F. Habitual constipation:
Functional fecal retention and withholding not associated with Medications or other disorders is the commonest cause of constipation in toddlers and school- age children. Withholding may result from discomfort during defecation or problems with toilet training. The stool when held in the external sphincter for long dries outs and becomes hard, and produces pain with passage. This reinforces withholding and retention. Eventually a very large mass may be passed or the child may develop Encopresis. Rectal examination usually reveals impacted stools.
G.Management of constipation in children>12 months:
Removal of fecal impaction with 2 or three Hyperphosphate Enema or give mineral oil I oz/year of age /day (8 oz maximum) by mouth for 3-4 days. Glycerine or bisacodyl suppositories can also be used.
Manual fecal disimpaction can be done but is highly unpleasant for both the physician and the patient Treat the child with stool softeners like mineral oil, Lactulose, Magnesium salts (Milk of Magnesia) for 3 months, until the diameter and the tone of the bowel return to normal. Children who hold back due to pain or negativism should be given a laxative in addition to the stool softener. Recommend plenty of water intakes.
Recommend a Diet that includes increased intake of high- residue diet such as fruits and Vegetables, and decreased milk products. Older children should be advised to sit on the toilet 3 times a day. Occurrence of encopresis is an indication to get a psychiatric evaluation.