Chronic constipation in children

Systematic delay of stool for 32 hours or more is classified in modern medicine as chronic constipation. Defecation in children should be daily and regular, and occur at approximately the same time. This is facilitated by a fixed and timely developed reflex.

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Causes chronic constipation in a child

In most cases, chronic constipation in children is caused by improper bowel function, although sometimes it can be caused by pathologies not related to the gastrointestinal tract (hypothyroidism, rickets).

During digestion, the intestinal walls begin to contract in a wave-like motion, which helps push the contents toward the outlet. In medicine, this is called intestinal motility or peristalsis. Intestinal motility in children is usually impaired for two main reasons:

1. Rare stool, which is accompanied by a large volume of feces (almost like in adults) and bloating, is called atonic constipation. It is associated with poor intestinal contractility. The child may not feel the urge to defecate for a long time. At the same time, many parents make the mistake of forcing the baby to sit on the potty for a long time. This should not be done.
2. If the stool in children is too dense and consists of smooth and hard pellets (often called "sheep feces"), which is accompanied by pain in the abdomen or during defecation, this indicates spastic constipation. Its cause is increased contractile activity of the intestine.

It is very rare for children to pass stool in the form of a thin and liquid ribbon. If you notice something like this in your child, you should immediately consult a surgeon. The cause of such defecation may be an organic pathology of the rectum.

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Pathogenesis

Newborns who are breastfed have bowel movements as often as they eat. If you notice that your child (under three months) has a bowel movement only once or twice a day, you should see a doctor. If a newborn (under one year) is bottle-fed, then chronic constipation is considered to be the absence of a bowel movement for one day.

In breastfed babies, constipation often occurs due to poor feeding or improper absorption of nutrients. If the baby is underfed, the amount of stool may be insufficient to cause the urge to defecate. In newborns who are on complementary feeding and breastfeeding, constipation may be caused by a small amount of products containing plant fiber. In this case, constipation is aggravated by eating foods with a high fat content. With a decrease in the frequency of bowel movements, abdominal pain and loss of appetite may also be observed.

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Symptoms chronic constipation in a child

In chronic constipation in children, the main complaints are:

1. No stool or very rare stool.
2. After defecation, there is a feeling of incomplete emptying.
3. The consistency of the stool changes.
4. The child has a stomach ache.
5. Flatulence.
6. The stomach swells.
7. Defecation is painful.
8. Encopresis.
9. During defecation, blood is mixed with the stool.
10. Paradoxical diarrhea.

First signs

Rare stool, complete absence of stool, a feeling of incomplete emptying after defecation and a change in stool consistency are the first signs of chronic constipation in children. Abdominal pain is not considered a specific symptom. It is observed in only half of all cases. Painful bowel movements are observed when passing too large or dense stool. In this case, the intestinal wall stretches, and cracks may appear in the anus. One of the important signs of chronic constipation is encopresis (smearing of feces), but it is rarely observed in children under three years of age.

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Complications and consequences

Chronic constipation as an independent disease is not considered too dangerous for human health. But fecal retention can cause many negative consequences. Moreover, each new problem aggravates the previous one, especially if fecal retention continues for a long time. The most common consequences of chronic constipation are:

1. The appearance of cracks in the anus.
2. Development of hemorrhoids.
3. Dilation of the sphincter muscles.
4. Formation of fecal stones.
5. Mechanical intestinal obstruction.
6. Volvulus.
7. Poisoning of the body with toxins when the immune system is weakened.
8. Loss of productivity, irritability, insomnia, frequent fatigue, bad mood.
9. Internal bleeding when the intestinal mucosa is damaged by too dense a stool.
10. Deformation of the rectum.
11. Decreased appetite.

What should you be afraid of with chronic constipation? Long-term problems with defecation can lead to intestinal diverticulosis, various diseases of the rectum (cracks that lead to inflammation, hemorrhoids ). The most terrible complication is colon cancer. Scientists believe that the tumor develops from carcinogenic substances that appear when stool stagnates.

In a child's body, chronic constipation can cause a decrease in the absorption of vitamins that are necessary for a young growing body.

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Diagnostics chronic constipation in a child

A full diagnosis of the causes of chronic constipation in children is carried out using instrumental and clinical laboratory methods. In the process of collecting the anamnesis of the disease and general examination, the doctor takes into account the duration, frequency and characteristics of the defecation disorder. At the same time, attention is necessarily paid to the so-called "alarm symptoms": constipation occurs in the first months of life, the child lags behind in development, meconium is late after birth, vomiting occurs, early motor development is impaired, weakness of the lower limbs.

