HOW IS FEAST CONTROL PERFORMED?
Defecation control is managed reflexively until the first 2 years of life. The child reflexively poops until he is two years old. Reflex defecation disappears at the age of 2-2.5 when toilet training occurs, the brain comes into play and poop control begins to be achieved.
Foods taken through nutrition are ground into building blocks throughout the entire digestive tract. Among these, the substances that the body needs pass into the blood, while the substances that the body does not need are transferred to the large intestine. As progress continues in the large intestine, the substance consisting of residues takes its final form, called feces.
For a healthy defecation function, the combination of 3 functions that are intertwined and keep each other in balance is required.
This Functions;
1-Transportation of intestinal contents from the large intestine to the rectum
2-Emptying the rectum (defecation) at certain intervals
3-Defecation It is the ability to keep the intestinal contents in the body (continence).
Anatomical or physiological abnormality of any of the mechanisms controlling these 3 functions will disrupt this balance.
Defecation is a combination of muscle structures and nerves in the anorectal region. It is achieved by working in harmony. The gastro-colic reflex is stimulated as food passes through the stomach. Propellant contractions begin in the intestines. The resulting poop reaches the rectum with peristaltic movements.
The rectum is the last 15cm section of the large intestine that opens into the anal canal. The rectum is not a poop storage site. When the feces reach here, the person feels the need to go to the toilet. Therefore, it is a signal station. Pelvic floor muscles are located in the rectum canal (puborectal muscle). The rectum canal continues with the anal canal. The anal canal is surrounded by the internal anal sphincter (internal muscles) and the external anal sphincter (external muscles).
The rectum is normally empty and its walls are sensitive to stretching. It expands and increases its internal volume according to the amount of incoming stool. With the increase in fecal content, the rectal wall becomes stretched. Stretching of the rectal walls causes the normally contracted internal anal sphincter to relax. Thus, the feces in the rectum descend and enter the inner part of the anus, which is covered with very sensitive nerve endings. It comes into contact with the layer covering its face. Thanks to the nerves here, the person detects whether there is gas, liquid or solid stool in the rectum. This information reaches the brain. If the conditions are suitable, the brain initiates the function of passing gas or defecation.
In order for the function of defecation to occur, the external anal sphincter and the pelvic floor muscles, which work voluntarily and surround the anus, must relax. Thus, the angulation between the rectum and anus disappears and with straining, intra-abdominal pressure increases and defecation occurs. If there is no suitable social environment for defecation, the person squeezes the pelvic floor muscles and the external anal sphincter and sends the stool back to the rectum and postpones defecation until a socially appropriate place and time occurs.
WHAT ARE THE STRUCTURES RESPONSIBLE FOR FEAST CONTROL?
The muscles around the anus (external anal sphincter consisting of striated muscle, internal anal sphincter consisting of circular smooth muscle) and pelvic floor muscles (puborectal muscle) remain contracted while at rest. Thus, they keep the anus closed and ensure stool control.
WHAT IS THE STRUCTURE AND FREQUENCY OF PEE AND POOPING IN BABIES AND CHILDREN?
Meconium, the first poop of the newborn, is greenish black in color. It is odorless and sticky. Meconium must be removed within the first 36 hours after birth. This period may be slightly longer in premature babies. The newborn's poop after the first poop is called transitional feces. It is greenish brown, less dense, smelly and has the appearance of curdled milk. This stool appears for the first week and then becomes milk stool. Milk stool is homogeneous, slightly sour-smelling, light yellow and sticky in babies who are breastfed. In those who are cow's milk, it is pale yellow and has a firmer consistency. It is known that children who are breastfed have more frequent and softer poop than those who are fed with formula. Breast milk contains indigestible proteins and oligosaccharides, causing the stool to increase in quantity and become softer. In addition, since breast-feeding babies feed more frequently, gastro-colic reflexes are triggered. As the baby grows, the number of defecations will decrease.
FUNCTIONAL DEFEATION DISEASES IN CHILDREN AND BABIES
(ROMA lll criteria)
1-Infant Dyschezia
2-Functional Constipation (constipation)
3-Functional non-retentive fecal incontinence
Infant Dyschezia; Sometimes babies' faces turn red, they stretch and contract when they poop. However, the poop that comes out has a normal soft texture. Dyschezia; In healthy babies under 6 months of age, it is defined as having a soft stool after straining and crying for at least 10 minutes before defecation. Babies are noticeably relieved after pooping. This is because babies contract the external anal sphincter and perineal muscles during defecation instead of relaxing them. In other words, there is an inability to relax the pelvic floor during the effort to defecate. It is not known exactly whether it develops as a conditioned response to painful defecation or is a developmental event. This situation resolves itself over time.
