What is constipation?
Constipation in children is a very common health problem. Constipation is defined as slowing of bowel movements and/or beading, hard and dry poop. In children who usually complain of constipation, severe intestinal pain and/or pain in and around the anus during defecation are also observed.
What is poop incontinence, what is its relationship with constipation?
Many children with constipation also suffer from poop incontinence. Although they are seen as contradictory conditions in terms of meaning, they are two health conditions that are very closely related to each other. Hardened and dried poop accumulates at the end of the large intestine (rectum) and settles in that area. Old poops cover the inner surface of the rectum, causing a decrease or disappearance of the rectal sensation that feels like new poops are coming. In this way, the child does not feel that new poops are coming, and misses poops that are smaller and softer than the old poops. Staining, which is usually seen in the underwear of constipated children, is a sign of incontinence (fecal incontinence). Families often confuse this condition with diarrhea.
Anatomically, the rectum is suitable only as a passageway, not as a storage place for poop. In chronic (long-lasting) constipation, the rectum loses its natural anatomical structure and begins to enlarge and lose its sensitivity. When hard poop accumulated in the rectum exceeds the capacity of the anal sphincters (muscles around the anus) to hold, it can also cause larger poops to escape in the form of overflow.
In addition to constipation, the presence of any neurogenic condition can also cause poop incontinence.
What are the causes of pooping?
In addition to constipation, other conditions that should be investigated are as follows.
- Genetic predisposition
- Loss of muscle control in the anus
- retention of stool
- toilet phobia
- Psychological traumas
- Hard and excessive discipline in toilet training
- Attention deficit/hyperactivity disorder (ADHD) and developmental disorders
- Cognitive and mental developmental delay
How is constipation diagnosed?
Patient history and complaints are very important in clinical decision making. The frequency of pooping is less than 3 times a week and the consistency of the poop is hard and in the form of small pieces. In addition, the presence of increased rectal diameter on ultrasound is a significant criterion for diagnosis.
How common is it?
It is seen in 3% of the patients who applied to the pediatric outpatient clinic.
Which children are in the risk group?
Children with the following conditions are more likely to suffer from constipation.
- Inactivity
- Not consuming enough fiber foods
- not drinking enough fluids
- side effects of some drugs
- Presence of a medical condition affecting the anus or rectum
- Presence of a neurological disorder
What are the symptoms of constipation?
A decrease in the frequency of defecation, abdominal pain and hard stools are the symptoms of constipation. Accompanying constipation lasting more than two weeks;
- Fire
- Loss of appetite
- Having blood in the stool or around the anus
- Poop stains or incontinence in the form of contamination on underwear
- Daytime urinary incontinence, urgency to urinate and/or urinary tract infection
- Excessive straining during defecation
- Presence of poop holding and procrastination behavior
- Feeling of incomplete emptying of the bowel
- Abnormal swelling in the abdomen
- Presence of pain before, during and after defecation
- Bad smell
- Conditions such as the presence of any tissue protruding from the anus (rectal prolapse, hemorrhoids) should be considered important and a doctor should be consulted without delay.
What are the causes of constipation?
Constipation in children occurs due to organic (congenital) or functional (acquired) causes. However, it should be known that as little as 5% of constipation is of organic origin. 95% of it was acquired afterwards.
Organic causes;
- anatomical disorders
- Intestinal nerve and muscle disorders
- Presence of abnormal abdominal muscle
- Metabolic and gastrointestinal disorders
- Genetic predisposition
Functional reasons;
- Postponement of poop
- Not drinking enough fluids
- Not eating enough fiber foods
- Inactivity
- Functional disorders in the pelvic floor muscles
- Failure to learn effective pushing skills
- Changes in life routines
- Giving toilet training at a very early age
- side effect of drugs
- Psychological traumas
- Lactose intolerance (sensitivity to milk and dairy products)
You can track your child's poop type on the Bristol Poop Chart.
How is it treated?
In the treatment plan, it is very important to change the life habits and add lower urinary system complaints such as daytime urinary incontinence accompanying constipation to the treatment.
Probiotic support recommended by your doctor will help reduce your child's complaints in this process. It is very important in this process to start consuming fibrous foods that help soften the poop and age-appropriate water consumption.
Enema at the dose and frequency recommended by your doctor will facilitate defecation and will help to eliminate the restless state of constipation.
In children with constipation complaints, physical evaluations usually reveal excessive tension and spasms in the pelvic floor muscles (muscles around the anus). In order for the treatment to be successful in the long term, pelvic floor rehabilitation must be added to the changes in living habits.
What problems can it cause if left untreated?
If the complaint of constipation is not treated, it can become chronic, disturbing the bladder of those who are in close contact, and may cause urinary complaints to begin. The bladder, which is anatomically in close contact with the intestine, is subjected to the pressure of hard poop that accumulates in the rectum. This can lead to overactivity of the bladder muscles, which can cause urinary incontinence with a feeling of urgent urgency. Thus, the situation can become more complicated and lead to a longer treatment process.
At the same time, constipation can cause pain and restlessness in the child, which may cause the child to avoid defecation. Avoidance of defecation can cause harder and larger poops, which can also increase complaints about constipation. This creates a vicious cycle between pain and constipation. Initiating treatment before this vicious cycle occurs not only shortens the treatment process, but also increases the success rate.
It should not be forgotten that poop is toxic to the body and must be removed from the body regularly every day. A doctor should be consulted as soon as the complaint or symptom of constipation is observed.
How do we treat as Tuğtepe Pediatric Urology Team?
As with other diseases, our approach to constipation is multidisciplinary. By questioning the life habits of our patients who apply to our clinic, we ensure that they gain the most appropriate eating habits for their age. In our sessions, we teach the correct defecation techniques by giving detailed bladder-bowel training.
Children with constipation and poop incontinence put an extra load on their pelvic floor muscles and the structure of the muscles is impaired. These complaints will be healed for a certain period of time by just giving medication. Problems are likely to recur after a while. For this, the function of the muscles must be corrected with pelvic floor rehabilitation.
Relaxing the abdominal muscles, which play an important role in evacuation, with manual therapy and breathing techniques, and rehabilitating the pelvic floor muscles enable us to offer successful treatments in the long term.
It should not be forgotten that; With timely treatment by experts in the field, many serious future health problems will be prevented.