Chronic constipation in children

Systematic stool delay for 32 hours or more is qualified in modern medicine as chronic constipation. Defecation in children should be daily and regular, at about the same time. This is facilitated by a reflex fixed and worked out in due time.

[1], [2], [3], [4], [5]

Causes of the chronic constipation in a child

In most cases, chronic constipation in children is caused by abnormal bowel work, although sometimes it may be caused by pathologies other than the gastrointestinal tract (hypothyroidism, rickets).

The walls of the intestine begin to shrink in the process of digestion, which helps to push the contents towards the outlet. In medicine, this is called motor function or peristalsis of the intestine. The intestinal motility in children, as a rule, is disrupted for two main reasons:

1. A rare stool, which is accompanied by a large volume of feces (almost like in adults) and bloating, is called atonic constipation. It is associated with poor bowel incidence. The child can not feel the urge to defecate for a long time. At the same time, many parents make the mistake of forcing the baby to sit on the pot for a long time. This should not be done.
2. If the children's chair is too tight and consists of smooth and hard pellets (often called "sheep's feces"), which is accompanied by abdominal pain or during defecation, this indicates a spastic constipation. Its cause is increased contractile activity of the intestine.

It is very rare that the children's chair stands out with a thin and liquid tape. If you notice this in your child, you should immediately consult a surgeon. The cause of such a defecation can be an organic pathology of the rectum.

[6], [7], [8]

Pathogenesis

In newborns who are on natural feeding, the bowel is emptied as many times as it eats. If you notice that your child (up to three months old) stools only once or twice a day, you need to see a doctor. If the newborn (under the age of one year) is on artificial feeding, then chronic constipation is the absence of stools within one day.

In children with natural feeding, constipation often occurs due to a disruption in feeding or improper absorption of nutrients. In case of underfeeding, the amount of feces in a baby may not be enough to cause a urge to emptying. In newborns who are on the lure and natural feeding, the cause of constipation can be a small amount of foods, which contain vegetable fiber. In this case, constipation is exacerbated due to eating high-fat foods. When the frequency of defecation decreases, abdominal pain, loss of appetite can also occur.

[9], [10], [11], [12], [13], [14], [15], [16]

Symptoms of the chronic constipation in a child

With chronic constipation in children, the main complaints are:

1. No chair or very rare stool.
2. After defecation, a feeling of incomplete emptying appears.
3. The consistency of the stool changes.
4. The baby has a stomach ache.
5. Flatulence.
6. The stomach is swollen.
7. Defecation is painful.
8. Encopres.
9. During stool, blood is mixed to the stool.
10. Paradoxical diarrhea.

First signs

A rare stool, a complete lack of stool, a feeling of incomplete emptying after a bowel movement and a change in stool consistency are the first signs of chronic constipation in children. Abdominal pain is not considered a specific symptom. They are noted only in half of all cases. The pain of defecation is observed when passing too large or dense stool. In this case, the intestinal wall is stretched, and cracks may appear in the anus. One of the important signs of chronic constipation is encopresis (calomization), but it is rarely observed in children under three years old.

[17], [18], [19], [20], [21]

Complications and consequences

Chronic constipation in the form of an independent disease is not considered too dangerous for human health. But stool delay can cause many negative consequences. At the same time, each new problem aggravates the previous one, especially if the stool delay continues for a long time. The most common effects of chronic constipation are:

1. The appearance of cracks in the anus.
2. Development of hemorrhoids.
3. Expansion of sphincter muscles.
4. Education of fecal stones.
5. Mechanical intestinal obstruction.
6. Volvulus.
7. Poisoning of the body with toxins, when the weakening of immunity.
8. Loss of productivity, irritability, insomnia, frequent fatigue, poor mood.
9. Internal bleeding, when the intestinal mucosa is damaged by too tight a stool.
10. Deformation of the rectum.
11. Decreased appetite.

What should you be afraid of with chronic constipation? Prolonged problems with defecation can lead to diverticulosis of the intestine, various diseases of the rectum (cracks that lead to inflammation, hemorrhoids ). The most terrible complication is cancer of the large intestine. Scientists believe that the tumor develops from carcinogenic substances that appear when the stool is stuck.

In a child's organism, chronic constipation can cause a decrease in the absorption of vitamins, which are necessary for a young growing organism.

[22], [23]

Diagnostics of the chronic constipation in a child

A thorough diagnosis of the causes of chronic constipation in children is carried out with the help of instrumental and clinical laboratory methods. In the process of collecting an anamnesis of the disease and general examination, the doctor takes into account the duration, frequency and characteristics of defecation. Attention must always be paid to the so-called "anxiety symptoms": constipation occurs in the first months of life, the child lags behind in development, meconium after birth retires late, the occurrence of vomiting, a violation of early motor development, and weakness of the lower limbs.

