CONSTIPATION AND ENCOPARESIS FOR CHILDREN

Clinical Features

  • Constipation is failure to open bowels regularly and is often accompanied by painful passage of hard stool. It may be associated with soiling of pants.
  • Encopresis is intermittent leakage of soft/watery stool in a child with chronic constipation.
  • Constipation may be caused by obstructive lesions (these include congenital or acquired defects), neurological or endocrine abnormalities (hypothyroidism), or they may be functional.
  • Note: Exclusively breastfed infants may take several days without passing a stool. But when they do the stool is soft. This should not be confused with constipation.

Investigations

  • Abdominal x-rays in suspected obstructive lesions
  • Barium enema when indicated
  • Thyroid function tests when indicated
  • Investigate and treat nonfunctional lesions

Management

Children with perceived constipation are often treated at home with herbs and even enemas. Such treatment may make it difficult to diagnose this condition and may lead to some complications. However, the inclusion of bananas or pawpaw
in the diet may be beneficial, especially in increasing fibre intake.

Treatment of functional constipation is in three stages:

  • Disimpaction (2–5 days): Mineral oils taken orally is the preferred treatment but daily enemas using magnesium salts can also be used. In general try to avoid enemas.
  • Sustained evacuation (about 3 months): this aims to restore normal bowel function. Child is encouraged to use toilet at regular intervals with positive rewards; diet is gradually modified to a low diary, high fibre one once
    disimpaction is achieved. Occasionally fibre supplement (1g/yr/day) may help. Encourage good water intake. Laxatives and stool softeners are used in conjunction with diet.
  • Gradual withdrawal of medication while maintaining bowel habits and diet.

Refer

  • All children with suspected nonfunctional lesions
  • Any child that fails to respond to above treatment
  • Children in need of psychological counselling