Pediatric Constipation
What is constipation?
Constipation is a symptom of a variety of diseases, manifested by too little stool, too hard, too difficult to pass, or a combination of specific symptoms, such as prolonged straining to pass stool, rectal distension, a feeling of incomplete defecation, or even the need to use manipulation to help defecate. In the absence of laxatives, spontaneous evacuation of stool does not occur more than twice in 7 d or for a long period of time.
Newborns usually pass fetal stool within 24 hours after birth, if more than 36 hours, the delay in passing fetal stool is called neonatal constipation. Normal interval between bowel movements generally does not exceed 48 hours, but some children usually 2 to 3 days to discharge 1 time, the nature of soft stool, this situation should be regarded as a physiological phenomenon. Therefore, it is more reasonable to judge by the nature of the stool than by the interval between bowel movements.
How does constipation occur?
The rectum is empty most of the time, and it is only after the stool from the colon enters the rectum that the rectum is dilated by the stool, stimulating the pressure receptors of the rectum, which is transmitted to the cerebral cortex through the afferent nerves of the defecation reflex, resulting in the intention to defecate, and the instructions to defecate are transmitted to the effector organs involved in defecation through the efferent nerves, so the rectum contracts, the anal sphincter relaxes, the diaphragm and the abdominal muscles contract, holding the breath, increasing the abdominal pressure, and expelling the stool out of the body This is the normal process of defecation.
Some factors cause the pressure receptors of the rectal wall to be blunted, the rectal and anal sphincters to malfunction, the intestinal peristalsis to be weakened, the feces cannot be discharged in time, the water is excessively absorbed, and the stool becomes dry and constipated.
What causes can cause constipation?
(1) Improper diet
Some children eat too little food, food digestion and absorption through the stomach and intestines, the remaining food residue less, in the colon can not form much pressure, so there will not be stool. Some children eat too much meat and too little vegetables and fruits, so the food contains more protein and less fiber. With more protein, the stool is alkaline and easy to dry; with too little plant fiber, the colon contents are less, and the intestines lack stimulation, so it is not easy to produce bowel movements. Some children like to eat dry food, drinking too little water, intestinal stimulation is not enough, also prone to constipation. Milk contains more casein and more calcium salts, so children who eat milk are prone to constipation.
(2) Bad bowel habits
Some children play to delay defecation, most children’s irregular life, diet is not regular, defecation is too large, the formation of the conditioned reflex of defecation, is also a common cause of constipation.
(3) Disease rickets, malnutrition, low thyroid function of children with poor abdominal muscle tone, or intestinal peristalsis is weakened, constipation is more common. Anal fissure; perianal inflammation, pain at the anal opening during defecation, children do not relieve stool due to fear of pain, resulting in constipation. In children with congenital megacolon, constipation, bloating and vomiting are present soon after birth. When abdominal tumor presses near the intestinal cavity, the stool cannot pass smoothly, which can also cause constipation.
(4) Neurological factors
Brain underdevelopment, microcephaly, cranio-cerebral injury and other brain disorders, are not easy to form stool, so easy to constipation.
What are the adverse consequences of long-term constipation in children?
If children are often constipated or have dry stools, it will affect the health of the child, or at least can lead to anal fissures or hemorrhoids, and can also affect the child’s digestive function, so that the appetite is reduced. If this situation continues, it can gradually cause malnutrition in the child and affect normal growth and development. In addition, many cases of pediatric constipation is caused by dietary reasons, diet high fine food, these high fine food in the processing process, a large number of vitamins and minerals have been lost and destroyed, the role of long-term lack of coarse fiber in the digestive system, intestinal peristalsis slow, so that the digestive function decreases, and therefore over time can appear in the child’s digestive system dysfunction.
How to prevent constipation?
(1) Improve the structure of the diet
Increase the content of fiber, partiality, picky eaters, children who eat refined rice and flour is particularly important. These children eat more celery, cabbage, fruit, corn, sorghum, white potatoes made meals, can prevent constipation.