Physical examination methods include palpation of the abdomen, examination of the buttocks, perianal region and back, evaluation of strength, muscle tone, reflexes in the lower limbs. Thorough examination of the perianal area allows you to see the early developmental anus of the anal opening, atresia of the anus, the genitourinary system. Children under the age of one year are shown a one-time digital rectal examination that helps assess the tone of the sphincter, the location, consistency and size of feces.

With the help of the received data of the anamnesis and physical examination the doctor solves a question on necessity of the further diagnostics and ways of treatment.

[24], [25], [26], [27], [28], [29]

Analyzes

The most popular tests that are performed with chronic constipation are as follows:

1. Sowing of feces for microflora.
2. Clinical analysis of urine and feces.
3. Clinical blood test.
4. Blood chemistry.
5. Parasitological and microbiological examination of feces.

Analyzes are given in very rare cases. Usually the doctor suffices palpation to put the right treatment.

[30], [31], [32]

Instrumental diagnostics

The popular methods of instrumental diagnosis of chronic constipation in children are:

1. Colonoscopy is a diagnostic procedure, during which the doctor assesses the condition of the colon and its walls, examining this area with a special probe.
2. Irrigoscopy is an X-ray examination, which is performed with the help of retrograde introduction of a special radiopaque preparation into the large intestine.

Differential diagnosis

When differential diagnosis is very important to consider that chronic constipation, usually, is not an independent disease, but only a symptom. If the connection with another disease during anamnesis has not been established, the patient is examined by the gastrointestinal tract. Among the main diagnostic methods that are mandatory for all patients, a special analysis is made of feces for occult blood, sigmoidoscopy (visual examination of the rectal mucosa), palpation of the internal sphincter of the rectum, colonoscopy or irrigoscopy.

Treatment of the chronic constipation in a child

Many parents are worried about whether it is necessary to put enemas in chronic constipation. Too often this should not be done, since the enema depresses the natural urge to emptying, which disrupts the formation of a reflex defecation in a child. But occasionally you can put enemas all the same, while observing all the rules.

For newborn babies (up to one month), the enema volume is not more than 30 ml. For children between one and three months old, this volume can be increased to 40 ml. Babies up to six months can put enemas with 90 ml of fluid, and from half a year to a year - 120 ml. Water is worth using room temperature. Sometimes it may seem that there was no complete emptying after the procedure. Do not hurry and make another enema. Usually after a while the child has an independent chair.

Also it is necessary to give the baby a sufficient amount of liquid. For the treatment of atonic constipation, massage of the abdomen, clockwise, is excellent. You can use the laying on the stomach or a mildly pronounced tactile irritation of the anus. To treat spasmodic constipation, it is best to use special candles, which include glycerin. It is not recommended to enter any third-party subjects into the rectum.

The correct treatment of chronic constipation in children can not be done without a regimen. Try to teach your baby to always emerge at the same time. To stimulate defecation, you can give your child a drink of fruit (especially apple) juice, cold water.

Medications

• Vaseline oil. It has hypoallergenic properties and has a slight laxative effect. Due to the fact that petroleum jelly acts only in the lumen of the intestine and is not absorbed, the fecal masses are perfectly softened, which facilitates their escape to the outside. It is not recommended to replace with other oils, as they can harm the baby's health. The active substance of the drug is liquid paraffin.

Vaseline oil is indicated for use in chronic and other types of constipation in children and adults, poisoning with certain poisons (in particular fat-soluble). Contraindicated in the inflammatory process in the abdominal region, intestinal obstruction, acute fever, individual intolerance of the drug.

With prolonged use, intestinal tone may decrease. Among the side effects are also highlighted problems with digestion of food. Due to the fact that vaseline oil does not allow the absorption of fat-soluble vitamins, hypovitaminosis may develop.

For chronic constipation in children, the drug should be taken orally in a dosage of 1-2 tablespoons twice a day. Note that the oil will only act for five to six hours after ingestion. Therapy can be conducted no longer than five days.

It should also be remembered that vaseline oil passes through the anus, not absorbed by the body, so it can contaminate the laundry.

• Lactulose Syrup. This drug is the most popular laxative for newborn babies. Lactulose is the usual disaccharide produced, which is absent in the wild. Due to the fact that this substance is not absorbed by the body, it is completely safe for human health. Penetrating into the large intestine, lactulose becomes a substratum in which useful bifido- and sour-milk bacteria multiply. They gradually convert it into organic acids, which are laxative.

