Constipation is a very common problem in infants and children and is frequently seen by both pediatricians and family doctors. Most of the time, reassurance, dietary changes, and laxatives are effective treatment for both the patient and family.
Constipation can occur at any age and the evaluation and treatment may be different depending on the child's age. The newborn infant should have his/her first stool within the first 24 hours after birth. Failure to pass stool by 48 hours of life may signify a more serious condition such as Hirschsprung's disease, meconium ileus due to cystic fibrosis, or hypothyroidism and further evaluation of the infant is needed.
Constipation is usually diagnosed when an infant or child has hard stools or has difficulty stooling. This condition can be quite distressing for the family but is usually easy to treat. Infants are noted to strain excessively and have difficulty passing stools, even though their stools are of normal consistency. The difficulty in passing stool is thought to represent a delay in maturation of intestinal motility and is self-resolving; use of glycerin suppositories may be helpful. The frequency of bowel movements in infants varies considerably, and an infant who has soft, pain-free, but infrequent stools is not constipated and does not need further evaluation.
As the child gets older, constipation can be due to a large number of factors including anal fissure, diet lacking in fiber and fluids, overuse of laxatives, family or behavior problems, and (rarely) ectopic anus. Constipation in children can also present, paradoxically, as watery diarrhea and incontinence due to overflow around impacted stool, a condition called encopresis.
Initial therapy consists of disimpaction of stool, dietary counseling, and stool softeners (such as mineral oil or Colace). Bulking agents (such as Metamucil or bran) may be helpful, but many children will not voluntarily take these products. Increasing the crude fiber in the diet (foods such as raw fruits and vegetables) and sprinkling raw bran on the food is useful in providing bulk. We usually avoid stimulants, as they are rarely necessary, although they can be helpful in establishing a bowel-training regimen in patients after operation for imperforate anus.
If a treatment regimen of bulking agents or laxatives is not effective, further diagnostic studies and evaluation may be warranted. Children with soiling (encopresis) need a bowel-training regimen, with daily use of enemas or stool softeners and frequent toileting. Surgery (either incision of the muscles around the rectum and anus or removal of the colon) has been done for very severe constipation, but is a last resort.
There is a great deal of controversy over whether an anterior ectopic anus (anteriorly displaced anus) causes constipation. It is important to distinguish an anterior anus (which is surrounded by normal sphincter muscles) from a very low imperforate anus (which lacks these muscles). With an anteriorly displaced anus, most patients have normal bowel habits and need no treatment. With an imperforate anus, however, evaluation and surgical treatment is essential for development of normal stooling patterns.
If you have further questions about your child's condition, please do not hesitate to contact our doctors.
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