Children who eat milk can put more sugar in the milk if they are constipated, such as adding up to 8%, sugar has a softening effect on the stool. Timely addition of complementary foods can also relieve infant constipation. Constipated children can usually eat some honey, tomato juice, fruit juice, vegetable soup, because these foods have a smooth bowel effect.
Malnourished children, we should try to improve appetite, gradually increase nutrition, improve the nutritional status of the whole body, abdominal muscles, intestinal wall muscle strength, to have the strength to discharge stool.
(2) Form the habit of regular bowel movements
Many children’s constipation is caused by irregular bowel movements, and the sensitivity of the bowel reflex is reduced. If you can develop good bowel habits, this part of the child’s constipation can be lifted. Because eating can promote the gastrointestinal reflex, so defecation is best arranged after meals, at this time, let the child sit in the potty or toilet, and gradually develop the conditioned reflex of defecation.
(3) If the child’s stool is very dry, really unable to defecate under the stool, can be used open plug or glycerin suppository laxative, because glycerin has a stimulating effect on the intestinal wall, can cause reflex defecation, glycerin itself also has the effect of slippery intestine. If you can not discharge stool, you can wear gloves to dilate the anus defecation, but this defecation method is only an emergency measure, can not be used frequently.
(4) timely treatment of colonic and anal diseases
If children suffer from anal fissures and perianal abscesses, they will be afraid of defecation and postpone the time of defecation, and the longer the postponement, the harder the stool will be, forming a vicious circle. Therefore, the primary disease should be treated promptly.
(5 ) constipation caused by neurological diseases, in addition to the treatment methods described above, but also to treat the original disease.
What are the main treatment measures for constipation in children?
First, acute constipation, most of the acute constipation occurs in childhood is a self-limiting situation, many factors can trigger, such as systemic diseases, dietary changes and travel, etc.. In another case, the infant is well fed, gaining weight, and has no abdominal distension or colic, and should continue to be observed. However, if the infant is overly irritable, poorly fed, or has significant abdominal distention, he or she should be treated immediately. Small glycerin suppositories can be inserted anally or by enema, and repeated intrarectal finger stimulation should be avoided. Older children may be treated with magnesium oxide emulsion or appropriately with laxatives orally.
Second, a successful treatment plan for chronic constipation in toddlers and older children is to explain clearly the pathophysiological mechanisms of constipation to the child, the child’s parents, and teachers and other caregivers at the outset so that they recognize that constipation is the result of chronic stool retention, rectal dilation, and reduced sensory feedback, rather than simply a lack of sensory feedback to the child’s request for a bowel movement. A successful treatment often takes several months to complete and is adhered to daily during the treatment period as described below.
There are two phases of treatment: first, a clearing phase, followed by a maintenance phase. The clearing phase is usually accomplished by a period of salt enemas once a day for 3 to 4 days, or until the fecal residue in the rectum is largely cleansed. Other methods include colonic irrigation solution and manual removal. Treatment in the maintenance phase:① medication, 2 tbsp of mineral oil emulsifier twice a day, or other alternatives, laxative, enema every other day. ② Diet, high fiber diet. ③ Training of bowel habits. Regular bowel movements and maintaining proper bowel posture, with calendar records and a system of rewards and punishments.
What should I pay attention to when applying laxatives to children?
Because the function of the digestive tract of children is not well developed, and laxatives stimulate the digestive tract more, which can easily cause the dysfunction of the digestive tract and cause indigestion, so drugs with less side effects and less stimulation to the digestive tract should be chosen. And because children cry when taking drugs, taking drugs is difficult, so it is appropriate to use suppositories such as glycerin suppositories, or enemas, such as open cologne.
What diseases that cause constipation in children need surgical treatment?
If a child’s chronic constipation does not improve after regular conservative treatment, a consultation with an experienced pediatrician is required. Once the diagnosis of congenital megacolon and sigmoid redundancy is confirmed, it is necessary to go to a specialized hospital and ask an experienced specialist for surgery. It is important to note that surgery carries certain risks and there is a possibility of various complications, as well as a variety of surgical options, which are related to the child’s lifelong well-being, so parents should pay attention to them.