Lactulose syrup is a so-called osmotic laxative. The mechanism of its action is based on the phenomenon of a special property of water to penetrate through the semi-impermeable membrane from the weak salt solution to the concentrated one. This property is called osmosis. Osmotic substances help to retain water in the intestine, which increases the volume of stool and improves peristalsis. This is enough to obtain a weak laxative effect.

Lactulose syrup is characterized by a sweetish taste, well tolerated by children and can be used for a long time. You can buy the drug in any pharmacy without a prescription. It is worth remembering that a positive effect occurs only on the second day after taking the remedy. It is recommended to start treatment with small doses, gradually increasing them. For children up to a year, the daily dose is 5 ml of syrup. Babies from one year to seven years - up to 10 ml, and from seven to twelve years - 15ml. Adults can also take lactulose in a dosage of 15-30 ml per day.

When taking too large doses of the drug, side effects are possible. They are manifested in the form of diarrhea and abdominal pain.

• Suppositories with glycerin. Excellent laxative for topical application. The drug has an irritant effect on the rectum, thus stimulating the peristalsis of the intestine. It also helps to soften the stool masses. It is rectally administered one suppository per day twenty minutes after breakfast.

With prolonged use of suppositories, it is possible to develop side effects: allergic reaction, skin irritation in the anal passage, weakening of the natural emptying process. Suppositories with glycerin, as a remedy for chronic constipation in children, are contraindicated in hemorrhoids, with cracks in the anal passage, tumors and inflammations of the rectum, individual intolerance to glycerol (the active ingredient).

• Mikrolaks. The drug is released as a viscous solution, which is used to conduct microclysters. It is considered one of the most effective means of chronic constipation in children and adults. Mikrolaks is a combined preparation. Its active components are: sodium lauryl sulfoacetate (with a diluting effect), sodium citations (for displacing bound water in fecal masses), sorbitol (to enhance laxative effect), glycerol (to improve rectal motility).

After using the drug, the positive effect occurs after 15 minutes. The agent is indicated for chronic constipation and in preparation for the study of the gastrointestinal tract. There are no contraindications to Mikalaks. It can be used without fear even when treating constipation in newborns. Among the main side effects are: possible allergies, irritation, burning in the rectal area. Usually, one tube (5 ml of the drug) is enough for treatment.

Physiotherapeutic treatment

Usually physiotherapeutic treatment of chronic constipation in children is carried out in complex with a special diet (food is taken, rich in dietary fiber). The main methods here are as follows.

• Treatment with mineral waters. Physiotherapy includes the use of special mineral sulfate waters (bitter salt, salt-exchangeable mineral and mixed with sulphate sources). Usually, to obtain a laxative effect, it is necessary to increase the dose level of SO4 (up to 3 g).
• Physical exercises. This method of treatment is suitable for children from seven years of age. It is very important to actively move to treat constipation. In addition, you need to do special exercises. First of all, it is necessary to deeply draw in the belly, and then release it at a slow pace. In this case, it is necessary that the child counts to ten. Repeat the exercise at least five times a day.

To stimulate the evacuation of the chair before each expected evacuation, the following exercise should be done: inhale the air more deeply, while drawing in the stomach, and then throw it sharply forward, exhaling. Exercise repeat ten times.

• Massage. To treat chronic constipation, an effective method is to massage the large intestine. Its goal is to stimulate the motor activity of the intestine. It is very important to do such a massage correctly: all pressure and touch are strictly in the direction of the anal opening. Each part of the colon should be massaged up to five minutes. The masseur must press on inclined, synchronous with the patient's breathing.

Alternative treatment

For the treatment of chronic constipation in children, there are several proven and effective alternative means.

• Vegetable oil. Before the first feeding in the morning, it is necessary to give the child vegetable oil (sterilized). On the first day - 1 drop, and then gradually increase and reach half a teaspoon. Use until the normal work of the intestine is restored.

To sterilize vegetable oil, it is necessary to pour it into a jar and put it in cold water. A pan of water and a jar should be placed on a weak fire and boiled. Leave the jar for another 30 minutes while the water is boiling.

• Prunes. Pour half a kilo of prunes with 3.5 liters of water and boil for 25 minutes. Allow the broth to cool. Then add there 50 grams of buckthorn bark and boil again (25 minutes). Again, cool and add 200 g extract from the hips (you can buy at the pharmacy "Holosas"). Take this drink before going to bed half the glass.
• Lemon and egg yolk. Take a small lemon and squeeze out the juice from it, add one raw yolk and mix with a glass of orange juice. Such a medicine is tasty and useful. Excellent for chronic constipation in children.

