Constipation in children is the absence of a stool in a child for a day or more, or a bowel movement that is normal in frequency, which is accompanied by the release of dry, lumpy feces. The symptom occurs with errors in diet and stress, congenital anomalies in the structure of the gastrointestinal tract, chronic diseases of the digestive system. To find out the cause of constipation in children, a scatological analysis, ultrasound, irrigography, sigmoidoscopy are performed. To normalize the frequency of bowel movements, dietary adjustments, physiotherapy, laxatives and enemas are necessary.
Constipation, which provoke alimentary causes, occurs in the second half of the child's life, when there is an active introduction of complementary foods. Disturbances in bowel movements are due to the predominance of solid foods and cereals, a decrease in the consumption of breast milk. The chair is observed 1 time per day or less, which is uncharacteristic for infants. In this case, the feces look like small lumps that irritate the rectum, which is why the child cries during bowel movements.
In older children, constipation is associated with insufficient intake of vegetables and fruits, which contain fiber. Fecal retention is provoked by an irrational diet with a predominance of cereals, cottage cheese, meat. Lack of stool is often due to inadequate drinking regimen, especially during the hot season. Feces stay in the rectum for a long time, lose water, dry, tuberous stools in the form of a cylinder are released during defecation.
Sometimes the stool begins to linger during the period of teaching the baby to use the potty. If parents at this time do not show enough patience and care, each act of defecation is accompanied by stress, conditioned reflex reactions occur with the participation of rectal receptors. The child involuntarily retains feces, with time the frequency of the urge to defecate decreases.
Constipation in young children is also caused by other psychogenic causes: embarrassment when using the potty in kindergarten, inconvenience when visiting the school toilet. The lack of a full-fledged discharge of feces is often combined with encopresis (fecal incontinence, soiling panties). With untimely diagnosis and treatment of such conditions, they can flow into persistent mental problems that persist into adulthood.
Violation of the normal microflora and the growth of pathogenic bacteria is a common reason why constipation occurs in a child, since beneficial microorganisms produce lactic acid and stimulate the peristalsis of the intestinal wall. Defecation with dysbacteriosis occurs every 2-3 days, feces are scarce, lumpy, fetid. Sometimes a grayish coating can be seen on the surface of the feces. Older children complain of rumbling and seething in the abdomen, cramping pains.
When the temperature rises, the child's body intensively loses water through sweating and rapid breathing. Due to dehydration, the feces become very dry, when going to the toilet, small lumps ("sheep feces") are released. At a febrile temperature, stools may be absent for 3-4 days, which indicates severe hypohydration, which cannot be cured at home.
With damage to the mucous membrane, defecation is accompanied by severe pain, so the child spontaneously restrains the urge so as not to experience pain. The situation is aggravated by the accumulation of a large amount of solid feces in the rectal ampoule, constipation reaches 5-7 days or more. Children complain of unbearable pain in the anus and lower abdomen, which are aggravated in a sitting position.
With proctitis and paraproctitis, constipation in children is combined with other symptoms: constant jerking or dull pains without a clear localization, lack of appetite, weakness and malaise. An anal fissure is characterized by the release of drops of blood from the anus during bowel movements. With rectal fistulas, along with prolonged constipation, there is a discharge of bloody or purulent contents from an opening near the anus.
The severity of symptoms depends on the form of Hirschsprung's disease. With diffuse lesions of the large intestine, constipation begins almost immediately after birth, the newborn does not have spontaneous defecation. The child is restless, constantly screaming, twisting his legs and trying to press them to his stomach. If left untreated, the childhood form of the pathology disease causes intestinal obstruction.
With a latent or prolonged variant of the anomaly, there is a decrease in the frequency of bowel movements up to 2-3 times a week, constipation is eliminated after the application of enemas. Manifestations often occur in schoolchildren and adolescents. Stagnation of feces causes chronic intoxication, which is characterized by dizziness, headaches, pale skin, fatigue.
