Constipation

Question 1

What social problems can cause constipation?

Answer 1

Diet e.g. low fluid, fibre or excess milk

Potty training difficulties

Question 2

What physical things could cause constipation?

Answer 2

Meds e.g. Gaviscon or anti-spasmodics
Intercurrent Illness
Anatomical Abnormalities

Question 3

Most chronically constipated kids don’t have a physical cause, instead they get into a difficult cycle

Answer 3

First they get an episode of constipation
This leads to a large hard stool which causes pain or a fissure
The kid learns to withhold stool to avoid the pain which leads to further constipation etc etc

Question 4

Other than not shitting, how would a chronically constipated kid present?

Answer 4

• poor Appetite
• Irritable
• Lacking energy
• Abdo pain/distension
• Withholding or straining
• Diarrhoea

Question 5

How would we go about managing a chronically constipated child?

Answer 5

With diet (more fibre, fruit, veg an fluids + less milk)

Reward good behaviour with praise & star charts
Reduce adverse factors e.g. school toilets, tall toilets, punitive reactions from parents

Laxatives

Question 6

What are the types of laxatives?

Answer 6

Osmotic e.g. Lactulose
Stimulant e.g. Senna
Isotonic e.g. Movicol

Question 7

What can we do if we suspect impaction?

Answer 7

That’s the only time we’d do a DRE and maybe a Stool marker X-ray study

Empty the colon with laxatives

Question 8

What other complication can occur from chronic constipation?

Answer 8

UTI due to mass of stool causing urinary stasis