Constipation and Soiling
- Common, affecting up to 30% of the child population
- Majority is idiopathic
- The exact cause of constipation is not fully understood but factors that may contribute include pain, fever, dehydration, dietary and fluid intake, psychological issues, toilet training, medicines and familial history of constipation
- It is rarely Hirschsprung’s, Neurological lumbosacral abnormalities, Anorectal malformations, Hypothyroid, Coeliac, Cystic fibrosis, Cow’s milk protein intolerance
- Bloods tests and imaging are usually not required
- Soiling/faecal incontinence is commonly due to constipation with impaction
- It often takes months-years for the condition to be resolved
Red flags:
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Refer:
- Any child with red flags → refer to General Paeds
- Children < 1 years of age with idiopathic constipation that does not respond to optimum treatment within 4 weeks → refer to General Paeds
- Children and young people with idiopathic constipation that does not respond to initial treatment within 3 months → refer to health visitor (if pre-school child) or school nurse
- Children whose constipation doesn’t improve despite input from health visitor or school nurse → refer to General Paeds
Key components of the physical examination:
- Inspection of the perianal area
- Abdominal examination
- Spine/Lumbosacral region/gluteal examination
- Lower limb neuromuscular examination including tone and strength (reflexes if red flags in hx)
Do not do a PR exam in General Practice.
If the history taking and /or physical examination shows evidence of faltering growth, treat for constipation and test for coeliac disease and hypothyroidism.
The Bristol Stool Chart is a good reference source.
Management:
NB –Please see the NICE Constipation in children and young people: diagnosis and management guideline if needing further information about management using lactulose.
References:
NICE Constipation in children and young people: diagnosis and management.
Clinical guideline [CG99] Published date: May 2010 Last updated: July 2017
https://www.nice.org.uk/guidance/CG99
Review Date May 2021
Next Review Date May 2022
Author Dr S Burns GP
Contributors Dr Matt Thorpe, Consultant Paediatrician, RCHT, October 2018,
Daphne Appleton, Clinical Nurse Specialist.
Version No. 2.2