  
• Intermittent relaxation of external anal sphincter → unexpected faecal leakage 

14

What are some rare causes of faecal incontinence

• Neurological
○ Anismus (incoordination between straining an release of the EAS) and withholding  
• Congenital/structural
• Inflammatory
• Psychogenic
• Toilet/defecation phobia with withholding 

15

What posture should one assume to relieve constipation?

• feet supported, knees above hips, legs apart, bulge tummy 
- footstool to ensure knees are higher than hips
- Lean forward and put elbows on knees
- A toilet ring should be placed over the toilet seat if needed.
• If baby, tummy rubs and bicycle legs

16

What kind of toileting changes can you make to improve constipation?

○ 5mins, 3 x D
○ Sit after meals to take advantage of gastro-colic reflex 
○ Maximise emptying 
○ Timer in bathroom
○ Keep toileting positive experience

• Stool diary
• Add rewards  
○ Reward for effort (sitting), rather than successful  
○ Charts with stars
• Regular review and encouragement 

17

Mx plan for constipation

1. Disimpact with laxatives if have to
2. Then maintenance laxatives with other non-pharmacological Mx options
3. Taper laxatives and maintain non-pharma options