Constipation ( types,causes ,symptoms.Diagnosis ,Treatment and Dietary Recomendations):-

 Constipation:-        

                                      Defined as delay or difficulty in defecation  present for 2 weeks or longer and significant  to cause distress to the patient.

 

Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. 

 

Chronic constipation may also cause people to strain excessively in order to have a bowel movement.

Treatment for chronic constipation depends in part on the underlying cause. However, in some cases, a cause is never found

 

Other Terms to Know:- 

                              

Intractable constipation:

Constipation not  responding to optimal conventional treatment  for at least 3 months.

Fecal Impaction:

A hard mass in the lower  abdomen or a dilated rectum  filled with large amount of stool on rectal  examination or excessive stool in the distal  colon on abdominal radiography.

 RESULTS IF CONSTIPATION  IS NOT RELIEVED

SYMPTOMS

liquid seeping from anus

Abdominal pain 

Nausea and loss of appetite  ,Abdominal Distension and rectal pain.

 

Soiling :

The involuntary passage of fluid or  semi solid stool into clothing, usually as a  result of overflow from a faecally loaded  bowel.

Normal bowel Movement:-                                   

                                                     It  Varies from person to person.

Some people have a bowel everyday, some every 2-3  days and some 2-3 times a week.

Some have bowel movement during the morning and  some in the evening.

Stools are normally brown in color.

Feces are normally soft, formed, moist and shaped like the rectum.

                     

 

Defecation:-   

          

Constipation

Causes:-

A. Organic

lStructural: anal stenosis, anal fissure.

lNeuromuscular: Hirshprung disease, spina  bifida, pseudo obstruction.

lMetabolic: hypokalemia,  hypothyroidism,

lDrugs: Narcotics, anticholinergic

Intestinal: IBD, celiac disease, tumors.

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.

 

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.

Sometimes rectal bleeding, poor appetite,  enuresis and history of UTI are associated.

lSoiling (an overflow incontinence of liquid  stool) can be

present in long  standing case.

lPhysical examination of the abdomen may  reveal distention or palpable fecal masses.  Digital examination of the rectum is needed  to evaluate the sphincter.

 

Constipation

Diagnosis:-

 lWhen no underlying cause is identified =>  history and physical examination

llaboratory tests => To rule out the organic  causes.

lBarium enema and anorectal manometry  are most helpful.

 

 

Diagnostic Criteria:-

   

 The most widely accepted definitions for childhood  functional constipation => ROME III definitions,  which are divided into 2 main groups, based on the  age of the patients.

 Infants up to 4 years have to fulfil >/2 criteria for at least  1 month

 Children above 4 years have to fulfil >/2 of the criteria  for at least 2 months.

 

 

In the absence of organic pathology, >/2 of the  following must occur

For a child with developmental age <4 years

 

For a child <4 years

1.</ 2 defecations per week

2.At least 1 episode of incontinence per week after the  acquisition of toileting skills

3.History of excessive stool retention

4.History of painful or hard bowel movements

5.Presence of a large fecal mass in the rectum

6.History of large-diameter stools that may obstruct  the toilet.

For a child >4 years 

                      <2 defecations in the toilet per week 

At least 1 episode of fecal incontinence per week  History of retentive posturing or excessive volitional  stool retention

History of painful or hard bowel movements  Presence of a large fecal mass in the rectum

History of large-diameter stools that may obstruct the

toilet.

 

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. 

 lsoftening of stool by lactulose, high fiber 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.

 

Dietary  Recommendations :-

•Increase intake of fiber, especially fruits and cooked vegetables.

•Drink 7-8 glasses of water each day, preferably  lukewarm in winters and room -temperature water in  summers.

•Have a mid-morning soup, preferably prepared with

•spinach and tomato.

•Take daily morning and evening walks for at least 20-30  minutes each.

•Eat whole grains and nuts.

•Avoid removing bran from the flour because the bran is  an insoluble fiber that clears off the intestines and  relieves constipation.

•Avoid refined foods like white flour, bread, pasta,  pizza, white rice, etc.

•High -protein foods like cheese, red meat, and  soybeans can cause constipation, so these must be  taken with a bowl of salad and lots of liquids.

•Meat is constipating and should be avoided.

•Natural antacid, baking soda can neutralize  stomach acids and reduce heartburn.