Constipation in Children Dr. Adnan Hamawandi Professor of pediatrics School of Medicine University of Sulaimani

Constipation Constipation is considered in children when hard stool is passed with difficulty every three days that persist for two weeks.

Constipation Causes A. Organic Structural: anal stenosis, anal fissure. Neuromuscular: Hirshprung disease, spina bifida, pseudo obstruction. Metabolic: hypokalemia, hypercalcemia, hypothyroidism, diabetes mellitus. Drugs: Narcotics, anticholenergic, lead, Intestinal: IBD, celiac disease,CF,tumors.

Constipation Causes B. Functional In an otherwise healthy child constipation may result simply from an episode of painful defecation, difficulties during the period of toilet training, inattention to the urge to defecate because of involvement in other activities or discomfort with toilet facilities in school.

Constipation Clinical features A detailed history of pattern of defecation may reveal stool-withholding behavior like contracting the gluteal muscles by stiffening the legs while lying down or holding on furniture while standing, some children will squat, push and cry which may be misinterpreted as an attempt to defecate. Accompanying symptoms include abdominal pain, abdominal distention and flatulence.

Constipation Clinical features Sometimes rectal bleeding, poor appetite, enuresis and history of UTI are associated. Soiling (an overflow incontinence of liquid stool) can be present in long standing cases.

Constipation Clinical features Physical examination of the abdomen may reveal distention or palpable fecal masses. Digital examination of the rectum is needed to evaluate the sphincter and ampulla

Constipation Diagnosis When no underlying cause is identified by history and physical examination a favorable response to treatment support the diagnosis of functional constipation. In refractory cases appropriate radiographic and laboratory tests are needed to rule out the organic causes. Barium enema and anorectal manometry are most helpful.

Constipation Therapy For functional constipation include: 1.patient education, a regular bowel training program including sitting on toilet for 5-10 minutes after each meal is often helpful in establishing a regular bowel habits. 2. Relief of impaction can be achieved by enema or polyethylene glycol. 3. softening of stool by lactulose, high fiber

Constipation Therapy diet, or mineral oil must be continued until regular bowel pattern has been established for several months. Biofeedback training may be beneficial in difficult cases.