Lets talk about constipation
Welcome to The Art of Patients – I’m Dr Golly and today we’re talking about constipation in children. Affecting 1 in 4 children, it’s extremely common and often inadequately treated. It’s not something that just affects children either, what we’re about to learn applies to kids, adolescents and adults too.
Constipation comes from the Latin word constipare, meaning crammed or squashed together. Let’s jump to the whiteboard and take a quick look at the anatomy of the gut to get a better understanding.
The gastrointestinal rollercoaster starts at the mouth, dives down the oesophagus to the stomach, takes a right turn into the duodenum and small bowel, high-fives the appendix as it climbs up the large bowel and then does a C-shaped curve to find the rectum and finally ends with the anus.
What is normal?
It is normal to pass a bowel action anywhere from three times a day to three times in a week. Constipation is defined as less than 3 times per week and/or significant straining in order to pass a hard bowel action. For babies, those who exclusively breastfeed may have soft stools from 7 times a day to once every 7 days, compared with bottle fed bubs who are more likely to deliver a diaper delight at least every 2-3 days.
If your child has:
- LARGE; and
- DIFFICULT TO PASS
stools, then your child is constipated.
Sometimes the sheer size of the stretched pipes can also put pressure on the bladder and this is a common cause of night-time bedwetting and urinary tract infections. Some children can also experience sharp, uncomfortable pain when on the toilet – as a result of small tears called ANAL FISSURES, which can also result in bright red blood being seen on the toilet paper. Not only is this scary for parents but this painful passage can then start a vicious cycle where kids voluntarily hold back from No.2s due to that previous painful experience.
Constipation with overflow
Now, some parents tell us their child can’t be constipated because they have infrequent episodes of diarrhoea, but that’s a myth we need to flush down the toilet. This is what we call ‘constipation with overflow’ – it means that a giant boulder is stuck way down in the rectum, stretching the sphincter and making it less reliable. The body then tries to expel this by flushing water down the bowel, which seeps around the big boulder. Combined with an unreliable sphincter from being overstretched, small amounts of liquid poo leak out, and get misinterpreted as diarrhoea, when the problem is actually the very opposite.
So how do we fix the concrete conundrum of chronic constipation? Remember the FOUR F’s! Fluids! Fibre! Fruit & veg! And Fun exercise! This is the cornerstone to a healthy bowel routine. And for those who need a little extra help, there are many medications that can be used too.