This content created by Halil Tuğtepe, Prof. Dr. with attribution to scientific articles.
Constipation in children is a common bowel problem. Constipation is defined as the slowing down of bowel movements and/or the beading, hard and dry of the stool. The fact that can defecate every day does not mean that the child is not constipated. If the stools are hard, dry and too large or small, this is a sign of constipation. In other words, contrary to what is known, constipation is not only a decrease in defecation frequency.
Generally, children suffering from constipation also suffer from severe bowel pain and/or pain in and around the anus during defecation.
Common causes include early toilet training and dietary changes. If it is not treated in the short term, it may disrupt the functioning of the pelvic floor muscles (the muscle group responsible for voiding and defecation) and may cause bladder-intestinal problems by affecting urination functions as well as defecation functions.
The slowness of passage through the intestine due to the hardness and dryness of poop is considered to be the most common cause of constipation. Also, many factors increase constipation. The most common factors are as follows;
Poop-holding behaviour: Generally, children exhibit the behaviour of holding their poop because they are afraid of going to the toilet or do not want to interrupt the activity they are engaged in. Some children avoid using public toilets - especially school and course toilets - other than their toilets at home. The delaying behaviours they develop by holding this type of poop cause the poop in the rectum (the last exit point of the intestine) to dry and hardened by drying and clumping. Large poop that hardens and dries up can cause pain and pain in children during defecation, causing children to avoid toilet.
Toilet training problems: Starting toilet training too early can sometimes result in the development of opposing to toilet use in children. Thus, by refusing to use the toilet, they may develop the behaviour of holding their poop and, as a result, they may become constipated.
Changes in dietary habits: Constipation can be triggered by insufficient intake or not consuming fibre-rich fruits and vegetables. Also, insufficient fluid consumption causes the stools to dry and harden. Switching from a diet in which fibre foods are mostly consumed and liquid consumption is abundant suddenly to a diet containing solid foods causes constipation in children. Consuming too many packaged foods also triggers constipation.
Changes in routines: In some situations where routines such as travelling, staying home, climate changes and stress change, they can affect bowel functions by causing changes in children's toilet habits. For this reason, children are more likely to experience constipation when they start school.
Side effects of medications: Some medications can cause constipation.
Difficulty indigestion caused by milk and dairy products (Lactose intolerance): Being allergic to cow's milk or consuming too much dairy products (cheese, yoghurt, etc.) can sometimes cause constipation in children.
Family: Children with family members who experience constipation are more likely to experience constipation. This may be due to inherited genetic predisposition or environmental factors.
Medical conditions: Rarely, constipation in children indicates an anatomical malformation (defect), a metabolic or digestive system problem, or any other underlying health condition.
It is seen in 3% of the patients who apply to the pediatric clinic.
Children with the following conditions are more likely to experience constipation.
Babies younger than two months usually do not have constipation. Before any change in the baby's diet, the doctor's opinion should be taken. Once the baby is over four months old, it may be attempted to provide high-fibre food. Examples of these fibre foods are apricots, beans, grains, peaches, pears, peas, plums or prunes.
Although it may be different in each child, some clinical evaluations are required to determine the underlying cause of constipation.
Taking detailed story: The symptom of constipation is in some cases a harbinger of bladder-bowel problems. Questioning the onset of constipation, triggering factors, toilet-feeding habits and family history is very important in understanding the source of constipation as well as complaints in clinical decision making. At the same time, questioning daytime and/or nighttime urinary incontinence complaints accompanying constipation is valuable for the correct treatment plan.
Many families confuse the traces of poop found on underwear with diarrhoea. However, this smear is a symptom of constipation. It is the trace of the new, soft poop that leaks through the old poop accumulated in the rectum. It is a typical constipation sign. Many parents learn that this is not diarrhoea, as the doctor takes a detailed history.
Physical evaluation: Constipation mostly causes muscle contractions in children. For this reason, it is very valuable for evaluating the abdominal muscles, hip muscles, inner leg muscles and pelvic floor muscles (muscles around the anus) and determining the areas of physical influence in the body. At the same time, during the abdominal examination, information about the motility of the intestines and the position of the poop in the intestine is also learned.
EMG pelvic floor muscle measurement test: EMG measurements are made with superficial electrodes to evaluate the tension and functionality of the pelvic floor muscles. The pelvic floor muscles of children who often suffer from constipation work excessively and lose the relaxation feature required for discharge. Before starting pelvic floor rehabilitation, the functions of the muscles should be evaluated so that they can work properly.
More extensive tests are usually ordered for severe constipation. The diagnostic tests requested when deemed necessary are as follows:
Tests requested for diagnosis:
Pelvic floor muscle rehabilitation: A group of muscles and soft tissues that make up the pelvic floor support the pelvic organs (bladder, intestine and reproductive organ) to help control bowel functions. For example, when there is a feeling of defecation, the muscles around the anus are actively contracting and allow to reach the toilet. During defecation, it relaxes and helps the stool to leave the body easily. In some cases, constipation may occur because the pelvic floor muscles do not function functionally, that is, they cannot relax sufficiently. The fact that these muscles are very tense or spasm prevents them from healthily performing their functions. For this reason, re-training of these muscles and regaining their lost functions is very valuable for long-term permanent treatment.
Changing life habits: With simple changes to be made about eating and toilet habits, constipation complaints can be alleviated until your doctor's appointment. Some suggestions for changes are as follows;
Two or three times a day, 20-30 minutes after each meal, sitting in the toilet or potty for at least five minutes.
Medication: Some children with constipation simply do not respond to changes in diet and toilet routines and need medication.
If the complaint of constipation is not treated, it may become chronic and cause complaints about urine by disturbing the bladder with a close relationship. The bladder is subjected to the pressure of hard poop that accumulates in the rectum. This can lead to overactivity of the bladder muscles, causing an urgent feeling of urgency and urinary incontinence. Thus, the situation may become more complicated and prolong the treatment process.
At the same time, constipation can cause the child to avoid defecation, as it can cause pain and discomfort in the child. Avoiding defecation can lead to harder and larger poop, which can increase constipation-related complaints. This creates a vicious cycle between pain and constipation. Starting treatment before this vicious circle occurs provides an increase in the success rate as well as shortening the treatment process.
A hard and large poop that stays in the rectum for a long time may disrupt the structure of the rectum and cause this area to expand too much. This situation further increases constipation and puts it in a vicious circle. It may even be possible to surgically remove the enlarged rectum area in the future.
It should not be forgotten that poop is toxic to the body and should be removed from the body regularly every day. A doctor should be consulted as soon as the complaint or symptom of constipation is observed.
Constipation complaint is an emergency in which a doctor should be consulted to determine the underlying cause and initiate appropriate treatment without waiting to pass over time. Untreated poop waiting in the body is highly toxic to the body.
It should not be forgotten that constipation is a health problem that should be considered. If left untreated, it becomes more difficult to solve by causing more serious bladder-bowel problems. Therefore, treatment should be started as soon as possible by consulting a pediatric urologist.
Published: 04 Şubat 2021
Updated: 25 Şubat 2021