Constipation
30% of children at some point
BO: infants 1/wk, children every 2-3 days
Hx
timing of mec (<24h): hirschprungs/mec ileus
infrequent stool passage
large stools
painful defecation
dyschezia (difficulty ie straining) normal <6mo as long as stools not hard (related to inability to coordinate abdo and pelvic floor muscles)
new onset faecal/urinary incontinence
withholding behaviour (hiding, crossing legs, holding furniture)
Precipitants of functional
introduction of solids
toilet training
starting school
dehydration
illness
Red flags
<6w
wt loss
vomiting
PR blood: CMPI, Coeliacs, Fissure,
Bristol chart
Ex
Ht wt
Abdo: mass/faecolith
Spine: cleft/tuft
Perineum: fistula, fissure, anorectal malformation, anal wink
Lower limb neuro
Ix
TFTs (hypoT4)
Ca (hypoCa)
Rx (aim is 1 soft non straining stool per day)
first line impacted with severe pain
Diet
FU escalation: 1) GP 2) Paed 3) Continence clinic
Continence clinic if
BO: infants 1/wk, children every 2-3 days
Hx
timing of mec (<24h): hirschprungs/mec ileus
infrequent stool passage
large stools
painful defecation
dyschezia (difficulty ie straining) normal <6mo as long as stools not hard (related to inability to coordinate abdo and pelvic floor muscles)
new onset faecal/urinary incontinence
withholding behaviour (hiding, crossing legs, holding furniture)
Precipitants of functional
introduction of solids
toilet training
starting school
dehydration
illness
Red flags
<6w
wt loss
vomiting
PR blood: CMPI, Coeliacs, Fissure,
Bristol chart
Ex
Ht wt
Abdo: mass/faecolith
Spine: cleft/tuft
Perineum: fistula, fissure, anorectal malformation, anal wink
Lower limb neuro
Ix
TFTs (hypoT4)
Ca (hypoCa)
Rx (aim is 1 soft non straining stool per day)
first line impacted with severe pain
- 5ml Microlax enema under nitrous oxide sedation
- second line inpatient 25ml/kg/hr (max 400ml/hr) glycoprep 1-3L
- need to take PO or IV maintenance hydration ontop
- Movicol disimpaction OPD regime
- <6months: Coloxyl 0.3mL tds
- 6-12mo: Lactulose 3-5mL/day
- >1y: Stool softener (paraffin oil eg Parachoc) or iso-osmotic laxative (Movicol™ or Osmolax™)
- Parachoc
- 1-6yo 10-15mL/day
- 6-12yo 15-20mL/day
- >12yo up to 40mL/day
- Parachoc
Diet
- hydration
- fibre as prevention (wont treat established)
- avoid excessive dairy
- footstool knees above hips, elbows on knees,
- Bulge tummy out
- for 5 min after the 3 main meals
- Praise regardless of result to keep as a positive experience
- Start chart to diarise attempt and reward success
FU escalation: 1) GP 2) Paed 3) Continence clinic
Continence clinic if
- incontinence
- ?organic
- difficulty managing