Constipation in children is a symptom of many diseases, not a disease. It is manifested by a significant reduction in the number of bowel movements compared to normal (1-2 times a day), and children with constipation have a bowel movement every 2-3 days or even 7-10 days, which is irregular, dry and difficult to defecate.
Long-term constipation can cause a variety of diseases such as: anal fissure, hemorrhoids, rectal prolapse, hernia, loss of appetite, depression, nutritional disorders, etc.. Constipation can be mild or severe in degree, and can be temporary or long-lasting in time.
As there are many causes of constipation, especially the more serious and long-lasting constipation, you should go to the hospital in time to find out the cause of constipation, so as not to delay the diagnosis and treatment of the original disease, and do not abuse laxatives.
Constipation is generally divided into two types: functional (physiological) constipation and organic (pathological) constipation
Functional constipation in children is mainly due to.
(1) improper food composition, food with more protein content and too little carbohydrate and crude fiber content, which can easily cause constipation; insufficient sugar in milk can also make the stool dry;
(2) The child does not develop the habit of regular defecation, when it is time to defecate, the child is still playing, which inhibits the intention to stool, so that the intestine loses its sensitivity to fecal stimulation, and the stool stays in the intestine for too long and becomes dry and hard;
(3) anorexic infants have too little diet, less residue produced by digestion, natural lack of stool.
(4) Rickets, malnourished children, etc. can make the intestinal peristalsis weak, the intestine lacks the driving force of feces;
Organic constipation is due to constipation caused by pneumatic lesions: anal stenosis, anorectal perineal fistula, congenital megacolon, redundant sigmoid colon, etc. can cause constipation.
The treatment of constipation is to first identify the cause of constipation, through anal finger diagnosis, barium enema, colonic transmission test, rectal manometry, rectal electromyography, mucosal biopsy, etc., to clarify the diagnosis, according to the cause, take the corresponding treatment measures.
If it is functional constipation, adjust the dietary habits, eat more vegetables and fruits and other foods containing fiber and B vitamins. To train defecation, biofeedback therapy is used to induce defecation by electrical stimulation, and after a period of training to develop the habit of regular defecation.
For severe constipation, laxatives (fruit-directed tablets, honey, senna, etc.) can be given appropriately, but laxatives should not be used for a long time to avoid dependence. Through the above treatment functional constipation can be relieved.
However, organic constipation needs to be examined in the hospital and treated for the original cause:
In the case of anal stenosis, the child is mostly asymptomatic in the neonatal period, but at about half a year of age, he or she has difficulty in passing stool and has a thin stool strip.
In the case of anorectal perineal fistula, the child has difficulty in passing stool during the neonatal period, and the examination reveals an atresia at the normal anus with a small hole slightly in front of the anal cavity or at the perineum, through which stool is passed. The child with anal stenosis and anorectal perineal fistula should be operated on as soon as it is detected, and can be cured by perineal anoplasty (a simple procedure).
The next disease that causes constipation is congenital megacolon.
Children with megacolon generally present with the following five conditions.
I. The child has intestinal obstruction after birth, such as abdominal distension, vomiting, absence of fetal feces, and bursting defecation after anal finger examination.
Second, the child has delayed discharge of meconium (normal neonatal feces within 24 hours after birth), while children with megacolon have fetal feces only after 48 or even 72 hours (or fetal feces only through the open plug or anal examination), and can have recurrent intestinal obstruction, which can be relieved naturally or by enema, often accompanied by intermittent vomiting.
Third, the child may present with mild constipation lasting for weeks or even months, followed by sudden onset of intestinal obstruction.
The child starts with constipation and suddenly develops small bowel colitis, such as diarrhea, bloating, fever, and deficiency.
V. The child has only mild constipation and other conditions are normal. The diagnosis can be clarified by barium enema imaging, rectal manometry, rectal mucosal biopsy, rectal mucosal acetylcholinesterase measurement, rectal anorectal electromyography, etc. if the above-mentioned manifestations are present.
There are 6 types of congenital megacolon:
Ultrashort segment type, short segment type, common type, long segment type, total colon type, and total intestine type. Except for the ultra-short segment type which can be treated by anal dilation, the other 5 types require surgery, and about 80% of the children can be treated with good results without opening the anus. This procedure has a small blow, fast recovery, no abdominal surgical scar, and satisfactory results.
Another common disease is sigmoid redundancy, the normal pediatric sigmoid colon 40-60 cm, more than this length is called sigmoid redundancy, because the feces in the colon for too long, excessive absorption of water, making the feces dry and hard, resulting in defecation difficulties, causing constipation.
Most children with redundant sigmoid colon have constipation around 1 year old, with normal exhaustion, no obvious bloating or slight bloating, accompanied by pain in the left lower abdomen, and some even have stools only once every 1-2 weeks, or can only have stools when given corkage or laxatives.
It is reported that about 25% of pediatric constipation is sigmoid redundancy, so in recent years the disease has attracted more and more attention, the diagnosis of the disease is mainly through barium enema, rectal manometry, colonic transmission test and other clinical manifestations to confirm the diagnosis.
Most children with redundant sigmoid colon are relieved by dietary regulation, bowel training, anal dilation and sigmoid colon electrical stimulation to induce defecation, but some children with severe constipation still need surgery. Sigmoid resection descending colorectal anastomosis or transanal sigmoid resection has satisfactory results!