≤2 stools per week for a duration of 2 months if patient >2 years
for duration of 4 months if patient <2 years
or with evidence of overflow incontinence (no stool, then diarrhoea, then no stool, etc),
or stools that clog toilet
Chronic: >8 weeks
Happens in 5 - 30%of the child population, progressing to chronic in > 1/3 of patients
<3 months, 2-3 stools/ day, 8.5 hours mouth to rectum time
<2 years, <2/ day, 16 hours mouth to rectum time
- Too busy to poo, scared to poo leads to reservoir constipation. Stools get larger and harder. Pass a large diameter stool every 1-2 weeks. It's painful to pass these.
The rectum stretches. The internal sphincter struggles leading to a numb, toneless rectum. Chronically, can lead to anal fissures, which are painful so poo-ing is avoided. The stool continues to become harder and more painful to pass.
1/500 live births
Normally diagnosed in newborns.
Get abdominal distension that is relieved by rectal stimulation, or enemas.
Cow's Milk: Tolerance may lead to constipation - should be investigated by a specialist before avoiding cow's milk.
Weigh the child
Perianal exam – appearance, position, patency, fissures
Scoliosis + Gait
Skin overlying the spine – discoloured/sinus/hairy patch/central pit
Gluteal muscles – is there asymmetry?
Red Flag Features
Constipation from early infancy
Delay in meconium >48hrs
Abdo distension & vomiting
Abnormal appearance of anus including multiple anal fissures
Asymmetry/flattening of gluteals
Sacral agenesis, skin changes over spine
Skin changes overlying spine
Deformity of lower limbs – talipes
Abnormal neuromuscular signs
This is summarised so clearly on CYP that I haven't re-written it
- Get rid of old, dark, hard and smelly poo
- Continue treatment for 3 months.
- Make going to the toilet fun