The lecture has been given on Nov. 25th, 2010 by Dr. Adnan.

1. Constipation
Dr. Adnan Hamawandi
Professor of pediatrics

2. Constipation
Constipation is considered in
children when hard stool is passed
with difficulty every three days that
persist for two weeks.

3. Constipation
Causes
A. Organic
 Structural: anal stenosis, anal fissure.
 Neuromuscular: Hirshprung disease, spina
bifida, pseudo obstruction.
 Metabolic: hypokalemia, hypercalcemia,
hypothyroidism, diabetes mellitus.
 Drugs: Narcotics, anticholenergic, lead,
 Intestinal: IBD, celiac disease,CF,tumors.

4. Constipation
Causes
B. Functional
In an otherwise healthy child constipation
may result simply from an episode of painful
defecation, difficulties during the period of
toilet training, inattention to the urge to
defecate because of involvement in other
activities or discomfort with toilet facilities in
school.

5. Constipation
Clinical features
A detailed history of pattern of defecation
may reveal stool-withholding behavior like
contracting the gluteal muscles by stiffening
the legs while lying down or holding on
furniture while standing, some children will
squat, push and cry which may be
misinterpreted as an attempt to defecate.
Accompanying symptoms include abdominal
pain, abdominal distention and flatulence.

6. Constipation
Clinical features
Sometimes rectal bleeding, poor appetite,
enuresis and history of UTI are associated.
 Encopresis (an overflow incontinence of
liquid stool) can be present in long standing
cases.
 Physical examination of the abdomen may
reveal distention or palpable fecal masses.
Digital examination of the rectum is needed
to evaluate the sphincter and ampulla.

7. Constipation
Diagnosis
 When no underlying cause is identified by
history and physical examination a favorable
response to treatment support the diagnosis
of functional constipation.
 In refractory cases appropriate radiographic
and laboratory tests are needed to rule out
the organic causes. Barium enema and
anorectal manometry are most helpful.

8. Constipation
Therapy
For functional constipation include:
1.patient education, a regular bowel training
program including sitting on toilet for 5-10
minutes after each meal is often helpful in
establishing a regular bowel habits.
2. Relief of impaction can be achieved by
enema or polyethylene glycol.
3. softening of stool by lactulose, high fiber

9. Constipation
Therapy
diet, or mineral oil must be continued until
regular bowel pattern has been established
for several months.
Biofeedback training may be beneficial in
difficult cases.

10. Constipation
Therapy
diet, or mineral oil must be continued until
regular bowel pattern has been established
for several months.
Biofeedback training may be beneficial in
difficult cases.