Pediatric constipation is a common symptom of pediatric gastrointestinal disorders, with a prevalence of 0.3-0.8% in the pediatric population, and pediatric constipation accounts for about 10-15% of pediatric surgery general outpatient clinics, with numerous causes, complex influencing factors and mechanisms, and far-reaching impact on the quality of life of children. Constipation is defined as incomplete rectal emptying, difficulty in defecation, long intervals between defecation, small volume of stool and dry stool.
According to the nature of constipation can be divided into functional constipation and organic constipation.
Functional constipation accounts for 90% of pediatric constipation. Functional constipation refers to constipation that is not caused by organic factors. The number of bowel movements decreases with age in healthy infants and children.
The Rome III diagnostic criteria for functional constipation were proposed at the Los Angeles International Conference in 2006.
1. 2 or less bowel movements per week.
2, having at least 1 bowel incontinence per week after being able to defecate on their own
3, history of massive fecal retention.
4, history of painful defecation or difficult defecation
5, large fecal masses in the rectum.
6. A history of excreted stool so large that it blocks the exit of the toilet seat. Accompanying symptoms include irritability, loss of appetite, and/or early satiety. These symptoms will soon disappear once a large amount of stool is passed.
7. Functional constipation can be diagnosed in children under 4 years of age who meet at least 2 of the above criteria within at least 1 month; functional constipation can be diagnosed in children over 4 years of age who meet at least 2 of the above criteria within at least 2 months. All organic constipation has a primary disease, and there are other different clinical manifestations in addition to constipation symptoms.
There are multiple causes of pediatric constipation.
1, dietary factors Infant diet is too little, the amount of sugar in the diet is not enough, can cause less residue after digestion, stool volume is low. High protein content in the diet makes the stool alkaline, dry, the number of times to reduce. Food containing more calcium can also cause constipation, such as milk contains more calcium than human milk, so cow’s milk feeding than breastfeeding more chances of constipation. The fiber in vegetables can stimulate intestinal peristalsis and promote bowel movements. Some children do not like to eat vegetables, is also a major cause of constipation.
2, habit factors due to irregular life or lack of regular defecation training, or individual children due to sudden environmental changes, can appear constipation.
3, anal diseases: anal atresia with skin fistula also manifests as constipation, and the symptoms of constipation are aggravated after adding supplementary food. Anal fissure; perianal inflammation, pain at the anal opening when defecating, children are afraid of pain and do not relieve stool, resulting in constipation. Various causes of anal stenosis can also be manifested as constipation.
4, endocrine diseases: infants and children suffering from rickets, malnutrition, hypothyroidism, because of poor abdominal muscle tone, or intestinal peristalsis is weakened, constipation is more common.
5, congenital megacolon: is due to ganglion cell deficiency, the intestinal canal in a spastic narrow state, intestinal contents through the difficulty, the proximal intestinal canal compensatory enlargement, manifested as repeated constipation, abdominal distension, intestinal obstruction symptoms. It is one of the most common congenital malformations of the gastrointestinal tract. The incidence rate is as high as 1/5000, more males than females.
6, intestinal neuronal dysplasia: is a group of diseases similar to congenital megacolon caused by the reduction and dysplasia of intestinal ganglion cells, also known as megacolon homozygosity, difficult to treat.
7, occult spina bifida: occult spina bifida is closely associated with spinal cord embolism syndrome, defecation and urinary dysfunction, and the incidence of anal spasm and urinary incontinence is higher in this child. Colonic transmission test results recessive spina bifida colonic transmission time is significantly prolonged, colonic transmission index is exit obstruction type.
8, sigmoid colon redundancy: sigmoid colon redundancy is a common cause of pediatric constipation, sigmoid colon length is too long, intestinal lumen expansion, intestinal wall thickening, manifested as chronic constipation and interstitial abdominal pain. Unlike megacolon, it appears later and is mostly curable with conservative treatment.
9, neurological diseases: brain underdevelopment, cerebral palsy or microcephaly can interrupt the defecation reflex or inhibit the parasympathetic nerve, resulting in different degrees of constipation.
What should be done after the occurrence of constipation in children? Functional constipation is treated by the following methods.
1, dietary adjustment Most of the children with constipation belong to the first case, most constipation can be relieved after adjusting the diet. Milk-fed infants constipation, the amount of sugar in the milk can be increased to 8%, and increase the amount of fruit juice, larger infants can add honey. Constipation in young children should reduce the protein diet, increase cereal, long increase vegetables, fruits and other dregs food.
2, defecation training habits defecation is a reflexive movement, children can develop the habit of defecation on time after training. Generally more than 3 months old infants can start training, breastfeeding in the early morning by the adult two hands to put the stool, or sit in the basin or sit defecation small chair, continuous and timely implementation of 0.5 ~ 1 month can develop a habit. Do not change the time at will after the habit is formed. For older children with chronic constipation, in addition to encouraging them to exercise more, more fibrous food, should also make them go to the toilet on time, to develop good bowel habits.
3, drug treatment: phenolphthalein, liquid paraffin, milk of magnesia, open cork, soap bars, etc., according to the specific circumstances and choose; enema method is not used for special needs.
4, Chinese medicine treatment Chinese medicine treatment of constipation, to laxative, laxative as the basic principle, but it is appropriate for the cause of the same with the elimination of accumulation, increase fluid and dryness, lung, spleen, liver, kidney and other methods of treatment. Medicine, food treatment, the lower method can only be used temporarily, not to attack too much, so as not to damage the vital energy.
Treatment of organic constipation varies from disease to disease.
Anorectal malformation or anal stenosis should be treated surgically; anal fissure patients through dietary adjustment, softening stool, smooth defecation, pain relief and natural healing of anal fissure.
Constipation in malnourished children.
To pay attention to supplementation, gradually increase the amount of intake, the nutritional situation improves, the abdominal muscle, intestinal muscle growth, tension increases, defecation naturally and gradually smooth. In rickets, vitamin D and calcium supplements are given to gradually relieve constipation; in children with hypothyroidism, once the diagnosis is obvious, thyroxine tablets are given to replace constipation.
For children with suspected congenital megacolon.
In the neonatal period, laxative treatment will be given to relieve abdominal distension, and barium colonography and colonic mucosal biopsy can be performed when the child is 3 months old. The management of children with megacolon homozygosity is the same as congenital megacolon, but the outcome of treatment is uncertain.
Children with simple occult spina bifida with constipation can be relieved with dietary modification and bowel training.
In contrast, children with combined lipoma, spinal bulge, and spinal cord embolism syndrome often require surgical treatment. Children with redundant sigmoid colon clearly identified by barium colonography are preferred for conservative treatment, and most of the symptoms will be relieved as the child grows older, while the indications for surgical treatment are very strict and not easily used in children with severe constipation.
Children with constipation due to central neurological diseases such as cerebral hypoplasia, cerebral palsy or microcephaly are treated with laxative, neurofeedback, brain cell activator and rehabilitation. In conclusion, constipation is a symptom with different etiologies and different treatments. Moreover, with the change of environment and lifestyle, children with constipation have a tendency to increase year by year, which attracts the attention of society and families.