Constipation is a symptom that is one of the most common clinical conditions seen in pediatric clinics. There are many differences between children and adults regarding constipation, so today we will talk to you in detail about constipation in children.
A girl who relieves her bowels once every 17 days
Let’s start with a case. 11-year-old Xiao Zhang, a thin and small girl, was admitted to our ward because of constipation. Xiao Zhang has been constipated for 5 years, and she usually has a bowel movement once every 10 days or so, with great effort to defecate. We perfected a series of auxiliary tests and finally found that the cause of Xiao Zhang’s constipation was caused by congenital megacolon, a condition that required surgical treatment and was later transferred to surgery.
Through this case, we systematically learn about constipation in children
1.Definition of constipation
Constipation in children generally refers to the number of bowel movements ≤ 2 times per week, accompanied by straining to defecate and dry stools. According to the Bristow stool classification, stool traits are generally 1 or 2.
2, the classification of constipation
Constipation can generally be divided into organic constipation and functional constipation.
Organic constipation: relatively rare, generally caused by intestinal developmental malformations, anal anomalies, redundant sigmoid colon, lumbosacral plexus injury, etc. The congenital megacolon suffered by Xiao Zhang in the above case belongs to this category.
Functional constipation: clinically, more than 90% of constipation is functional, with a prevalence of about 4.73% in the population. It is mainly manifested by a series of symptoms such as reduced frequency of stools, difficulty in defecation, fecal incontinence, and abdominal pain.
Functional constipation can be divided into normal transmission type, slow transmission type, defecation disorder type and mixed type according to the pathological mechanism.
3.The causes of constipation in children
Dietary factors
This mainly includes dietary quantity and dietary structure.
(1) the amount of diet: too little and too much diet can easily cause constipation, when the diet is too little, the formation of food residues less, can not cause effective stimulation of the intestinal tract, can not cause defecation response, over time, the stool in the intestinal tract to retain dry; and often overeating children, due to the formation of a large number of stool, intestinal peristalsis is impeded, resulting in the stool in the intestinal tract to stay too long, water is excessively absorbed, resulting in constipation .
(2) water, dietary fiber intake is too little: water is well understood, water intake is too little, the stool is more likely to dry; and dietary fiber intake is too little, the osmotic pressure in the intestine is reduced, water is more easily absorbed by the colon, the stool is also more likely to dry.
4.Defecation habits
Many children do not develop good bowel habits from childhood, or due to a difficult defecation led to fear of psychology, fear of defecation, and deliberately, actively hold the stool, slowly the intestines adapt to the tension of the stool, the desire to stool will disappear.
5.Low exercise
Many children are addicted to cell phones, ipads and other electronic products, especially after eating insufficient activity, resulting in slow intestinal peristalsis, stool can not enter the rectum in time, resulting in constipation. During the epidemic, the amount of outdoor activities is low, and the number of children with constipation increases.
6.Spiritual factors
If parents pay too much attention to the child’s bowel movement, the child will easily become nervous and even anxious during bowel movement, which will aggravate constipation over time; in addition, sudden mental shock from family and school will also cause constipation in children.
7, infants and children food intolerance
For example, children with milk protein allergy or lactose intolerance may also suffer from constipation due to intolerance to protein components in food or lactose.
Treatment of constipation
(1) Organic constipation: Most of them need surgical treatment. For example, congenital megacolon requires surgical removal of part of the colon.
(2) Functional constipation: First of all, we need to clarify the cause with the help of medical history and auxiliary examination, and then intervene for the cause.
Dietary modifications
Increase the intake of water.
Increase dietary fiber and eat more fruits and vegetables, such as celery, spinach, broccoli, apples, pears, dragon fruit and other seasonal fruits and vegetables. It should be said that bananas do not have a very obvious effect of relieving constipation and should not be eaten in large quantities.
In addition, it is important to eat regularly, to eat on time, to correct partial eating, and to avoid overeating.
Defecation training
Developing good bowel habits is the key to treating constipation. This requires parents’ patience and strong execution. The best way to get your child to develop the habit of regular bowel movements is to squat on the potty, with your child’s feet on the ground to facilitate force. For older children, tell him to take the initiative to force a bowel movement and exhale with abdominal force at the end of the breath to increase intra-abdominal pressure.
Increase the amount of activity
Walk slowly after meals to increase outdoor activity time. But be careful not to exercise too intensely immediately after meals to avoid dietary abdominal pain and indigestion.
Correct guidance and education
First of all, parents should not be too anxious and avoid reprimanding their children for the matter of constipation. On the contrary, if parents keep a relaxed state of mind, their children will also be more likely to correct their eating and bowel habits. Rewards can be used to induce positive rewards for better results!
Medication
Commonly used medications for constipation include laxatives (opiates, lactulose, polyethylene glycol, etc.), motivational drugs, probiotics, herbs, etc. Medications only temporarily relieve symptoms, and prolonged use may lead to dependence, so they need to be applied under the guidance of a doctor.
Psychological intervention
Many children suffer from constipation due to psychological factors, and appropriate psychological interventions can have a significant effect when necessary.
Summarize
1, the causes of constipation in children are very different from those in adults.
2, children’s constipation is mainly functional constipation, severe constipation should also exclude the possibility of organic constipation.
3, the diagnosis of constipation is not difficult, the focus is on the analysis of the cause.
4, the treatment of functional constipation in children is never a quick fix, but a protracted war, requiring the patience, persistence and good attitude of parents.