ASSESSMENT AND MANAGEMENT -
BACK TO 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,
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
Constipation commonly causes tummy pains. The pains are
usually colicky, can be severe, and are often worse around meal times.
Overflow diarrhoea may develop. The new stool is
"fluidly", and may leak around a large stool mass producing offensive
Soiling / Encopresis
Constipation is closely associated with soiling. (See
Nausea / Vomiting
Attacks of nausea and vomiting can occur. Delayed stomach
emptying can be associated with chronic constipation.
Urine Problems :
Wetting / Infection / Frequency
wetting and frequency of urine may occur frequently with chronic
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
Poor appetite, feeling full, and a tendency to "graze"
can be associated with constipation. Vague tiredness and being "unwell" may
also be associated.
Secondary behaviours may develop around the problem.
There may be holding on, toilet refusal and associated conflicts around
Many features are listed in the development of
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
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