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.