The Problems

"It might be poo to you, but to a paediatrician, it is his bread and butter"!

An old saying but true !

Constipation is very common, can be quite distressing and may have quite a varied presentation.
Hardness or consistency of the stool is more important than the frequency.
Stools may invariably be described as hard, large, pebbles, rocks, monsters, "sculptured" !

Painful Defaecation / Rectal Bleeding Pain on passing, and a small split to the anus may develop, leading to a show of bright blood. This can lead to holding on to stools.
Abdominal Pain Constipation commonly causes tummy pains. The pains are usually colicky, can be severe, and are often worse around meal times.
Diarrhoea Overflow diarrhoea may develop. The new stool is "fluidly", and may leak around a large stool mass producing offensive diarrhoea.
Soiling / Encopresis Constipation is closely associated with soiling. (See Encopresis)
Nausea / Vomiting Attacks of nausea and vomiting can occur. Delayed stomach emptying can be associated with chronic constipation.
Urine Problems :
Wetting / Infection / Frequency
Urine infections, day wetting and night wetting and frequency of urine may occur frequently with chronic constipation.
The exact mechanism is unknown although it is possible a rectum loaded with faeces may press on the bladder producing reflex spasms of the bladder muscle.
Generally "Unwell" Poor appetite, feeling full, and a tendency to "graze" can be associated with constipation. Vague tiredness and being "unwell" may also be associated.
Behaviours Secondary behaviours may develop around the problem. There may be holding on, toilet refusal and associated conflicts around toiletting.

Many features are listed in the development of constipation .
However the common pathway seems to be one of painful passing and subsequent holding on with delayed emptying.

Less common or rare causes - Bowel nerve supply - Hirschsprung's/NID
- Anal / rectal anomaly
- Neuromuscular or spine anomaly
- Metabolic disorders or hypothyroidism.

Pain and Holding On
Many factors lead to the cycle of painful passing and holding on and subsequent painful passing, including:

Reduce fluid intake
Poor diet/dietary change
Anal fissure
Holding on 2 year olds ! ,Toilet refusal at school/camps, Too busy
Slowly a cycle of pain and holding on can lead to large bowel (megacolon). Subsequently large stools can be passed. There develops lesser and later recognition of stool in the rectum, with experiencing urgency to pass once a stool is felt.

Last Updated  Sunday, 01. May 2016

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