Treating Different Types of Constipation in Children Video

Stool holding is the most common cause for constipation in children. Dr. Hands shares information on different types of constipation and their consequences to children's health.
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Treating Different Types of Constipation in Children Next, we’re going to discuss a common medical problem in childhood that is probably for pediatricians, maybe the least exciting of all problems, and this is constipation. Now, there are many important aspects of history that we’ve asked the parents when they come in with this. We ask them the frequency and consistency of stools. We want to know if there’s pain or bleeding. We want to know if there’s abdominal pain associated with it. We want to know when the age onset was. We want to know about toile training and how it may have had a factor on the constipation. We also want to know about soiling. Is there fickle soiling in the underwear. In other words, leaking around stool. We also ask for withholding behavior, the classic squatting, standing or sitting in the corner trying not to go. Does it affect the appetite? Is there any nausea or vomiting? Has there been any weight loss? We ask about fishers which are little cuts in the rectal area, abscesses, skin problems in the rectal area, and any treatment that’s been used up to this point. And the last, of course, the changing pattern stool over time. This is all important in trying to link it into either physiologic causes, which are organic which are not common but are worrisome, and the most common problems which are stool holding which leads to constipation. Now, the physical findings when you look at these youngsters are vey important, they tell us that there might be a medical problem causing it or failure to thrive, the child isn’t growing and thriving. Abdominal distention, lack of a limbo sequel curve meaning the back is affected so their back is straight and this is often seem with neurologic disorders which lead to poor defecation, for going to the bathroom. A pilonidal dimple, this is often seen as what we call spinal disruptism which is a name given for little abnormalities over the spine which indicate that the child might have a -- or chromosome problem with the lower nerves in the spine, which in turn would lead to a stool problem, a very important kick off on a physical exam, either by the parent actually or in the pediatric office. We talked about an altered anus, not in the right place; a patulous anus that sticks out; a tight empty rectum, in other words, we do a rectal exam and the rectal area is tight and there is no palpable stool in the rectal area. You have to risk some in the abdomen when we do an abdominal exam. This tells us that the stool isn’t getting all the way down and goes with a disease called Hershman’s disease which is not all uncommon which can cause constipation. Also, if we see a gush of liquid stool come out, when we do the rectal exam with air but no real stool, it’s a little bit worrisome then maybe something is going on. Obviously, we don’t like a blood, we don’t mind bleeding from a fisher from a hard stool but a cold blood is a concern. An absent -- this is when we actually pinch next to the anus and the anus should contract. That means the nerves are intact for that reflex. And lastly, the strength of the lower extremities, the tone of the lower extremities because if nerves are affected, you may see it in the legs as well. Now, the organic causes we’re talking about are not frequent. It’s most often stool holding but what you have to think about are anatomic problems, metabolic problems, neurologic problems, abnormal abdominal mass, a connective tissue disorder like lupus, drugs that the youngster maybe on, toxicity due to lead. These are all things that can cause organic causes of constipation. It must be ruled out. The most common, however, is simply stool holding, expanding your rectal area, not sensing when it’s full, leaking around and holding on your stools. Now, what do we do -- what are the options for treatment for stool holding? Obviously, the others have medical treatments. We first have to disimpact the patient. This is either do

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