Parents should be concerned about constipation only when it causes other problems such as pain while passing stools or frequent withholding of stools. In a baby, the frequency of stools vary quite a lot and hence it is difficult to define constipation. Bowel movements can vary from three times a day to once every 2 days. Some infants may pass stools comfortably while others may cry even when passing soft stools. Straining does not qualify as constipation as infants take time to develop the muscles needed for bowel movements. In newborn babies if meconium is not passed within 24 hours then it could be Hirschsprung's disease. In babies, inability to pass stools for several days combined with pain should be investigated.
In older kids, constipation is often caused by a lack of dietary fiber. Passing of hard stools can also lead to anal fissure which can cause severe pain and sometimes even blood to be passed. External fissures can be diagnosed by a physical examination of the anus. In order to improve the healing process, fluid intake should be increased and stool softeners may be used.
Evaluation of Constipation
Evaluation of the patient is done by examining the history of stools – the frequency and consistency are analyzed. Diet composition is also evaluated to check whether adequate fluids and fibre is consumed. Physical examination of the stomach and the anus may also be done. A distended abdomen should be investigated further to rule out other causes such as tumors. If an obstruction is suspected then tests such as X-Rays, MRI or CT scans may be done. A biopsy may be ordered if Hirschsprung's disease is suspected.
Treatment for Constipation
Often a change in diet would be sufficient treatment for constipation. Dietary fibre and fluid intake should be increased and in some cases reducing milk consumption would help as well. Yound children who get easily distracted while trying to sit on the potty should be gently coaxed to sit longer so that all stools are passed. A fixed routine would also be helpful. In some cases stool softeners and laxatives may be needed to help the bowel movement though sometimes it may be difficult to wean kids off the habit. Sometimes a gentle enema may also be given. The dosage of the laxatives should be discussed with the physician in order to avoid any problems that may be caused by wrong dosage.