4. Constipation
Organic
spina bifida, pseudo obstruction.
Metabolic: hypokalemia,
hypercalcemia, hypothyroidism,
diabetes mellitus.
Drugs: Narcotics, anticholenergic, lead,
Intestinal: IBD, celiac disease,CF,tumors
Functional
otherwise healthy child
may result simply from an episode of
painful defecation,
difficulties during the period of toilet
training, inattention to the urge to
defecate because of involvement in
other activities or discomfort with
toilet facilities in school
5.
6.
7. Functional consti…..
• Usually, there is an intentional or subconscious withholding of
stool.
• An acute episode usually precedes the chronic course
• In toddlers, coercive or inappropriately early toilet training is a
factor that can initiate a pattern of stool retention
8. Clinical features
• When children have the urge to defecate, typical behaviors
include contracting the gluteal muscles by stiffening the legs
while lying down, holding onto furniture while standing, or
squatting quietly in corners, waiting for the call to stool to pass.
• The urge to defecate passes as the rectum accommodates to its
contents. A vicious cycle of retention develops, as increasingly
larger volumes of stool need to be expelled.
• underlying pathology include failure to thrive, weight loss,
abdominal pain, vomiting, or persistent anal fissure or fistula.
9. • In functional constipation, daytime encopresis is common.
• Encopresis is defined as voluntary or involuntary passage of
feces into inappropriate places at least once a month for 3
consecutive months once a chronologic or developmental age of
4 yr has been reached.
Clinical features..
10. Diagnosis
• a large volume of stool palpated in the suprapubic area; rectal
examination demonstrates a dilated rectal vault filled with guaiac-
negative stool.
• In retentive encopresis, associated complaints of difficulty with
defecation, abdominal or rectal pain, impaired appetite with
poor growth, and urinary (day and/or night) incontinence are
common
11. • In refractory patients (intractable constipation)..
• hypothyroidism, hypocalcemia, lead toxicity, celiac disease, and
allergy testing.
• Colonic transit studies using radio-opaque markers or scintigraphy
techniques may be useful.
• Selected children - MRI of the spine to identify an intraspinal
process,
• motility studies - myopathic or neuropathic bowel abnormalities,
or a contrast enema to identify structural abnormalities.
15. • Maintenance therapy is generally continued until a regular bowel
pattern has been established and the association of pain with
the passage of stool is abolished.
• stress reduction and learning effective coping strategies can play
an important role in responding to the encopresis.
• Children with spinal problems can be successfully managed with
low volumes of fluid through a cecostomy or sigmoid tube.
16. Organic causes to be ruled out…..
• Hirschsprung disease is usually diagnosed in the neonatal period sec-
ondary to a distended abdomen, failure to pass meconium, and/or
bilious emesis or aspirates with feeding intolerance.
