How to help a child with constipation

How to help a child with constipation

By Donya Betancourt

SANUR, Bali (JP): I was recently on call at the hospital and I
met a five-year-old boy who came in suffering from severe
abdominal pain. It had lasted for two days and was getting worse.

When I examined him I found a big mass in the lower abdomen.
It was a fecal impaction because the boy had not had a bowel
movement for five days. He told me he sometimes had stool spots
in his pants at school and was being teased by his friends; after
that the problem began. He held the stool until he could no
longer prevent its discharge. When he wanted to have a bowel
movement, he could not. This condition is called "chronic
constipation" or "encopresis".

The colon works to expel stools. The colon's function is to
remove water from the waste material and provide a storage area
for stool. Normal bowel habits in normal healthy people vary from
three times a day to three times a week. Constipation is defined
as hard stools, infrequent bowel movement or difficulty in
passing stool. It may occur because stool moves too slowly
through the colon and too much water is removed, thus causing dry
and hard stools.

From 5 percent to 20 percent of the general population may be
chronically constipated. Constipation is usually not serious but
untreated chronic constipation may lead to more serious problems
such as hemorrhoids, fecal impaction (blockage due to hard stool)
and soiling. Depending on the age, in a small infant,
constipation or the delayed passage of bowel movement should be
considered abnormal until proven otherwise. In newborns, failure
to pass stool within the first 24 hours of life should suggest
intestinal obstruction.

After the newborn period, a common cause of constipation is
from diet, such as the introduction of solid foods or an
excessive intake of cow's milk, but it could be from a metabolic
disorder such as hypothyroidism or renal disorder. After 18
months of age, in many children it occurs as a result of
decreased fluid intake or a painful bowel movement, forced toilet
training or some types of medication. The goal of treatment is to
create normal bowel habits without using medication (laxatives or
enemas).

In the small infant, juices such as prune juice, pureed
pineapple or apple juice can relieve simple constipation. In the
older child, addition of fiber to the diet is often successful in
relieving the problem. Dietary fiber or roughage passes through
the colon almost unchanged, holding it's water keeping the stool
soft and moving through the rectum more easily. Natural food,
unprocessed bran, wheat, oats and brown rice are common sources
of bran. There is also tablet brain available.

The side effects of bran are stomach bloating, fullness,
abdominal cramps and gas which are temporary symptoms and usually
disappear in two weeks. If bran bothers you, you can reduce the
amount of fiber intake. A simple routine to avoid constipation in
your children is to have them drink plenty of water, avoid dairy
products, allow them 10 minutes to sit on the toilet after
breakfast, exercise daily and teach them to never ignore their
bowel movements.

Chronic constipation can cause fecal impaction, colon
dilatation and soiling on clothing called "encopresis", which is
mostly caused by a behavioral problem, and requires psychological
intervention. Next week's column will discuss the problem.

The writer is a pediatrician based in Sanur, Bali. If you have
any questions, please feel free to write to her. Her e-mail
address is drdonya@hotmail.com, or you can reach her through
features@thejakartapost.com.