Constipation is one of the most common diseases in children. Its clinical manifestations include dry and hard stools, difficulty in defecation, reduced or prolonged bowel movements, which may be accompanied by bloating, refusal to eat, irritability, vomiting and other phenomena, sometimes with blood on the surface of the stool, pain in the anus during defecation, and even leading to external hemorrhoids, and severe constipation can be followed by filling incontinence. Functional constipation and symptomatic constipation (also known as secondary constipation) are the two major classifications, with functional constipation accounting for more than 90% of constipation in children, and is one of the most common symptoms seen in children’s gastroenterology clinics.
What is functional constipation?
Functional constipation is primary and persistent constipation that is not caused by systemic or intestinal diseases, also known as habitual constipation or simple constipation. It is also called habitual constipation or simple constipation. Simply put, it is constipation where the exact cause and location cannot be found through a series of medical tests.
Why do children get functional constipation?
1, dietary factors milk feeding, excessive protein content in food, insufficient water intake or dehydration can make the stool dry and hard, resulting in constipation. Low dietary fiber intake in food is also one of the risk factors for chronic constipation in children.
2, intestinal malfunction life irregularity and lack of defecation training, not formed the conditioned reflex of defecation leads to constipation.
3, abnormal psychological behavior and environmental factors autism, obese children, aggressive or timid, disappointment, depression, neuroticism, anal fissure pain, public toilet phobia, life and learning environment changes, parental over-intervention, etc. can lead to constipation.
4, insufficient exercise exercise, intestinal peristalsis slowed down, easy to form constipation.
5, transmission factors some children with constipation have a genetic predisposition.
How can I be sure that my child has functional constipation?
1.Children under 4 years old meet at least 2 of the following conditions, and the symptoms persist for at least 1 month.
(1) Having no more than 2 bowel movements per week.
(2) Has a history of heavy fecal retention.
(3) History of crying and straining to defecate due to painful defecation
(4) History of large stools.
For children who are already bowel trained, the following may also be included as options.
(5) history of fecal incontinence at least 1 time per week after being able to control defecation
(6) History of blockage of the toilet by coarse fecal masses.
2. Children 4 years of age and older with an insufficient diagnostic basis for irritable bowel syndrome who meet at least 2 of the following conditions that occur at least once a week for at least 1 month.
(1) The number of bowel movements in the toilet is not greater than 2 times per week.
(2) Having fecal incontinence at least 1 time per week
(3) A history of excessive restraint in defecation.
(4) History of painful or strained defecation.
(5) A history of blockage of the toilet by large stools.
What should be done?
1.Non-medical treatment
(1) Learning and education parents should fully learn about functional constipation, when parents have a correct understanding, some factors that may cause constipation can be paid attention to, some children’s constipation may be prevented, even out of functional constipation, can also be treated early through early intervention measures.
(2) Psycho-behavioral treatment is much more common in children with functional constipation than in normal children. A small number of children with significant psychological factors should be treated by a psychologist. Parents of most children with mild symptoms should explain patiently, blame less, encourage more, adjust their mindset and encourage toilet training.
(3) Dietary treatment should be provided to prevent or reduce constipation in children by ensuring adequate protein intake, adding coarse grains, adding appropriate amount of fruits and vegetables, and drinking appropriate amount of water to laxative.
(4) Increase physical activity in school-age and older children can accelerate gastrointestinal motility, promote defecation and improve constipation.
(5) defecation training to artificially carry out regular positive and effective reinforcement training for children’s defecation behavior, so that they develop good regular defecation habits, so as to achieve the role of prevention and treatment of functional constipation in children.
2.Medication
(1) Laxatives recommended to use sugar-based osmotic laxatives: polyethylene glycol, lactulose
①Polyethylene glycol (Fosamax Polyethylene Glycol 4000 10g) is suitable for children 8 years old and above, 1 bag each time, 1-2 times a day; or 2 bags a day, one time in one dose. The longest course of treatment should not exceed 3 months.
②Lactulose (Lactulose Oral Liquid 100ml:66.7g) should be taken once at breakfast, and if no obvious effect is seen after two days, consider increasing the dosage.
(2) Probiotic preparations are recommended to use Bifidobacterium lactis triplex (Gold Bifidobacterium) and compound Lactobacillus acidophilus tablets.
(1) Bifidobacterium lactis triplet (Gold Bifidobacterium 0.5g) should be stored under refrigeration and taken with warm water or warm milk.
②Lactobacillus acidophilus tablets (Yijunkang 0.5g) children’s dosage, please consult a physician or pharmacist
(3) Enemas are commonly used with isotonic saline or sodium dihydrogen phosphate, which are not generally preferred.
(4) Biofeedback therapy is mainly used for children who can understand the doctor’s instructions and cooperate with the treatment (generally required to be over 6 years old).
(5) Gastrointestinal prokinetic agents include dopamine antagonists, serotonin agonists and gastrin receptor agonists. However, they are not recommended because of the lack of adequate trials of their use in children.
In conclusion, early interventions can be effective in improving the prognosis of functional constipation in children. In addition, the selection of safe and appropriate drugs, such as polyethylene glycol, in the course of pharmacological treatment, and the achievement of adequate dosage and full course of treatment and slow reduction followed by discontinuation of the drug are conducive to improving the cure rate and reducing the recurrence rate. At present, most children with functional constipation can be relieved after regular treatment.