A high fiber diet and lots to drink is the usual first line treatment for constipation. Laxatives are usually prescribed. Laxatives are likely to be needed if the child has a large impacted stool with overflow soiling. If laxatives are needed, they are normally advised for several months. The first aim is to clear any impacted stool. This can usually be done quickly.

However, if laxatives are stopped too soon, a large stool is likely to recur again in an enlarged rectum. Regular laxatives for a few months means that the child is likely go to the toilet and pass stools regularly. As they go to the toilet more often, the stools will be smaller and softer. So, the stools will be passed more easily. Any fear of going to the toilet to pass large and hard stools will ease. The enlarged rectum can gradually get back to normal. Constipation is unlikely to recur.

There are different types of laxatives such as stool softeners, for example, lacunose. These make the stools soft and slippery and easier to pass. Bulk forming agents, for example, fibre supplements, bran etc. These make the stools softer but bulkier, and give the bowel more to work. Stimulant laxatives, for example, senna or docusate. These act on the muscle in the wall of the gut to squeeze harder than usual.

A doctor will normally advise a stool softener or bulk-forming agent at first. If one of these does not work alone, it is quite common to add in a stimulant laxative as well - but only once the stools have been softened. So, two different laxatives may be advised for several months. The dose is then gradually reduced and stopped. It is important to keep on with the treatment for as long as the doctor advises. Constipation commonly recurs if treatment is stopped too soon.

Other treatments

Painkillers for a painful cracked anus may be needed in some cases. An enema may be needed in some cases if the constipation is very severe. Some other points about constipation in children. Although we can buy laxatives at pharmacies, it is not advisable to give them to children unless advised by the doctor. The type and dose of laxative needs to be different in each case. We can Try and get children into a regular toilet habit. After breakfast, before school is often best. Try and allow plenty of time so they don't feel rushed.

Some kind of reward system is sometimes useful in younger children who are prone to resist the stools. For example, a little treat after each successful toilet trip. However, try not to make an issue over the toilet issue. The aim is to be relaxed about it. The more relaxed we are, the more likely our child will be relaxed.

Severe constipation may be treated surgically provided precise evaluation of colon-transit-time and rectal evacuation can be performed. Straight X-ray of the abdomen may study colon-transit-time after oral intake of small plastic markers. Rectal evacuation may be evaluated by defecography. In patients, where Hirschsprung's disease with a short aganglionic segment is suspected, ano-rectal manometry with evaluation of the recto-anal reflex must be performed. Electromyography of the external anal sphincter and puborectal muscle during simulated defecation will be necessary in order to evaluate whether obstructed defecation is due to a spastic condition in the anal sphincter or pelvic floor muscles.

Surgical treatment of obstructed defecation depends on the specific pathology. Treatment of slow transit constipation is subtotal colostomy and ileo-rectal anastomosis. In patients, where constipation is based on a combination of obstructed defecation and prolonged colon-transit-time, surgery for obstructed defecation should be carried out first. In patients, where the constipation is due to prolonged colon-transit-time and a dynamic rectum without anatomical abnormalities the only possibility of surgical treatment is total colostomy with an ileo-anal pouch.

 

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