constipation in children
Introduction
Introduction to Pediatric Constipation Constipation is often caused by changes in bowel movements. It means that the stool is dry, hard, and the secret is unreasonable. The interval between defecations is longer (> 2 days), or there is no stool in the stool. basic knowledge The proportion of illness: 80% incidence Susceptible people: infants and young children Mode of infection: non-infectious Complications: anal fissure rectal prolapse ischemic colic
Cause
Causes of constipation in children
Insufficient diet (20%):
When the baby eats too little, the liquid is absorbed after digestion, and the remaining residue is less, causing the stool to decrease and thicken. When the amount of sugar in the milk is insufficient, the intestinal peristalsis is weak, which can make the stool dry, and the lack of diet for a long time causes malnutrition, abdominal muscles and intestinal muscles. The tension is reduced or even atrophied, and the contractile force is weakened to form a vicious circle, which aggravates constipation.
Inappropriate food ingredients (15%):
If the food contains a lot of protein and the carbohydrate is insufficient, the intestinal flora will reduce the fermentation of the intestinal contents, and the stool is easy to be alkaline and dry. If the food contains more carbohydrates, the intestinal fermentation bacteria increase, the fermentation effect is enhanced, the acid production is more, the stool is easy to be acidic, and the number is soft and soft; if the fat and carbohydrate are high, the stool is smooth.
Intestinal dysfunction (20%):
Irregular life and irregular bowel movements, conditioned reflexes that do not form bowel movements are common in constipation, commonly used laxatives or enema, lack of physical activity, or chronic diseases such as malnutrition, rickets, hypercalcemia, dermatomyositis, dyslexia And congenital muscle weakness, etc., due to muscle wall weakness, dysfunction and constipation, sympathetic dysfunction, abdominal muscle weakness or paralysis often make stools secret, taking certain drugs can reduce bowel movements and constipation, such as resistance Cholinergic drugs, antacids, certain anticonvulsants, diuretics and iron.
Physical and physiological abnormalities (20%):
Such as anal fissure, anal stenosis, congenital megacolon, spina bifida or tumor compression ponytail can cause constipation, should be performed anus, lower spine and perineal examination, and some children even if secret after birth, if family history may Genetically related.
Mental factors (10%):
Sudden mental stimulation, or sudden changes in the environment and lifestyle habits can also cause constipation in a short period of time.
Pathogenesis
Consciously suppress bowel movements
It can make the bowel movements disappear, the stools become dry, and the bowel movements are painful. This situation can further inhibit the bowel movements. The reasons for suppressing bowel movements at random can be: children are too playful, have no time to defecate; afraid to be late for class, do not dare to spend time defecation; Or do not dare to ask the teacher to go to the toilet during class; or do not know the location and direction of the toilet, hospitalized children with defecation intention may not be known to the medical staff; children over 4 years old may wish to go to the toilet alone; frequent bowel movements during long trips Being disturbed; staying away from the familiar home, feeling anxious about the unfamiliar environment, unable to get used to the toilet there, all of them, during the training of childrens bowel habits, so that he learns to expel stools or go back according to subjective wishes, since then the child is based on himself The will to act, the punishment, the unpleasantness and the mandatory defecation training can make the children react to the stool and refuse cooperation.
2. Abuse of suppositories, laxatives and enema.
3. Spinal cord lesions
When the spinal cord is blocked above the defecation center, it loses the ability to control the stool freely. The bowel movement becomes a reflex action. If the defecation center is damaged, the rectal sensation is completely lost, and fecal incontinence is formed. The normal rectum is controlled by the anal internal sphincter (reflection). Sexual control) and the action of the external anal sphincter (reflexive and random control), rectal incontinence occurs only when the nerves that innervate the external sphincter are damaged. In this case, the filling of the rectum is only reflected by the internal sphincter. Sexual diastolic emptying, external sphincter loss of voluntary movements and reflex movements leading to rectal incontinence, visible in spinal cord transection, meningocele, spinal dysplasia, spinal cord fissure and spinal cord tumor.
Prevention
Pediatric constipation prevention
Children over the age of three, every day after breakfast and dinner, remind him to defecate, each time the defecation time should not be too short, and encourage as much as possible to clean up, no matter whether there is defecation every time, you must go to the toilet on time every day, so that you can develop A good habit of defecation on time, constipation must be treated for a period of time before the large intestine can restore good defecation function, use the treatment to develop good bowel movements and eating habits, and then stop the drug, constipation will not relapse.
Complication
Pediatric constipation complications Complications, anal fissure, rectal prolapse, ischemic colic
Often complicated by anal fissure, rectal prolapse, colic, and even malnutrition.
Symptom
Symptoms of constipation in children Common symptoms Anal pain, bloating, loss of appetite, abdominal pain, bowel, constipation, exhaust, neonatal constipation, intestinal peristalsis, slowness, fatigue
1. Dry stool:
The number of bowel movements was reduced, the stool was dry and hard, and there was difficulty in bowel movement and pain in the anus. Sometimes feces scratch the intestinal mucosa or the anus causes bleeding, while the stool surface may carry a small amount of blood or mucus.
Because the feces stay in the intestine for too long, it can also cause systemic symptoms, such as loss of mental appetite, fatigue, dizziness, headache, and loss of appetite.
