CONSTIPATION

Abnormally infrequent and difficult passage of motions is not common in children, but can be quite troublesome when it does happen. A child may pass hard motions because of which he may get fissures or cuts near the anus. These can be very painful. The child starts thinking that the passage of motions causes pain. He then purposely starts withholding his stools. In consequence, the stools become drier and firmer, making it more difficult for the child to evacuate. Soon, a vicious cycle starts. Sometimes, the child soils his underclothes when liquid waste leaks around the solid waste.


Normal Infrequent Motions
Some exclusively breastfed babies pass normal motions once every 2 to 3 days and sometimes even less frequently. The motions are never hard. This is normal and requires no treatment.

TREATMENT: Eating sufficient fruits, vegetables, sprouts, whole grains and fluids helps in the prevention as well as the treatment of constipation. Regular bowel habits and a relaxed pace for morning routines also helps to avoid constipation. 

A glass of water on getting up in the morning is helpful. Warm water with a teaspoon of honey is preferable. Many children may get a normal urge to pass a motion after that. Others may get used to passing the motion after drinking milk or after breakfast. The child should be relaxed while sitting in the toilet. A younger child may be encouraged to sit for about 15 minutes. He can be engaged by the mother or others with something interesting like a toy or a book or a puzzle. If he does not evacuate, he should not be forced to do so.

The diet should have more of fibre in the form of fruits like figs (fresh as well as dry), raisins, plums, apricots and prunes; vegetables, especially raw and leafy vegetables, peas and beans, sprouts, whole wheat flour chapatis and bread, unpolished rice, and enough liquids.

Foods that should be omitted or reduced include white bread, bakery goods, milk, butter, cream, cheese, ripe banana, nuts, popcorn, sausages, sweet potatoes, spaghetti, macaroni and noodles. Avoid giving the child milk products since they can depress the activity of the colon. Cow and buffalo milk can also cause milk allergy and anal fissures which may cause chronic constipation via stool avoidance. Soya-based milk may be tried in such cases.

Although medicines can be helpful, do not medicate without consulting your doctor. Bisacodyl suppository (available as Dulcolax), 5 mg. for under-twos and 10 mg. for children over 2, may be used. It should be inserted at the same time each day, preferably after a meal. Use it daily for a month, 2 times a week in the next month and then once a week for 3 months.

In severe cases, hospitalisation may be needed to manage the child and also to investigate for some other rare causes like congenital megacolon (Hirschsprung Disease) and hypothyroidism that can give rise to constipation.

11 February, 2013