Constipation in children

Constipation in children - a slow, difficult or systematically insufficient emptying of the intestine. For most children, a chronic stool delay of more than 36 hours is considered constipation. At the same time, straining takes more than 25% of the total time of defecation. Sometimes, with constipation, there may be several bowel movements a day with a small amount of stool without a sense of satisfaction, it is also important to take into account changes in the frequency and rhythm of the chair that are habitual for this subject.

The amount, color and consistency of the feces vary considerably between the same child and the children of the same age, regardless of food and environmental conditions. Original feces (meconium) is a dark, viscous, sticky mass. When milk starts, instead of meconium, greenish-brown curdled feces are released, which after 4-5 days turns yellowish brown. The frequency of defecation in completely healthy infants varies from 1 to 7 times a day, the color of the stool is not particularly important, with the exception of the admixture of blood. At some children the issued feces appears only in 2-3 years age. A rare dry stool is observed when the filling or, more often, the emptying of the rectum. The first situation is due to the weakness of peristalsis, for example, with hypothyroidism, as well as obstructive phenomena (developmental anomalies, Hirschsprung's disease). Delayed contents in the intestine lead to excessive dryness and a decrease in the volume of feces. For this reason, reflexes that realize the act of defecation do not "work". The defecation center is localized in the area of the variolium bridge near the vomiting center. Desires to the bottom are under the control of the cerebral cortex, the centers of the lumbar and sacral parts of the spinal cord, as well as pressure receptors in the musculature of the rectum, participate in the implementation of the corresponding reflex. Therefore, the cause of constipation can be the defeat of these muscles (as well as the pathology of the anal sphincter, which prevents its relaxation), afferent and efferent fibers of the lumbosacral spinal cord, the musculature of the anterior abdominal wall and pelvic floor, as well as pathological changes in the central and autonomic nervous system, as a rule, a residual-organic genesis.

In infants and young children, the propensity to constipation is due to the relatively large length of the intestine, while the sigmoid colon occupies the right position in approximately 40% of the observations.

In some cases, the liquid contents of the proximal parts of the rectum can flow around dense feces and spontaneously outward. This condition, often mistaken for diarrhea, is referred to as calomization. Constipation does not usually have a general adverse effect on the body, although he himself and the anxiety of surrounding adults can affect the psycho-emotional sphere of the child. With prolonged persistent constipation, there is a danger of developing stagnant phenomena in the genitourinary system. Transient constipation occurs more often 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 in the form of lumps, a feeling of incomplete evacuation of the intestine, two or less acts of defecation per week. If there are two or more criteria within three months, you can talk about chronic constipation.

Conventionally, there are 3 groups of causes of chronic constipation in children: alimentary, constipation of a functional origin and organic constipation. The most common cause of constipation in children is alimentary. The basic errors of the diet, leading to constipation - this is a quantitative underfeed, a lack of dietary fiber, excessive intake of fats and animal protein, gentle culinary treatment, insufficient use of liquid. Alimentary constipation is aggravated with a sedentary lifestyle, with the use of aluminum-containing antacids, preparations of bismuth, calcium. The basis of functional constipation is the discoordination of contractions and the violation of the tone of the musculature of the intestine.

Hypertonic, or spastic, constipation is typical for preschool and school-age children with vagotonia. The background for spastic constipation is neurosis, chronic diseases of the stomach, bile ducts, organs of the urinary system, intestinal dysbacteriosis. Fecal masses in the large intestine dry up, take the form of lumps, stand out in small portions, causing unpleasant sensations in the anus, down to painful cracks and the appearance of an impurity of blood. In these cases, the child develops "pot disease" and the condition is aggravated.

Hypotonic constipation is more common in early childhood - with rickets, hypotrophy, hypothyroidism. In adolescents, hypotension of the intestine is one of the manifestations of sympathicotonia. With hypotonic constipation, irregular discharge of a large amount of fecal matter after an artificially induced defecation is noted, which is accompanied by the escape of gases. Conditional-reflex locks occur when suppressing a natural urge to act as a defecation. This is due to the lack of time for the child in the morning hours before leaving for school, because of the poor condition of the toilets, because of the unpleasant sensations once carried by the child in the act of defecation and entrenched in the form of a conditioned reflex. The most common organic causes of constipation are Hirschsprung's disease or congenital aganglion of the colon, dolichosigma, megacolon, primary megarectum.

[1], [2], [3], [4], [5], [6], [7]

Treatment of chronic constipation in children

Before prescribing drug therapy, it is necessary to exclude the causes of constipation. In the diet of the child, products with sufficient amounts of fiber are introduced, the amount of liquid increases. It is necessary to increase physical activity, provide regular walks, limit the time spent in front of a TV or computer. It is important to take care of the comfort of the toilet and follow the hygiene procedures to avoid inflammation and cracks in the anus. These measures may be sufficient to overcome functional or reflex constipation. If the general measures are not effective, then you can choose a laxative, based on the nature of intestinal motility disorder.

All the numerous laxatives are divided into 4 groups:

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

When recommending this or that laxative, we must warn the patient and his parents that the drug can not be used systematically and for a long time. Artificial stimulation of the peristalsis of the large intestine raises the sensitivity threshold of the receptors and causes the need for amplification of stimuli.