What is Constipation?
Constipation, defecation later than two days, very hard stool, difficulty in defecation, incontinence at least once a week, painful and hard stool. can be defined as . Children who have painful and hard stools even though they defecate every day should also be considered constipated. The number of defecations varies with the age of the child. While babies may have 4-10 defecations a day, the number of defecations decreases in older children depending on the type of nutrition and diet, and at older ages, it returns to once a day.
Constipation in Babies
Your baby should pass his/her first stool (meconium) within the first 24 hours after birth. If your baby has not had his/her first defecation (has not passed meconium) after 48 hours after birth and/or has had hard and invasive defecation since birth, it would be appropriate to have your baby examined by a pediatric surgeon for an underlying organic cause.
Constipation is less common in breastfed babies. This is due to the proteins and oligosaccharides found in breast milk. In addition, since breastfed babies feed more frequently, this positively affects bowel movements. The frequency of the baby's defecation and the consistency of the stool are the two most important criteria for constipation.
Causes of Constipation in Babies:
- Not consuming enough fluids during the transition from breast milk to complementary foods
- Excessive amounts of milk and dairy products Consumption
- Diet lacking fiber
- Organic reasons such as anal stenosis that prevents normal defecation, the anus not being in its normal place or the neural structure that provides normal defecation not being formed
How is Constipation in Babies Treated?
- First of all, a full examination should be performed by a pediatric surgeon to check for an organic cause that may cause constipation. In the presence of an organic cause, treatment is planned for it.
- Breast milk should be given to the baby for as long as possible. Ensuring adequate fluid consumption during and after the transition from breast milk to supplementary feeding
- Attention should be paid to the appropriate preparation of ready-made food.
- It may be beneficial to bathe the baby frequently with warm water and massage the abdomen after bathing
- According to the age of the baby. Fruit puree and vegetable soups may be beneficial.
- If these do not relieve constipation, medications recommended by your doctor can be used.
Constipation in Children
Constipation is a condition that is very common in children and can become chronic if not treated appropriately in time. The most common cause is constipation, which occurs in breastfed children during the transition to complementary foods or during the adaptation process to toilet training, and it is temporary. Apart from this, the causes of constipation that require treatment may be organic reasons due to an underlying disease, or they may be functional reasons, which is the most common condition.
1. Organic Causes
- Congenital anatomical disorders (anal stenosis etc.)
- Congenital intestinal nervous tissue diseases (Hirschsprung Disease etc.)
- Gastrointestinal system diseases
- Diseases affecting the nervous system
- A wide variety of organic causes such as connective and muscle tissue diseases can be listed, but these are rare. These are the diseases diagnosed as the cause of constipation.
2. Functional Constipation (Habitual Constipation)
We can define functional constipation as the act of retaining feces. There is no underlying organic cause. It is the most important cause of constipation in children. It is seen in children who may or may not voluntarily retain their stool. It occurs due to familial, environmental, social and cultural reasons. The child retains feces due to reasons such as separation from family, going to school, caregiver problems, incompatibility with siblings, incompatibility with friends, school failure, etc., which affect the child's social life, not wanting to go to the toilet for social reasons or hygienic reasons outside the home, not being able to leave the computer and television, not being able to stop playing, etc. . The feces that accumulate in the last part of the intestine, defined as the rectum, harden and solidify over time. It is expelled with difficulty. Meanwhile, cracks around the anus clar (fissure)forms. These cracks then cause painful defecation, and because of this pain, the child is afraid of defecation, and the stool accumulated in the rectum becomes harder and becomes difficult to expel voluntarily. In this way, a vicious circle situation arises. The feces accumulated in the rectum involuntarily overflow from time to time and contaminate the underwear, resulting in involuntary defecation, which we call encompresis. If this situation continues, the nerves and muscles involved in defecation become lazy and the condition enters a process that is difficult to treat.
Does Constipation Cause Urinary Problems?
Yes . Another negative effect of constipation is that hard stool in the rectum puts pressure on the bladder and urinary tract, causing urinary problems. Urinary problems such as urinary incontinence, urinary tract infection, reflux of urine from the bladder (vesicoureteral reflux), involuntary bladder contractions are also undesirable conditions that may develop as a result of constipation.
How is Constipation Diagnosed? How is it placed?
