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Answering The Call Of Constipation

Constipation is the condition in which an individual has reduced frequency of bowel movements, or finds difficulty in having bowel movements or clearing the bowels. It is a relatively common problem in children during toilet training period and school-going age.

Causes of constipation

There are many causes of constipation, including diet, medications, activity, diseases and disorders. Children can also suffer from intentional stool retention, which is constipation due to stress when they’re not ready for toilet training.

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Insufficient water and fibre – A diet that includes an excessive intake of soft drinks, with insufficient drinking water, fruits, and vegetables

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Taking some medication – Antipyretics, analgesics, cough medicine, diarrhoea medicine could be a cause of dry stools and difficult bowel movements

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Anal fissure – Difficult and painful bowel movements

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Inactivity – That causes inactive peristalsis

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Emotional disorders – Being in a stressful home or family atmosphere, with divorced parents, etc.

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Diseases – Development of disorders related to the colon, rectum, nervous system, blood, etc.

Intentional stool retention

Some children under the age of 5 cannot control their faecal excretion reflux, or have a fear of sitting on the toilet which could cause difficult bowel movements. As such, they choose to intentionally hold back their stool, a habit that can cause constipation.

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Your child refuses to go to the toilet

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This causes anal muscle spasms and squeezed buttock muscles

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As a result, faeces is pushed up to the rectum valve

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In turn, this causes constipation in your child

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Leading to colon dilation and decreased rectal sensitivity

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This results in prolonged faecal cumulation, contributing to constipation

Symptoms

Constipation is generally difficult to define, as there are no clear indications of what is ‘normal’ in terms of the frequency of bowel movements, and symptoms may vary from child to child. Here are some signs if you’re concerned that your child could be suffering from constipation.

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Difficult and infrequent bowel movements

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Refusal to go to the toilet

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Underwear is sometimes unknowingly soiled

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Experiences anal pain, has uncontrolled bowel movements or blood in stool

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Stool looks solid, lumpy, or generally abnormal

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Home fixes

Not all constipation incidents need medical attention. Before you rush to your medical practitioner, you may want to try these tips at home to ease the situation.

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TUMMY RUB
Massage your child’s tummy with warm hands using gentle pressure

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MORE FRUITS
Apples, pears and prunes are great for making bowel movements smoother

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HYDRATE OFTEN
Make sure your child is drinking enough water throughout the day

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HIGHER FIBRE
Bran flakes, oatmeal, brown rice, and beans can help to soften stools

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WARM BATH
This can help to relax the anal muscles and help to pass the stool

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RIGHT POSITION
Use a footstool to ensure that the feet are properly supported

The Bristol stool scale

The Bristol stool scale is a good indication of whether or not your child is suffering from constipation, as normal faeces should be the texture of Types 4 to 6, rather than dry, lumpy pieces in Types 1 to 3.

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Physical constipation

In hard lumps or shaped like nuts

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Functional constipation

Sausage-shaped or lumpy stools

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Functional constipation

Like a sausage but with many cracks on the surface

Normal bowel movements

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Like a sausage or snake, smooth & soft

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Soft blobs with clear cut edges

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Fluffy pieces with ragged edges or mushy stools

Diarrhoea

Diarrhoea

Watery with no solid pieces or entirely liquid

Effects of prolonged constipation

If your child has experienced this condition for a prolonged period, it would be wise to call your doctor. Do seek medical attention especially if your child is suffering from any of these symptoms.

Colon dilation (where the colon is unnaturally extended)

Colon dilation (where the colon is unnaturally extended)

Rectocele (or rectum prolapse)

Rectocele (or rectum prolapse)

Poor appetite of your child

Poor appetite of your child

Slow weight gain in your child

Slow weight gain in your child

Persistent abdominal pain

Persistent abdominal pain

Vomiting

Vomiting

References:

1. NHS. Constipation - causes. Available at: http://www.nhs.uk/Conditions/Constipation/Pages/Causes.aspx 

2. Afzal NA, Tighe MP, Thomson MA, et al. Constipation in children. Ital J Pediatr. 2011;37:28.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143086/

3. John Hopkins Medicine. Constipation in children. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/constipation_in_children_90,P01986/

4. Ali SR, Ahmed A, Qadir M, et al. Fecal Incontinence and Constipation in Children: A Clinical Conundrum. Oman Med J. 2011 Sep; 26(5): 376–378.

5. Mayo Clinic. Constipation in children. Available at: http://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/dxc-20235978

6. Mayo Clinic. Self management. Available at:http://www.mayoclinic.org/diseases-conditions/constipation-in-children/manage/ptc-20236058

7. NIDDK. Treatment for Constipation in Children. Available at:https://www.niddk.nih.gov/health-information/digestive-diseases/constipation-children/treatment

8. Continence Foundation of Australia. Bristol stool chart. Available at:https://www.continence.org.au/pages/bristol-stool-chart.html

9. Chao HC, Chen SY, Chen CC, et al. The impact of constipation on growth in children. Pediatr Res. 2008 Sep;64(3):308-11.

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