![]() ![]() ![]() Ask about other medications (eg anticholinergics), previous laxative use, and their duration and effect. When constipated, there may be hard stools (types 1–2) if there is retained impacted stool, there may be watery overflow diarrhoea (types 6–7).ĭietary factors, including inadequate fibre and water intake, are rarely the primary cause of constipation but may contribute. 10 A Bristol type 3 or 4 stool every day or every second day is the goal. The Bristol stool form scale (Figure 1) allows a reproducible, subjective assessment of stool consistency, 6 and the chart is freely available online from the Royal Children’s Hospital’s Constipation clinical practice guideline. Other precipitants to investigate include painful bowel actions leading to withholding behaviour (eg perianal skin conditions, anal fissures), toileting refusal, change of diet and psychosocial stressors. While the median age for onset of functional constipation is 2.3 years, 5 common times for constipation to arise include transition to solids, toilet training and school entry. ![]() >1 episode per week of faecal incontinence after toilet training completed.presence of large faecal mass in rectum.Childhood functional constipation is best described using the Rome IV criteria and is defined by the presence of two or more of the following features for at least one month: 5,7–9 Key features to ask about are the stool frequency and consistency using the Bristol stool form scale (Figure 1), 6 precipitating factors (eg painful stool events, behavioural toileting refusal), faecal soiling, and the presence of any red flags that suggest serious organic pathology (Table 1). Successful management of childhood functional constipation in primary care will have a significant positive impact for children and families, and be very rewarding for clinicians. A supportive and long-term outlook to treatment over months is required. Treatment needs to first disimpact hard stool from the bowel, then maintain ongoing soft stools. Soiling can be embarrassing and distressing. This rectal hyposensitivity can lead to involuntary soiling and will persist until chronic stretching is alleviated and prevented from recurring. Over time, the sensation of ‘needing to go’ when the rectum is full diminishes with persistent rectal stretching from chronic stool loading. 5 This faecal retention stretches the lower bowel and rectum. Stool builds up within the colon and rectum, leading to the absorption of water and, therefore, accumulation of hard faecal matter. 4Ĭonstipation in children is usually functional or idiopathic, and related to behavioural withholding after a painful or unpleasant stool event. ‘Functional constipation’ describes constipation that does not have an organic aetiology. Constipation is defined as the infrequent passage of stools (≤2 per week) with associated stool retention, and possible painful bowel actions or overflow faecal incontinence and soiling (encopresis). 1–3 There is a degree of variability in the expected frequency of stools in healthy children however, most children pass stools every two to three days, whereas breastfed babies may only pass stool once a week. Constipation is a common problem in childhood, affecting an estimated 3% of children worldwide and up to 30% in some settings. ![]()
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