Physical examination methods include abdominal palpation, examination of the buttocks, perianal area and back, assessment of strength, muscle tone, reflexes in the lower extremities. A thorough examination of the perianal area allows you to see early malformations of the anus, anal atresia, and the genitourinary system. Children under one year of age are shown a one-time digital rectal examination, which helps to assess the tone of the sphincter, location, consistency and size of feces.

Using the data obtained from the anamnesis and physical examination, the doctor decides on the need for further diagnostics and treatment methods.

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Tests

The most popular tests performed for chronic constipation are the following:

1. Stool culture for microflora.
2. Clinical analysis of urine and feces.
3. Clinical blood test.
4. Biochemical blood test.
5. Parasitological and microbiological examination of feces.

Tests are taken in very rare cases. Usually, palpation is enough for the doctor to prescribe the correct treatment.

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Instrumental diagnostics

Popular methods of instrumental diagnostics of chronic constipation in children are:

1. Colonoscopy is a diagnostic procedure during which a doctor evaluates the condition of the colon and its walls by examining this area with a special probe.
2. Irrigoscopy is an X-ray examination that is performed using retrograde injection of a special radiopaque agent into the colon.

Differential diagnosis

In differential diagnostics, it is very important to consider that chronic constipation is usually not an independent disease, but only a symptom. If a connection with another disease was not established during the anamnesis, the patient undergoes examination of the gastrointestinal tract. Among the main diagnostic methods that are mandatory for all patients, the following stand out: stool analysis for occult blood, rectoscopy (visual examination of the rectal mucosa), palpation of the internal sphincter of the rectum, colonoscopy or irrigoscopy.

Treatment chronic constipation in a child

Many parents are concerned about whether it is necessary to give enemas for chronic constipation. This should not be done too often, since an enema suppresses the natural urge to empty the bowels, which disrupts the formation of the child's defecation reflex. But it is still possible to give enemas occasionally, while observing all the rules.

For newborn babies (up to one month), the enema volume is no more than 30 ml. For children aged one to three months, this volume can be increased to 40 ml. Babies up to six months can be given enemas with 90 ml of liquid, and from six months to one year - 120 ml. In this case, water should be used at room temperature. Sometimes it may seem that complete emptying after the procedure did not occur. Do not rush and do another enema. Usually, after some time, the child begins to have an independent bowel movement.

It is also necessary to give the baby a sufficient amount of liquid. Clockwise abdominal massage is excellent for treating atonic constipation. You can use laying on the stomach or mild tactile irritation of the anus. For treating spastic constipation, it is best to use special suppositories that contain glycerin. It is not recommended to insert any foreign objects into the rectum.

Correct treatment of chronic constipation in children is impossible without a regime. Try to teach your baby to always defecate at the same time. To stimulate defecation, you can give your child fruit juice (especially apple juice), cold water.

Medicines

• Vaseline oil. It has hypoallergenic properties and a mild laxative effect. Due to the fact that Vaseline oil acts only in the lumen of the intestine and is not absorbed, feces are perfectly softened, which facilitates their exit. It is not recommended to replace it with other oils, as they can harm the baby's health. The active substance of the drug is liquid paraffin.

Vaseline oil is indicated for use in chronic and other types of constipation in children and adults, poisoning with some poisons (particularly fat-soluble ones). Contraindicated in inflammatory processes in the abdominal area, intestinal obstruction, acute febrile conditions, individual intolerance to the drug.

With prolonged use, intestinal tone may decrease. Side effects also include problems with digestion. Because Vaseline oil does not allow fat-soluble vitamins to be absorbed, hypovitaminosis may develop.

For chronic constipation in children, the drug should be taken orally in a dosage of 1-2 tablespoons twice a day. Please note that the oil will only work within five to six hours after administration. Therapy can be carried out for no longer than five days.

It should also be remembered that Vaseline oil passes through the anus without being absorbed by the body, so it can contaminate underwear.

• Lactulose syrup. This drug is the most popular laxative for newborns. Lactulose is a common disaccharide that is not found in nature. Due to the fact that this substance is not absorbed by the body, it is completely safe for human health. Penetrating the large intestine, lactulose becomes a substrate in which beneficial bifidobacteria and lactic acid bacteria multiply perfectly. They gradually convert it into organic acids, which are distinguished by their laxative effect.