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Herbal Treatment

• Senna. Very powerful laxative. To get a positive result, you need to mix 2 teaspoons of Senna with 100 g of prunes. Add three cups of boiling water and cook. Infuse for three hours, then drain. Eat three tablespoons every hour until the constipation disappears. There is no contraindication to the use of such a drink. Relief usually occurs six to ten hours after ingestion.
• Collection of herbs. Combine the collection of effective for constipation of herbs (licorice, fennel, marshmallow and flax). Grind to get a powder. Brew one teaspoon of this collection in a glass of water and let it brew. Drink before going to bed half a glass.
• Stonecoat and aloe vera. Extract the juice from aloe vera and a century old and mix it with honey. To obtain juice, it is best to use a young plant (not older than 3 years). To do this, cut off its leaves and put it on the refrigerator for a few days. Take them out and put them under the press. Juice take a whole day for one teaspoon.

Homeopathy

• Acidum Nitrikum. The composition of this homeopathic preparation includes nitric acid, which effectively acts on all openings in the human body, including the anus. It is indicated for use if the feces strongly damage the rectum, with chronic constipation, with cracks in the anus. Take after meal 5 grains twice a day. Duration of treatment - two to three weeks.
• Alumina. The preparation is a purified anhydrous alumina. It is used for constipation, which is characterized by a loss of tonus of the rectum, very effective in the treatment of chronic constipation in children, especially in combination with another drug "Brioni". Use a day for 5 grains before meals twice a day. Treatment lasts from two to three weeks.
• Bryony. The active active ingredient is a perennial bryony plant (or white steppe). The granules dissolve three times a day. The dosage depends on the age of the patient. For example, children under two years can be given no more than two pellets a day.
• Lycopodium. Has analgesic, anti-inflammatory, wound-healing, antiseptic, enveloping action. From this drug make tinctures and broths, which are excellent for chronic constipation in children.

Diet for chronic constipation in children

If your child has constipation, do not rush to use known laxative drugs or put enemas. All this can be avoided if you eat right.

Water is considered to be the most important component in the treatment of constipation, since dehydration dries out the rectal mucosa and causes stool hardening. If you give the baby enough of the usual water, it will help him get rid of chronic constipation and make the stool softer. Remember that you need to drink at least 2 liters of water per day (adults).

Do not forget to include in the diet of the child foods rich in vegetable fiber. Thanks to them, the intestinal motility can be improved. Cellulose perfectly stimulates contractile processes, so food quickly passes through the body. In addition, it removes toxins and toxins. The most effective products are:

1. Fruit.
2. Vegetables.
3. Berries.
4. Nuts.
5. Dried apricots.
6. Dates.
7. Prunes.
8. Oatmeal.
9. Figs.

With constipation, products that help to cleanse the body are also useful: bran, dried fruit, rye bread. No less effective are sour and fresh white cabbage, legumes, broccoli. For breakfast, it is best to give the child vegetables, fruits, making them salads with sour cream or vegetable oil.

An irreplaceable product in the diet of chronic constipation in children are whole grains porridge (pearl barley, buckwheat, barley, oatmeal, wheat). Do not forget about yogurt, kefir (better one-day).

An exemplary diet menu for chronic constipation is as follows:

• Breakfast: salad of vegetables, seasoned with sour cream, beans (boiled), oatmeal in milk, fried eggs and tea.
• Second breakfast: fresh apples.
• Lunch: soup from vegetables, stewed cabbage and boiled meat, compote based on dried fruits.
• Afternoon snack: a handful of prunes (can be replaced with dried fruits to taste).
• Supper: cabbage rolls of vegetables, buckwheat, cottage cheese and tea.
• Before going to bed, be sure to drink a glass of yogurt.

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Prevention

To prevent chronic constipation in children, it is necessary to teach them to eat properly, monitor their physical development and teach them to be emptied every day at the same time. Also for preventive purposes, you can use some effective means. For example, one such means is "Evita". This product contains all the necessary vitamins (group B, A, E, C), minerals (calcium, potassium, magnesium), folic acid. It has a positive effect on the enzymatic and secretory functions of the intestine.

To prevent constipation in infants, it is very important that the nursing mother should eat properly. It is also necessary to choose a full-fledged diet and consume enough water.

[40], [41]

Forecast

The problem of chronic constipation in children today is very relevant. Thanks to timely and correct diagnosis, nutrition, use of dietary supplements and other drugs, exercise and massage, you can avoid unpleasant complications and achieve daily natural defecation.

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