The proceeding discussion covers constipation due to poor bowel habits, and NOT due to an organic medical problem.
What is functional constipation? Functional constipation is:
- Hard stools
- Painful passing of these hard stools
- Large volume of retained stools in colon
Keep in mind that constipation is mainly defined by the stool’s consistency (hard) and NOT by the frequency of bowel movements. The frequency of bowel movements varies from person to person, and sometimes can be once every 5 days.
What happens if a patient fails to evacuate the colon well? The colon absorbs water from its contents. The longer fecal matter stays in the colon, more water is absorbed, resulting in harder stools. Also the hard stools, building-up in the colon over time, cause distention of the colon and rectum.
My child defecates everyday. So how can he/she be constipated? Again, the definition of constipation is NOT based on how often a person has bowel movements, but instead on how well the person defecates. Many times, kids have what’s called “busy kid syndrome,” where the child is “too busy” to sit on the toilet long enough to completely evacuate the colon. The child defecates a little to relieve the pressure of needing to defecate, and then the child runs off to watch TV or play his/her games. Not sitting on the toilet long enough to completely evacuate the rectum results in stool build-up over time in the colon.
What are some common complications due to constipation? Normally, when the rectum is full of stools, there is a sensation to defecate. If the patient doesn’t defecate, further distention is needed to have this feeling. After a while, a person with prolonged constipation may not respond to normal distention of the rectum as once before.
Another complication is encopresis: leakage of loose stools around the hard stools, resulting in involuntary fecal soiling of undergarments.
The passage of hard stools may cause anal tears, resulting in streaks of blood on top of hard feces. A tear of the anal sphincter is painful, and may result in further retention of stools, because of the fear of painful defecation, making constipation worse.
Also, a rectum full of stools may press against the urinary bladder outlet, resulting in obstruction of urine release. Patients may have symptoms of difficulty starting a urinary stream or feeling of incomplete bladder emptying, resulting in longer and more frequent attempts at urination. The retained urine is a risk factor for urinary tract infections.
How do I treat constipation? Functional constipation is NOT an emergency, and therefore no emergency room visits are necessary.
If constipation is not defined as “functional,” and the lack of passage of stools causes vomiting or abdominal distention (big belly that sounds like a drum when tapped) or if there are abundant bloody stools or dark black, tarry appearing stools, then have the patient seen by a healthcare professional.
Treatment plan for constipation consists of the following:
- Adequate hydration—make sure that the patient drinks plenty of fluid to help make the stools soft. For infants, make sure the formula is mixed appropriately and is not concentrated. Also for newborns and infants, you can give them 2 to 4 oz. of extra water per day. For children, encourage them to drink at the very least 6 glasses of fluid per day.
- Avoid constipating medications and foods. Dairy products are notorious to cause constipation. Allow only 2-3 servings per day of dairy products. Starchy foods (rice, potato, etc.) can bind up or thicken the stools making them harder. Excessive meat intake can lead to harder stools too.
- Increase fiber intake. Fruits and vegetables and some legumes are high in fiber. Fruit juices (e.g., prune juice) are good, but avoid citrus fruits in children less than 12 months (higher risk of allergies if citrus is introduced too early).
- Sitting on the toilet longer. Have the patient sit on toilet for 15 minutes after a meal, at least once daily.
- Medication is used if the above tips do not work. Medication is then used to “jump start” the treatment, and eventually, with the above tips for good bowel practice, the patient could be weaned off the medication with continual production of softer stools. This weaning process may take a few months to a few years, depending on how well the child establishes good bowel practices.
- Stool softeners (e.g., docusate)
- Lubricants (e.g., mineral oil)
- Stimulants (e.g., senna)
- High sugar preparations (Karo syrup)
- Bulk laxatives (e.g., psyllium)
- Osmotic laxatives (polyethylene glycol [Miralax])
- Enemas and suppositories (e.g., Fleet enemas, glycerin suppositories)—only used for initial disimpaction of hard stools “stuck” in rectal shelf. These are not for long-term usage. Chronic usage of enemas and suppositories can decrease the sensation of defecation. Also, high phosphate containing enemas (e.g., regular Fleet enemas) may cause hypocalcemia (low calcium level in blood), which can become a medical emergency.
- For anal tears, apply petroleum jelly to the tear. This will act as a sealant and protect the tear as it heals. Also the application of petroleum jelly will lubricate the passage of stools.
For further information about functional constipation, then please consult your healthcare professional.
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