Lactulose syrup is a so-called osmotic laxative. Its mechanism of action is based on the phenomenon of a special property of water to penetrate through a semi-impermeable membrane from a weak salt solution to a concentrated one. This property is called osmosis. Osmotic substances help to retain water in the intestines, which increases the volume of feces and improves peristalsis. This is enough to obtain a weak laxative effect.

Lactulose syrup has a sweetish taste, is well tolerated by children and can be used for a long time. You can buy the drug at any pharmacy without a prescription. It is worth remembering that the positive effect occurs only on the second day after taking the drug. It is recommended to start treatment with small doses, gradually increasing them. For children under one year, the daily dose is 5 ml of syrup. For children from one to seven years old - up to 10 ml, and from seven to twelve years old - 15 ml. Adults can also take lactulose in a dosage of 15-30 ml per day.

When taking too large doses of the drug, side effects are possible. They manifest themselves in the form of diarrhea and abdominal pain.

• Glycerin suppositories. An excellent laxative for local use. The drug has an irritating effect on the rectum, which stimulates intestinal peristalsis. It also helps soften feces. It is used rectally, one suppository per day twenty minutes after breakfast.

With prolonged use of suppositories, side effects may develop: allergic reaction, irritation of the skin in the anus, weakening of the natural process of emptying. Suppositories with glycerin, as a medicine for chronic constipation in children, are contraindicated in hemorrhoids, in the presence of cracks in the anus, tumors and inflammation of the rectum, individual intolerance to glycerol (active component).

• Microlax. The drug is produced in the form of a viscous solution, which is used for microclysters. It is considered one of the most effective remedies for chronic constipation in children and adults. Microlax is a combination drug. Its active components are: sodium lauryl sulfoacetate (with a thinning effect), sodium citrate (to displace bound water in feces), sorbitol (to enhance the laxative effect), glycerol (to improve rectal motility).

After using the drug, a positive effect occurs within 15 minutes. The drug is indicated for chronic constipation and in preparation for gastrointestinal examination. There are no contraindications to Mycolax. It can be used without fear even in the treatment of constipation in newborns. The main side effects include: possible allergies, irritation, burning in the rectal area. Usually, one tube (5 ml of the drug) is enough for treatment.

Physiotherapy treatment

Usually, physiotherapy treatment of chronic constipation in children is carried out in combination with a special diet (food rich in dietary fiber is taken). The main methods here are the following.

• Treatment with mineral waters. Physiotherapy includes the use of special mineral sulfate waters (bitter salt, salt-replaceable mineral and mixed with sulfate springs). Usually, to obtain a laxative effect, it is necessary to increase the dose level of SO4 (up to 3 g).
• Physical exercises. This method of treatment is suitable for children from seven years old. To treat constipation, it is very important to move actively. In addition, you need to do special exercises. First of all, you need to deeply draw in your stomach, and then release it at a slow pace. In this case, the child needs to count to ten. Repeat the exercise at least five times a day.

To stimulate the evacuation of stool before each expected bowel movement, you need to do the following exercise: inhale deeply, drawing in your stomach, and then sharply throw it forward, exhaling. Repeat the exercise ten times.

• Massage. An effective method for treating chronic constipation is colon massage. Its purpose is to stimulate intestinal motor activity. It is very important to do this massage correctly: all pressure and touching is done strictly in the direction of the anus. Each part of the colon should be massaged for up to five minutes. The massage therapist must press at an angle, synchronously with the patient's breathing.

Folk remedies

There are several proven and effective folk remedies for treating chronic constipation in children.

• Vegetable oil. Before the first feeding, in the morning, it is necessary to give the child vegetable oil (sterilized). On the first day - 1 drop, and then gradually increase and reach half a teaspoon. Use until normal bowel function is restored.

To sterilize vegetable oil, pour it into a jar and place it in cold water. Place the pan with water and the jar on low heat and boil. Leave the jar for another 30 minutes while the water boils.

• Prunes. Pour 3.5 liters of water over half a kilogram of prunes and boil for 25 minutes. Let the decoction cool. Then add 50 g of buckthorn bark and boil again (25 minutes). Cool again and add 200 g of rosehip extract (can be purchased at the Holosas pharmacy). Take this drink before bed, half a glass at a time.
• Lemon and egg yolk. Take a small lemon and squeeze the juice out of it, add one raw yolk and mix with a glass of orange juice. This medicine is tasty and healthy. It helps with chronic constipation in children.