Functional constipation; It is a condition of infrequent defecation as a result of the inability or insufficiency of normal defecation without a structural or biochemical reason. A child who has very painful and hard stools despite defecating every day should also be considered as constipated. Constipation is a common problem in childhood. It is seen in almost one in every three children. It constitutes 3% of pediatric outpatient clinic applications. It is thought that 0.3-28% of children worldwide have a constipation problem. There are regional data in our country, and in a study conducted in Istanbul and its surroundings, the frequency of constipation in school children was found to be 7.2%.
Constipation is short-term, temporary or chronic. it could be. Short-term temporary constipation may be due to a change in the environment or diet, due to pain due to anal fissure, a condition that reduces bowel activity. Constipation that lasts longer than a month is called constipation chronic constipation. Chronic constipation; It can cause serious complaints including abdominal pain, stool accumulation in the intestine, fecal incontinence, and even urinary incontinence, which negatively affect the quality of life. It may cause more complex clinical conditions accompanied by internal system infections.
What are the symptoms of constipation?
- Pooing less than 3 times a week
- Stains on underwear or poop incontinence
- Pain, straining and soreness in the butt while passing stool
- Abdominal pain, abdominal tension
- Small, dry and hard poop or very loose poop
- Very large poop
- Poop holding behavior
- Not wanting to go to the toilet, reacting against the toilet, hiding when it comes to poop
- Feeling of not being able to empty the bowel completely
- Bad odor
- Daytime and/or nighttime urinary incontinence
- Excessively frequent urination and/or urgent need to urinate
- Anorexia, vomiting
- Recurrent urinary tract infection
- Rectal bleeding
Functional non-retentive fecal incontinence: Functional non-retentive fecal incontinence is also defined according to the Rome Criteria. All of the specified criteria must be present:
1-Defecation in inappropriate social environments at least once a month (voluntary or involuntary)
2-No fecal retention (absence of feces accumulating in the rectum)
3-There is no anatomical, infective, metabolic or neoplastic disease that would explain the symptoms
One of the indispensable conditions for this diagnosis is the measurement of rectal diameter. Here, the reason is mostly behavioral and psychological in origin.
CAUSES OF CONSPOSITION IN CHILDREN
Constipation in children occurs due to organic or functional reasons. However, in a very small percentage of children (5%), constipation is due to organic causes. In 95%, functional constipation is observed.
ORGANIC CAUSES
A-Anatomical
- Imperforated anus
- Anal stenosis
- Anus anteriorly localization
- Pelvic mass (teratoma etc.)
B- Metabolic and Gastro-intestinal
- Hypothyroidism
- Hypercalcemia
- Hypokalemia
- Cystic fibrosis
- Diabetes mellitus
- Multipl endocrine neoplasia type 2B
- Celiac disease
- Renal tubular acidosis
C-Neuropathic Diseases
- Spinal cord abnormalities
- Spinal cord trauma
- Neurofibromatosis
- Encephalopathy
- Tethered cord
- Cerebral palsy
- Hirschsprung disease
- Intestinal neuronal dysplasia
- Intestinal pseudoobstruction
- Visceral myopathies
- Visceral neuropathies
- Prune belly syndrome
- Gastrochisis
- Down syndrome
D-Intestinal nerve and muscle disorders
E- Abnormal abdominal muscle structure
F-Connective tissue diseases
<G-Drugs
- Opiates
- Phenobarbital
- Sucralphate
- Antacids
- Antihypertensives
- Anticholinergics
- Antidepressants
- Sympathomimetics
H-Other
- Heavy metal poisoning ( lead)
- Vitamin D poisoning
- Botulism
- Cow's milk protein intolerance
FUNCTIONAL CAUSES
- Genetic causes (28-50% of children with constipation have a family history of constipation. )
- In 25% of cases, constipation begins in infancy. Causes of constipation in babies: formulas prepared with little liquid, hardening of the poop and difficulty passing during the transition from breast milk to complementary food and cow's milk, consuming less liquid between meals, insufficient fiber consumption and excessive milk consumption
- Poop retention behavior due to various reasons
- Insufficient fluid intake or excessive fluid loss
- Bad eating habits, low consumption of fibrous foods
- Starting toilet training too early
- Ensure that the toilets at the school are clean, It is not safe and appropriate or children delay pooping until they get home because they are too busy playing during recess.
- Sudden emotional changes, fear, anxiety, family stress, psychological trauma such as a new sibling, divorce or starting school.
Read: 0
