Constipation

A friend of mine who has been having constipation asked me to look into this.

Description

Constipation occurs when stools become hardened and difficult to pass. Some people may be concerned about the frequency of their bowel movements because they have been taught that healthy people should have a bowel movement every day. This is not true. People usually pass stools from three times a day to three times a week. If your stools are soft and pass easily, you are not constipated.

As with adults, the frequency of children's bowel movements varies from child to child. New-born babies can pass loose, runny stools a couple of times a day or only once a week. Breastfed babies usually have frequent stools and may even have a stool with every feeding. As babies grow older, the number of daily bowel movements usually decreases, and the size of the stools increases.

It is important for parents to realise that there are many "normal" patterns for bowel movements in children. Sometimes children's faces turn red and they appear to strain to pass a stool, but if the stool is soft and the child has no other problems, this is not a concern.

Most children will occasionally become constipated. Usually this is only a short-term problem requiring home treatment. However, some children are frequently constipated (chronic constipation).

Cause

• A diet that includes too little fibre and/or too little water
• Voluntary delay of bowel movements:
• Sometimes children resist the urge to have a bowel movement because they are too involved in play and will not take time to go to the bathroom.
• Others may be anxious about defecating in a particular place, such as toilets away from home.
• Delay may be part of a more general pattern of oppositional or anxious behaviour.
• In the case of young children, delay may be caused by stress related to toilet training.
• The cause of chronic constipation cannot always be identified, but the most significant factor appears to be the painful passing of a stool once constipation has already developed. The longer a bowel movement is resisted the larger and harder the stool becomes, which may cause pain when it is passed. Children in particular may then withhold stools, which cause cramping. After some time the child may be unable to resist the urge to have a bowel movement and will pass a large mass of faeces. This can be painful, as the child may have to "push hard" during the bowel movement. Passing the stool relieves the pressure until another mass of stool collects and the cycle repeats itself.
• Circumstances such as travelling that disrupt diet, and time and place of defecation.
• Lack of exercise
• Medication
• Pain caused by haemorrhoids and anal fissures
• Laxative overuse
• Irritable bowel syndrome
• Diseases of the metabolism
• Diseases of the endocrine system:
• Hypothyroidism
• Excessive amounts of calcium in the blood due to hyperparathyroidism
• Diseases of the nervous system or diseases affecting the whole nervous system such as spinal cord damage
• Chronic lead poisoning

Symptoms

• Constipation may occur with cramping and pain in the rectum from the strain of trying to pass dry, hardened stools.
• Some bloating and nausea may occur.
• Sometimes small amounts of bright red blood appear on the stool. This can be the result of anal fissures – slight tearing of the anal membrane as the stool is pushed through the anus - which make the passing of stools very painful. The fissures, which often appear when constipation is chronic, should heal when the constipation is controlled.
• Appetite may be suppressed.
• There may be decreased interest in usual activities.
• Urination may be more frequent because of pressure on the bladder. In the case of chronic constipation, there may be involuntary release of urine (incontinence).
• Occasionally, particularly when constipation is chronic, a stool becomes lodged in the rectum (impacted), with mucus and fluid leaking out around the stool. This can be experienced as constipation alternating with liquid diarrhoea.
• In rare cases, uncontrollable leakage of liquid or loose faecal material (faecal incontinence) occurs and underwear gets soiled. This is called encopresis when it occurs in a child who is past the age of normal toilet training. Some children, out of embarrassment, might hide or throw away underwear.

Prevention

Diet

• Normal bowel function is promoted by eating well-balanced, regularly scheduled meals.
• Eat plenty of high-fibre foods:
• Increase your fibre intake gradually to allow your body to adjust and to minimise potential abdominal gas or discomfort.
• Cereals are good fibre sources if they contain 3 g or more of dietary fibre per serving.
• Increase the fibre content of low-fibre foods by adding two to three tablespoons of 100% bran cereal or unprocessed wheat bran to cereal or soup. Add bran and whole grain cereals to casseroles, home-made breads and other baked goods to provide additional fibre.
• Cooked and raw vegetables and fruits are good choices. Cooking does not greatly reduce the fibre content.
• Choose fibre-containing snacks, such as whole grain crackers, fresh and dried fruits (apricots, peaches, pears, raisins, figs, prunes, and dates), raw vegetables (broccoli, cauliflower), popcorn, nuts and seeds.
• Pulses (dried peas, beans and lentils) and nuts are high in fibre and protein. They may serve as high-fibre substitutes for meat, fish or poultry, which have no fibre content.
• Avoid foods that are high in fat and sugar. Constipation may worsen with diets high in fat, sugar, protein or diary products.
• Drink enough fluids:
• The fibre you eat will absorb liquid and keep your stools soft.
• Drink two to four extra glasses of water per day, especially in the morning. Try to drink at least 1.5 to 2 litres of liquids throughout the day in the form of water, juice, milk, soup or other fluids.
• Prune juice may be helpful as a mild laxative.
• For babies and young children:
• Breast-feed your infant; constipation is rare in breast-fed infants.
• Make sure you are adding the correct amount of water to the infant's formula. For infants under six months give additional water (up to 60 ml twice a day).
• From the age of six months, give your infant prune juice. Start with 2.5 ml and slowly increase the amount to 60 ml. From nine months, add one to three tablespoons of strained prunes per day. Alternatively, give infants from six to 12 months of age 60 to 120 ml of fruit juice, such as grape, pear, apple, or cherry, twice a day.
• Make sure your child is not eating or drinking too many dairy products, such as milk, ice cream, cheese and yoghurt. At age one, a child needs four servings a day.

Exercise

• Exercise more. A walking programme is a good start.

Habits

• Set aside relaxed times for having bowel movements. As urges usually occur after mealtimes, it may help to ask a constipated child to sit on the toilet after meals, especially breakfast. It may help to make this a daily routine.
• Defecate when you feel the urge. When a stool needs to pass, your bowel sends you signals. If you ignore these signals, the urge will go away and the faeces will eventually become dry and difficult to pass.
• A firm footing, perhaps with the aid of a footstool, helps children position themselves properly on the toilet.

Help yourself. Eat, drink fluids and don’t sit on your ass. Exercise!