Rectal atresia manifests itself already in the first day of a newborn's life: meconium does not pass, there is no stool, there is no anus. This condition is diagnosed by neonatologists immediately after childbirth. False constipation (pseudo-constipation) is pathognomonic of cleft lip and palate. With this defect in the structure of the facial skull, milk and mixtures flow into the respiratory tract or pour out of the mouth. Fecal retention is associated with malnutrition.
For dolichosigma, the appearance of persistent constipation after 6 months of life is typical, which is due to the introduction of complementary foods. At first they disturb sporadically and last from 2 to 3 days, then the duration and frequency of stool retention increases. The stool is large in diameter, looks like a "spruce cone", has a sharp fetid odor. In 30% of children, constipation occurs between 3-6 years of age.
Small children do not observe hygiene, so the development of constipation in a preschool child is often associated with the ingress of parasites into the gastrointestinal tract. With helminthiases, the processes of digestion of food and intestinal motility are disturbed. Some of them (roundworms) form large "tangles" in the intestinal loops, so with ascariasis there is an obstacle to the movement of feces. Stubborn stool retention is always detected, children feel pain in the abdomen, sometimes vomiting occurs.
The appearance of constipation is characteristic of gastroduodenitis and peptic ulcer. These causes cause dysmotility of the gastrointestinal tract, as a result of which partially digested food lingers in the intestine for a long time. Constipation is short-lived, defecation resumes after 2-3 days on its own or after setting an enema. The symptom is repeated regularly, it is provoked by errors in the diet, stress.
Prolonged constipation in children, developing against the background of sharp pains in the abdomen, tenesmus, is typical for ulcerative colitis. With the urge to defecate, blood and mucus are released from the anus, the retention of feces during an exacerbation reaches a week. The symptom is sometimes replaced by profuse diarrhea, the feces are liquid and fetid, contain blood impurities.
With lead poisoning, constipation in a child may be the only symptom. Sometimes there is diffuse pain in the abdomen and a single vomiting. The retention of feces is also caused by endogenous causes: intoxication with protein breakdown products, release of toxins by microbial cells. Constipation is prolonged, the urge to stool is often absent. The symptom occurs against the background of a general serious condition requiring emergency medical care.
Most often, persistent constipation is caused by the abuse of laxatives without the advice of a doctor. Uncontrolled intake of these drugs inhibits the natural reflex to empty the intestines, rectal muscle fibers stop responding to impulses from the spinal cord. Independent defecation is difficult or impossible. Constipation is also provoked by other medicinal causes: the appointment of anticholinergics, chemotherapy drugs.
Children who have delayed stools are examined by a pediatrician. If necessary, a pediatric gastroenterologist is involved for consultation. The specialist collects a detailed history of the disease and identifies predisposing factors, dietary changes, concomitant diseases. To verify the cause of constipation, an instrumental examination of the gastrointestinal tract and laboratory methods are prescribed. Most informative:
Short-term (up to 2 days) constipation that occurs during normal health does not require specific treatment. To normalize the stool in infants, it is necessary to add fruit and vegetable purees to the diet, older children are given more fresh or stewed vegetables, healthy dairy products. Effectively increase physical activity, which promotes bowel function and improves motility.
During potty training, it is important for parents to be patient, not to yell at the child and not force him to defecate. When stool retention is accompanied by changes in the color or consistency of feces, general malaise, pain in the abdominal cavity, this indicates pathological causes. Be sure to consult a doctor who knows how to treat constipation in a child correctly.
Constipation in children in most cases is secondary to the underlying pathology, so their treatment is aimed at eliminating the root cause. Children with long-term absent stools are prescribed cleansing enemas. In severe illness, when defecation continues to be delayed despite following a special diet, the treatment regimen includes:
With hypotension, galvanization, pulsed currents, and other stimulating methods are prescribed. With intestinal hypertonicity, paraffin applications are shown on the abdomen. To eliminate intestinal hypotension, massage courses with elements of exercise therapy are used, which are aimed at accelerating intestinal motility and increasing the processes of neuromuscular transmission. If the chair is absent under the influence of a psychogenic cause, a consultation with a child psychologist is required.