Difficulty in passing stool which is firm to hard in consistency is called constipation.If untreated, it can lead to rectal impaction of feces and overflow incontinence (encopresis). Constipation is seen more common in male children than female children.
Causes of Constipation:
1. Dietary cause- Change from breast feeding to bottle feeding or introduction of solid food can cause constipation. Even if the formula feed is not mixed with sufficient quantity of water can give rise to constipation.
2. Cow's milk is itself a constipatory agent. If given in excess, can lead to hard stool.
3. Cystic fibrosis which is a genetic disease can cause constipation.
4. Anorectal problems- Anorectal problems like Anal stenosis, anterior ectopic anus, Anal fissure, Presacral mass can cause constipation.
5. Neurological problems- Meningomyelocele can involve the bowel leading to constipation.
6. Local intrinsic neuronal problems like Hirschsprung's disease, meconium plug syndrome or colonic dysmotility can cause constipation.
7. Metabolic problems like hypothyroidism.
8. Functional Constipation (most common)
Clinical features:
1. Chronic recurrent, nonspecific pain in abdomen
2. Difficulty in passage of stool
3. Eneurosis
4. Soiling of stool
5. Hard stool
6. Perianal pain/ Fissure-in- ano
On Examination:
1. Abdominal Examination: On examination, abdomen will be soft, non-tender, mildly distended. Fecolomas may be palpable.
2. Peri-anal & Anal examination: Fissure, anal stenosis, rectal mucosal prolapse can be seen on perianal examination.
3. Per-rectal examination: Decreased anal tone, shortened anal canal & distended rectal ampulla with full of stools.
Diagnosis:
1. Abdominal X-ray- Fecal matter, vertebral anomalies
2. Contrast Enema- Dilatation of colon & rectum up to the anal verge is suggestive of functional constipation while narrow rectum/ recto sigmoid with dilated proximal colon is suggestive of Hirschsprung's disease.
3. Cinedefecography
4. Anorectal manometry with electromyography can differentiates between Hirschsprung's disease and functional constipation.
5. CT/ MRI- For anatomical problems
6. Rectal full thickness biopsy- To rule out Hirschsprung's disease.
Treatment:
Treatment of underlying cause is the mainstay of management.
1. Correction of anatomical anomalies like dilatation in case of anal stenosis, anoplasty in case of ectopic anal opening.
2. Colostomy followed by pull-through surgery in case of Hirschsprung's disease.
3. Enemas, laxatives, stool softeners, toilet training
4. High fiber diet, plenty of liquids
5. Avoidance of milk or milk related products.