A complete history is taken regarding nutritional status since birth, stool habits and control, and the onset and course of constipation. Constipation from birth usually suggests an underlying organic cause such as Hirschsprung's Disease. Constipation that occurs at older ages primarily suggests a functional cause. A complete physical examination is performed to determine the suspected cause. In order to detect anal fissures (anal fissure) or anal problems, anal examination and rectal examination are performed while wearing gloves. It is evaluated by taking an x-ray of the abdomen. If necessary, a barium intestinal radiograph is taken and if Hirschsprung's Disease is considered, a rectal biopsy is performed. In some cases, more detailed tests called anorectal manometry may be performed.
Should Constipation Be Treated?
Yes. The aim of treating constipation in children is to ensure that your child defecates normally and regularly. For this, it is necessary to ensure that the stool remains soft and to prevent painful defecation and fecal incontinence. When the feces accumulated in the rectum are not expelled, it hardens inside the rectum and forms a large mass. turns into forehead. During the removal of this hard stool, cracks form around the anus and these cause pain. The child avoids defecation and a vicious cycle occurs. Hard stools may need to be removed only with interventions such as enema etc. Hard stool that accumulates in the rectum and is not expelled causes laziness in the sensory nerves over time, and the child may not feel the need to poop. In addition, undesirable situations such as fecal incontinence due to the pressure effect are also encountered. At the same time, in order to prevent urinary problems, constipation must be treated first. If constipation is not treated in time, it can turn into a very difficult condition to treat in the future.
How is Constipation Treated?
Motivation is primarily important in treatment. The constipated child should not be blamed, but should be motivated positively. It should be known that constipation is a condition that can be treated, but this situation can be overcome with a good dialogue and patience between the family, the child and the doctor.
First of all, if there are crack-like conditions in the anus due to constipation, these should be treated. If there is hardened stool in the rectum, the rectum and intestines may need to be evacuated with an enema. If Hirschsprung's Disease, anal stenosis or other organic causes that may cause constipation are detected, treatment is planned for the cause.
If your child does not have an organic cause, the social and psychological situation that may cause functional constipation must be corrected. Both the family and the child should be well informed on this subject.
There are three basic principles in the treatment of constipation:
1. Diet Treatment:
What Should Be Done?
- Emphasis should be placed on fibrous foods and adequate fiber intake should be ensured. For this purpose, whole wheat bread should be consumed, emphasis should be placed on vegetable dishes and plenty of fruit should be consumed. Fruits such as apples should be eaten without peeling, and fibrous fruits such as apricots, grapes with seeds and figs should be consumed depending on the season.
- Regular eating habits should be maintained. In particular, breakfast should not be neglected and the habit of eating three meals a day should be established.
- Drinking a glass of warm water on an empty stomach in the morning. habit should be established.
Things that should not be done:
- Excessive tea, coffee and cola drinks should not be consumed.
- Consumption of ready-made foods called fast-food should be minimized.
- Foods such as biscuits, crackers, wafers and chocolate should be restricted, especially between meals.
- If your child is over one year old, more than half a liter of milk a day. should not consume.
- Rice, pasta and banana consumption should be reduced.
2. Restoring the Toilet Habit
Due to constipation, the intestines have become lazy and the sensory nerves have weakened. Therefore, in order to reintroduce toilet habits, it is aimed for your child to go to the toilet after every meal and especially after breakfast, even if there is no need to defecate, and to reactivate the sensory nerves by sitting on the toilet for at least 5 minutes. To ensure that young children sit comfortably on the toilet, it is important to place steps under their feet and keep their knees slightly above hip level. If your child says it hurts while going to the toilet, lift him off the toilet and then sit him on the toilet again. When he feels the need to defecate during the day, make him go to the toilet without waiting. Warn your child not to hold back his stool, especially while at school, and make him go to the toilet. The aim is to regain the habit of painless defecation once or twice a day. For this purpose, your child's motivation can be ensured by keeping a "Defecation Diary".
If your child has fecal incontinence, never resort to punishment.
Genital and anal area cleaning. pay attention.
3. Drug Treatment
Stool softening drugs, enemas and creams may be recommended to ensure the functioning of the intestines, to prevent stool accumulation and to have painless defecation, but these should not be used unconsciously unless recommended by the doctor.
Sample Treatment for Chronic Constipation:
Start appropriate diet and bowel regulating medication as recommended by your doctor.
When you wake up in the morning, drink a warm glass of water. drink it. dah
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