Constipation
Childhood constipation is typically characterised by infrequent bowel movements, large stools, and difficult/painful defecation.
It's very common for children to become constipated because of a:
Low fibre diet
Dislike of using the toilet
Reluctance to pass stool due to pain
Not recognising sensation of needing to pass stool i.e. Encopresis
The most common cause of childhood constipation is Diet. Some of the other less common causes include:
Hirschsprung’s disease
CF – particularly Meconium ileus
Hypothyroidism
Spina bifida
Bowel obstruction
Anal stenosis
Presentation
Rabbit dropping stools
Pain on opening bowels
Rectal bleeding
Faecal impaction causing overflow soiling
Management
Lifestyle - High fibre diet, good fluid intake, and encouraging good toileting habits
Medical - Movicol (osmotic laxative)
If impacted, start on a high-dose movicol disimpaction regime first before giving a maintenance dose
Complications
Anal fissures
Overflow incontinence
Encopresis - Also known as faecal incontinence. Chronic constipation stretches the rectum, causing a loss of sensation.