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Herbal treatment

• Senna. A very powerful laxative. To get a positive result, mix 2 teaspoons of senna with 100 g of prunes. Add three glasses of boiling water and boil. Leave for three hours, then strain. Take three tablespoons every hour until constipation disappears. There are no contraindications to using this drink. Relief usually occurs six to ten hours after consumption.
• Herbal collection. Mix a collection of herbs effective against constipation (licorice, fennel, marshmallow and flax). Grind to obtain a powder. Brew one teaspoon of such a collection in a glass of water and let it brew. Drink half a glass before bedtime.
• Aloe vera and aloe vera. Extract the juice from aloe vera and aloe vera and mix it with honey. It is best to use a young plant (no older than 3 years) to obtain the juice. To do this, cut off its leaves and put them in the refrigerator for a few days. Take them out and put them under the press. Take the juice all day, one teaspoon at a time.

Homeopathy

• Acidum Nitricum. This homeopathic preparation contains nitric acid, which effectively acts on all openings in the human body, including the anus. It is indicated for use if feces severely damage the rectum, with chronic constipation, with cracks in the anus. Take 5 grains twice a day after meals. Duration of treatment is two to three weeks.
• Alumina. The drug is purified anhydrous aluminum oxide. It is used for constipation, which is characterized by loss of tone of the rectum. It is very effective in the treatment of chronic constipation in children, especially in combination with another drug "Brionium". Take 5 grains per day before meals twice a day. Treatment lasts from two to three weeks.
• Bryony. The active ingredient is the perennial plant bryony (or white bryony). The granules are absorbed three times a day. The dosage depends on the patient's age. For example, children under two years of age can be given no more than two granules a day.
• Lycopodium. It has analgesic, anti-inflammatory, wound-healing, antiseptic, enveloping effects. Tinctures and decoctions are made from this drug, which are excellent for chronic constipation in children.

Diet for chronic constipation in children

If your child has constipation, do not rush to use well-known laxatives or enemas. All this can be avoided if you eat right.

Water is considered the most important component in treating constipation, as dehydration dries out the rectal mucosa and leads to hardening of feces. If you give your baby enough plain water, it will help him get rid of chronic constipation and make the stool softer. Remember that you need to drink at least 2 liters of water per day (for adults).

Don't forget to include foods rich in plant fiber in your child's diet. They can improve intestinal motility. Fiber perfectly stimulates contractile processes, so food passes through the body faster. In addition, it removes toxins and waste. The most effective products are:

1. Fruits.
2. Vegetables.
3. Berries.
4. Nuts.
5. Dried apricots.
6. Dates.
7. Prunes.
8. Oatmeal.
9. Fig.

In case of constipation, products that help cleanse the body are also considered useful: bran, dried fruits, rye bread. No less effective are considered pickled and fresh white cabbage, legumes, broccoli. For breakfast, it is best to give the child vegetables, fruits, making salads from them with sour cream or vegetable oil.

An indispensable product in a diet for chronic constipation in children are whole grain porridges (pearl barley, buckwheat, barley, oatmeal, wheat). Do not forget about sour milk, kefir (preferably one-day old).

An approximate menu for a diet for chronic constipation is as follows:

• Breakfast: vegetable salad seasoned with sour cream, beans (boiled), oatmeal with milk, scrambled eggs and tea.
• Second breakfast: fresh apples.
• Lunch: vegetable soup, stewed cabbage and boiled meat, dried fruit compote.
• Afternoon snack: a handful of prunes (can be replaced with dried fruit to taste).
• Dinner: vegetable cabbage rolls, buckwheat, cottage cheese and tea.
• Before going to bed, be sure to drink a glass of kefir.

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Prevention

To prevent chronic constipation in children, it is necessary to accustom them to proper nutrition, monitor their physical development and teach them to defecate at the same time every day. Also, for preventive purposes, you can use some effective means. For example, one of such means is "Evita". This product contains all the necessary vitamins (group B, A, E, C), minerals (calcium, potassium, magnesium), folic acid. It has a positive effect on the enzymatic and secretory functions of the intestine.

To prevent constipation in infants, it is very important for the nursing mother to eat properly. It is also necessary to choose a complete diet and drink enough water.

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Forecast

The problem of chronic constipation in children is very relevant today. Thanks to timely and correct diagnostics, proper nutrition, the use of dietary supplements and other drugs, physical activity and massages, you can avoid unpleasant complications and achieve daily natural bowel movements.

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