Constipation in children

Constipation in children is a slow, difficult or systematically insufficient emptying of the intestines. For most children, chronic delay in stool for more than 36 hours is considered constipation. In this case, the time of straining takes more than 25% of the total time of defecation. Sometimes, with constipation, there may be several bowel movements per day with a small amount of feces without a feeling of satisfaction; it is also important to take into account changes in the frequency and rhythm of stool that are usual for a given subject.

The amount, color and consistency of feces vary significantly both in the same child and in children of the same age, regardless of food and environmental conditions. Original feces (meconium) is a dark, viscous, sticky mass. When breastfeeding begins, greenish-brown cheesy feces are excreted instead of meconium, which becomes yellowish-brown after 4-5 days. The frequency of bowel movements in completely healthy infants ranges from 1 to 7 times a day, the color of the feces does not have much significance, with the exception of blood. In some children, formed feces appear only at the age of 2-3 years. Rare dry feces are observed when the filling or, more often, emptying of the rectum is impaired. The first situation is caused by weak peristalsis, for example, with hypothyroidism, as well as obstructive phenomena (developmental anomalies, Hirschsprung's disease). Retention of contents in the intestine leads to excessive dryness and reduction of the volume of feces. For this reason, the reflexes implementing the act of defecation do not "work". The center of defecation is localized in the area of the pons near the vomiting center. The urge to defecate is controlled by the cerebral cortex, the implementation of the corresponding reflex involves the centers of the lumbar and sacral sections of the spinal cord, as well as pressure receptors located in the muscles of the rectum. Consequently, constipation can be caused by damage to these muscles (as well as pathology of the anal sphincter, preventing its relaxation), afferent and efferent fibers of the lumbosacral sections of the spinal cord, muscles of the anterior abdominal wall and pelvic floor, as well as pathological changes in the central and autonomic nervous system, usually of residual organic genesis.

In infants and young children, the tendency to constipation is due to the relatively long length of the intestine, with the sigmoid colon occupying the right position in approximately 40% of cases.

In some cases, the liquid contents of the proximal rectum may flow around dense fecal matter and be released involuntarily. This condition, often mistaken for diarrhea, is called fecal smearing. Constipation does not, as a rule, have a general adverse effect on the body, although both the constipation itself and the anxiety of the surrounding adults can affect the child's psycho-emotional sphere. With prolonged persistent constipation, there is a risk of developing congestion in the genitourinary system. Transient constipation often occurs reflexively, for example, after an attack of biliary and renal colic, with diseases of the stomach, cardiovascular system, etc.

Standard criteria for chronic constipation: straining takes at least 1/4 of the time of the act of defecation; the consistency of feces is dense, feces are in the form of lumps, a feeling of incomplete emptying of the intestines, two or less acts of defecation per week. If two or more criteria are present for three months, we can talk about chronic constipation.

Conventionally, there are 3 groups of causes of chronic constipation in children: alimentary, constipation of functional origin and organic constipation. The most common cause of constipation in children is alimentary. The main dietary errors that lead to constipation are quantitative underfeeding, lack of dietary fiber, excessive consumption of fats and animal protein, gentle cooking, insufficient fluid intake. Alimentary constipation is aggravated by a sedentary lifestyle, the use of aluminum-containing antacids, bismuth and calcium preparations. Functional constipation is based on discoordination of contractions and impaired tone of the intestinal muscles.

Hypertensive, or spastic, constipation is typical for preschool and school-age children with vagotonia. The background for spastic constipation is neuroses, chronic diseases of the stomach, biliary tract, urinary system organs, intestinal dysbacteriosis. Fecal matter in the large intestine dries out, takes the form of lumps, is excreted in small portions, causing unpleasant sensations in the anus up to painful cracks and the appearance of blood. In these cases, the child develops "potty disease" and the condition worsens.

Hypotonic constipation is more common in early childhood - with rickets, hypotrophy, hypothyroidism. In adolescents, intestinal hypotonia is one of the manifestations of sympathicotonia. Hypotonic constipation is characterized by irregular passage of large amounts of feces after artificially induced defecation, which is accompanied by the passage of gases. Conditioned reflex constipation occurs when the natural urge to defecate is suppressed. This occurs due to a lack of time in the child in the morning before leaving for school, due to poor toilet conditions, due to unpleasant sensations once experienced by the child during defecation and fixed in the form of a conditioned reflex. The most common organic causes of constipation are Hirschsprung's disease or congenital aganglionosis of a section of the colon, dolichosigma, megacolon, primary megarectum.

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Treatment of chronic constipation in children

Before prescribing drug therapy, it is necessary to exclude the causes of constipation. Products with sufficient fiber are introduced into the child's diet, the amount of liquid is increased. It is necessary to increase physical activity, ensure regular walks, limit the time spent in front of the TV or computer. It is important to take care of the comfort of the toilet and ensure compliance with hygiene procedures to exclude inflammation and cracks in the anus. These measures may be enough to overcome functional or reflex constipation. If general measures are not effective, then a laxative can be selected based on the nature of the intestinal motility disorder.

All numerous laxatives are usually divided into 4 groups:

1. softening - castor or olive oil;
2. increasing the volume of intestinal contents - bran, mucofalk, synthetic macrogels such as forlax;
3. increasing osmotic pressure in the intestine - xylitol, sorbitol, lactulose;
4. enhancing intestinal motor function - motilium, propulsid.

When recommending a particular laxative, it is necessary to warn the patient and his parents that the drug cannot be used systematically and for a long time. Artificial stimulation of the peristalsis of the large intestine increases the sensitivity threshold of receptors and will cause the need to increase irritants.