When can constipation be managed at home and when does it require a visit to your doctor?  Constipation occurs when stools become hardened and difficult to pass.

Normally, people pass stools from three times daily to three times weekly. If stools are soft and pass easily, you aren’t constipated.

Frequency of children's bowel movements also varies. New-borns can pass stools a couple of times daily or once weekly. As babies grow older, number of bowel movements usually decreases, and stool size increases.

Sometimes children's faces turn red and they appear to strain to pass stools, but if the stool is soft and the child has no other problems, this isn’t concerning.

Most children occasionally become constipated. Usually this is a short-term problem requiring home treatment. However, some children develop chronic constipation.

Causes:



    • A diet low in fibre and/or water

    • Voluntary delay of bowel movements:

    • Sometimes children resist the urge to have a bowel movement because they are too involved in play.

    • Others are anxious about defecating in a particular place e.g. toilets away from home.

    • Delay may be part of a general pattern of oppositional or anxious behaviour.

    • Delay may be caused by stress related to toilet training.

    • Painful passing of stool once constipation has already developed. The longer a bowel movement is resisted, the larger and harder the stool becomes. Children in particular may then withhold stools, which causes cramping. After some time the child may be unable to resist the urge to have a bowel movement and will pass a large mass of faeces, which can be painful.

    • Circumstances such as travelling that disrupt diet, and time and place of defecation.

    • Lack of exercise

    • Medication

    • Pain from haemorrhoids and anal fissures

    • Laxative overuse

    • Irritable bowel syndrome

    • Diseases of the metabolism or endocrine system e.g. hypothyroidism

    • Diseases of the nervous system

    • Chronic lead poisoning



Constipation symptoms may include:



    • Rectal cramping and pain.

    • Bloating and nausea.

    • Small amounts of bright red blood. This can be from anal fissures –slight tearing of the anal membrane as the stool pushes through the anus ? making defecation very painful. Fissures, which often appear during chronic constipation, should heal once constipation is controlled.

    • Poor appetite.

    • Decreased interest in usual activities.

    • Frequent urination from pressure on the bladder. With chronic constipation, there may be urinary incontinence.

    • Occasionally, particularly with chronic constipation, a stool becomes lodged in the rectum (impacted); mucus and fluid leaks around it. This can be experienced as constipation alternating with diarrhoea.

    • In rare cases, faecal incontinence occurs. This is called encopresis in children past normal toilet training age.



How to prevent constipation



    • Get regular exercise.

    • Eat well-balanced, regularly scheduled meals.

    • Eat a high-fibre diet:

    • Increase fibre intake gradually to allow your body to adjust and minimise potential abdominal gas or discomfort.

    • Cereals are good fibre sources if they contain 3g or more fibre per serving.

    • Add 2-3 tablespoons 100% bran cereal or unprocessed wheat bran to cereal, soup, casseroles, home-made baked goods.

    • Cooked and raw vegetables and fruits.

    • Pulses (peas, beans, lentils) and nuts are high in fibre and protein.

    • Diets high in fat, sugar, meat or dairy may worsen constipation.



Drink enough fluids:



    • Dietary fibre absorbs liquid and keeps stools soft.

    • Drink 2-4 extra glasses of water per day, especially in the morning. Drink at least 1.5- 2 litres of liquids throughout the day.

    • Prune juice may help as a mild laxative.



For babies and young children:



    • Breast-feed; constipation is rare in breast-fed infants.

    • Add the correct amount of water to formula. For infants under six months give additional water (up to 60 ml twice daily).

    • From six months, give your infant prune juice. Start with 2.5 ml and slowly increase to 60 ml. From nine months, add 1-3 tablespoons strained prunes daily. Alternatively, give infants from six to 12 months60-120 ml fruit juice e.g. grape, pear, apple or cherry, twice daily.

    • Avoid too much dairy. At age one, a child needs four servings daily.

    • Defecate when you feel the urge. Otherwise, the urge will pass and the faeces eventually become dry and difficult to pass.

    • Set aside relaxed times for having bowel movements. As urges usually occur after mealtimes, ask a constipated child to sit on the toilet after meals, especially breakfast.



Contact your doctor if:



    • Rectal bleeding is heavy (more than a few red streaks on the stool surface)

    • The blood is dark red/brown/black

    • Blood is mixed with the stool

    • Rectal bleeding continues more than 2-3 days after constipation improves, or if bleeding recurs

    • Constipation is accompanied by severe abdominal pain or swelling, or nausea

    • Rectal pain continues longer than 30 minutes after a bowel movement, or prevents bowel movement

    • Uncontrolled stool leakage occurs

    • Acute constipation or other bowel habit changes persist after home treatment for one week (adults) or three days (children)

    • Constipation becomes chronic; chronic constipation worsens, or is accompanied by other bowel habit changes (changes in stool size, shape or consistency)

    • You’re unable to have bowel movements without laxatives

    • Any change in bowel habits that can’t be ascribed to dietary change or drug therapy



Natural Supplements to treat constipation


With a lack of dietary fibre being one of the main culprits when it comes to constipation, taking a fibre supplements or a fibre rich 'superfood' dietary additive can help easily boost your intake of fibre and reduce constipation. Taking a daily probiotic supplement can also help with reduction of constipation, as it supports normal bowel function and gut health.

Home treatment of constipation


Occasional constipation can be treated at home:

    • Follow a fibre-rich diet.

    • If your child has rectal pain because he/she is unable to have a bowel movement, add 60 ml baking soda to a warm bath. This may relax the anal sphincter and help pass the stool.

    • Bulking agents such as bran and psyllium increase stool volume, making it easier to pass. These are safe and regular use renders them more effective.



Medication


Your doctor may recommend a laxative or stool softener if improvements in diet and habits don’t ease constipation. Laxatives irritate the bowel lining, which speeds up the passage of faeces. Regular use isn’t recommended: it decreases tone and sensation in the large bowel, causing laxative dependence. Don’t use laxatives longer than two weeks without consulting your doctor.

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