Insufficient long-term feeding can lead to malnutrition, further aggravating constipation and forming a vicious circle.
If the stool stays in the rectum for too long, local inflammation may occur and there is a feeling of falling. Sometimes children with constipation often have a willingness but can't drain it, which increases the number of times. Severe constipation, the stool is partially congested, and the intestinal secretions can flow out unconsciously around the dry feces, which is similar to fecal incontinence. Constipation is a common cause of colic.
2, abdominal distension, abdominal pain:
Self-conscious bloating and lower abdomen pain, bowel and exhaust. Occasionally, children with severe constipation often have sudden abdominal pain and begin to discharge hard stools. Following the discharge of odorous and dilute feces, Chinese medicine calls it heat knot bypass.
3, rectal detachment:
Long-term constipation can be followed by hemorrhoids or rectal prolapse.
Examine
Pediatric constipation check
General routine examination is normal, there may be blood in the stool and mucus when anal fissure occurs. The thyroid function should be checked, and the diseases such as hypothyroidism and rickets should be excluded.
1. Gastrointestinal X-ray angiography
According to the operation of tincture in the gastrointestinal tract, understand the motor function state of the colon, distinguish between hypotonic constipation and spastic constipation, and timely discover organic diseases such as congenital megacolon, tumor, tuberculosis and so on.
2. Proctoscope
Sigmoidoscopy and fiberoptic colonoscopy can directly understand the state of intestinal mucosa. Due to constipation, retention and stimulation of the stool, colonic mucosa, especially the rectal mucosa, often have varying degrees of inflammatory changes, manifested as congestion, edema, and vascular tract. Unclear, in addition, in the constipation of constipation, the contracture contraction of the intestine can be seen, and the lumen of the intestine becomes narrow.
3. Anorectal manometry
Anorectal manometry is a technique commonly used in pediatrics to understand rectal and anal dysfunction. In patients with severe constipation, pressure measurement can be used to determine the resistance of rectal dilatation, resting tension of anal canal, and voluntary contraction of anal The intensity and self-perception of the rectal dilatation of the sick child, and can be evaluated on the anal sphincter reflex. Note that it must be operated by experienced personnel to avoid misjudging the result, according to Karen's anorectal and distal to children with chronic constipation. In the study of end-colon dynamics, almost all cases have dysfunction.
4. Electromyogram
Electromyography observation of the pelvic floor muscles and the external anal sphincters is a useful method for evaluating chronic constipation. The tension of the pelvic floor striated muscles is maintained at rest during normal rest, and the surface skin electrodes are used to detect the anal external sphincter tension during normal defecation. Decreased, and only 42% of children with constipation had decreased myoelectric activity in the puborectal or anal external sphincters.
5. X-ray defecation angiography
In recent years, due to the clinical application of defecography, the static and dynamic observation of the anal sphincter and anorectal can be performed, and rapid filming (2 to 4 per second) can be performed continuously to observe the whole process of defecation. Some constipation was found to be due to different degrees of obstruction at the exit, such as rectal intussusception, rectocele, pelvic floor tendon syndrome, etc. These obstructions are difficult to find in clinical and endoscopy, and are not actually habitual constipation. category.
Diagnosis
Diagnosis and identification of constipation in children
diagnosis
Should consult the history and defecation rules in detail, whether there are symptoms associated with the gastrointestinal tract, such as abdominal pain, abdominal distension, vomiting, growth disorders, medication history, etc., should check the perineum, around the anus, for anal examination, pay attention to Whether there is anal fissure, skin infection, diaper rash, etc., if the finger touches a lot of hard stools or a large amount of feces after the fingerprint test, the symptoms will be relieved, and the diagnosis can be made clear.
Medical history:
(1) Feeding history:
Pay attention to the composition of the food and the amount of food.
(2) Defecation training:
The child should be asked in detail whether or not the child has undergone defecation training. From the age of the child, the defecation can be intentionally controlled. Whether the parents regularly supervise the examination or let them go.
(3) Whether to use lubricant or enema frequently:
Parents are in anxious mood, excessive intervention in constipation of children, often using lubricants, cathartic agents, finger anus or enema, which can reduce the sensitivity of rectal reflex, so that although the feces are inflated, it is not enough Causes effective nerve impulses and constipation.
(4) Drug factors:
In the near future, there are no drug factors, such as taking calcium, opiates, antiarrhythmic drugs, anticholinergics and antispasmodic drugs, which can cause constipation.
(5) Mental factors:
Such as the history of forced toilet training, sudden changes in the environment and living habits, excessive mental stress or depression, can inhibit natural bowel reflexes.
Some children often have behaviors to retain bowel movements, and excessive control can cause abnormal bowel function.
In addition, some parents, because children can not control bowel movements, often soiled underwear and seek medical treatment, should carefully ask whether there are various factors leading to constipation, can not be easily diagnosed as fecal incontinence or diarrhea.
constipation
The newborn did not expel the fetus 24 hours after birth, and was highly suspected of obstruction of the digestive tract. It should be further examined, such as the flat film of the abdomen, and the baby should start constipation after birth. It should be distinguished from thyroid dysfunction and congenital megacolon. In addition to colonic expansion, enema examination can be seen with segmental stenosis, while chronic constipation is full expansion of the colon, detailed medical examination and necessary auxiliary examination for constipation in children to identify with neurological or organic obstruction.
