How to help a child with constipation<\/p>\n
By Donya Betancourt<\/p>\n
SANUR, Bali (JP): I was recently on call at the hospital and I
\nmet a five-year-old boy who came in suffering from severe
\nabdominal pain. It had lasted for two days and was getting worse.<\/p>\n
When I examined him I found a big mass in the lower abdomen.
\nIt was a fecal impaction because the boy had not had a bowel
\nmovement for five days. He told me he sometimes had stool spots
\nin his pants at school and was being teased by his friends; after
\nthat the problem began. He held the stool until he could no
\nlonger prevent its discharge. When he wanted to have a bowel
\nmovement, he could not. This condition is called \"chronic
\nconstipation\" or \"encopresis\".<\/p>\n
The colon works to expel stools. The colon's function is to
\nremove water from the waste material and provide a storage area
\nfor stool. Normal bowel habits in normal healthy people vary from
\nthree times a day to three times a week. Constipation is defined
\nas hard stools, infrequent bowel movement or difficulty in
\npassing stool. It may occur because stool moves too slowly
\nthrough the colon and too much water is removed, thus causing dry
\nand hard stools.<\/p>\n
From 5 percent to 20 percent of the general population may be
\nchronically constipated. Constipation is usually not serious but
\nuntreated chronic constipation may lead to more serious problems
\nsuch as hemorrhoids, fecal impaction (blockage due to hard stool)
\nand soiling. Depending on the age, in a small infant,
\nconstipation or the delayed passage of bowel movement should be
\nconsidered abnormal until proven otherwise. In newborns, failure
\nto pass stool within the first 24 hours of life should suggest
\nintestinal obstruction.<\/p>\n
After the newborn period, a common cause of constipation is
\nfrom diet, such as the introduction of solid foods or an
\nexcessive intake of cow's milk, but it could be from a metabolic
\ndisorder such as hypothyroidism or renal disorder. After 18
\nmonths of age, in many children it occurs as a result of
\ndecreased fluid intake or a painful bowel movement, forced toilet
\ntraining or some types of medication. The goal of treatment is to
\ncreate normal bowel habits without using medication (laxatives or
\nenemas).<\/p>\n
In the small infant, juices such as prune juice, pureed
\npineapple or apple juice can relieve simple constipation. In the
\nolder child, addition of fiber to the diet is often successful in
\nrelieving the problem. Dietary fiber or roughage passes through
\nthe colon almost unchanged, holding it's water keeping the stool
\nsoft and moving through the rectum more easily. Natural food,
\nunprocessed bran, wheat, oats and brown rice are common sources
\nof bran. There is also tablet brain available.<\/p>\n
The side effects of bran are stomach bloating, fullness,
\nabdominal cramps and gas which are temporary symptoms and usually
\ndisappear in two weeks. If bran bothers you, you can reduce the
\namount of fiber intake. A simple routine to avoid constipation in
\nyour children is to have them drink plenty of water, avoid dairy
\nproducts, allow them 10 minutes to sit on the toilet after
\nbreakfast, exercise daily and teach them to never ignore their
\nbowel movements.<\/p>\n
Chronic constipation can cause fecal impaction, colon
\ndilatation and soiling on clothing called \"encopresis\", which is
\nmostly caused by a behavioral problem, and requires psychological
\nintervention. Next week's column will discuss the problem.<\/p>\n
The writer is a pediatrician based in Sanur, Bali. If you have
\nany questions, please feel free to write to her. Her e-mail
\naddress is drdonya@hotmail.com, or you can reach her through
\nfeatures@thejakartapost.com.<\/p>",
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