Clinical Reference Systems: Pediatric Advisor 10.0

DESCRIPTION

• Painful passage of bowel movements: The most reliable sign of constipation is discomfort with the passage of a bowel movement.
• Inability to pass stools: Such people feel a desperate urge to have a bowel movement (BM), have discomfort in the anal area, and strain, but they are unable to pass a BM after straining and pushing for more than 10 minutes.
• Infrequent bowel movements: Going 3 or more days without a BM can be considered constipation, even though this may cause no pain in some people and even be normal for a few.

COMMON MISCONCEPTIONS IN DEFINING CONSTIPATION

Large or hard BMs unaccompanied by any of the conditions just described are usually normal variations in BMs. Some normal people have hard BMs daily without any pain.

CAUSE

Constipation is often due to a diet that does not include enough fiber. Drinking or eating too many milk products can cause constipation. It's also caused by repeatedly waiting too long to go to the bathroom.

EXPECTED COURSE

Changes in the diet usually relieve constipation. After you are better, be sure to stay on a nonconstipating diet so that it doesn't happen again.

Sometimes the trauma to the anal canal during constipation causes an anal fissure (a small tear). This is confirmed by finding small amounts of bright red blood on the toilet tissue or the stool surface.

HOME CARE

1. Diet treatment
   • Eat fruits or vegetables at least three times a day (raw unpeeled fruits and vegetables are best). Some examples are prunes, figs, dates, raisins, peaches, pears, apricots, beans, peas, cauliflower, broccoli, and cabbage.
   • Increase bran. Bran is an excellent natural stool softener because it has a high fiber content. Make sure that your daily diet includes a source of bran, such as one of the new "natural" cereals, unmilled bran, bran flakes, bran muffins, shredded wheat, graham crackers, oatmeal, high-fiber cookies, brown rice, or whole wheat bread. Popcorn is one of the best high-fiber foods.
   • Eat fewer constipating foods, such as milk, ice cream, cheese, yogurt, and cooked carrots.
   • Increase the amount of water you drink.

2. Stool softeners

   If a change in diet doesn't relieve your constipation, take a stool softener with dinner every night for 1 week. Stool softeners (unlike laxatives) are not habit-forming. They work 8 to 12 hours after they are taken. Examples of stool softeners that you can buy at your drugstore without a prescription are, Haley's M-O (1 tablespoon), Metamucil or Citrucel (1 tablespoon), and mineral oil (1 tablespoon).

   If you have acute rectal pain and need immediate relief, try one or more glycerin suppositories.

3. Common mistakes in treating constipation

   Don't use any enemas without your physician's advice. These can cause irritation or fissures (tears) of the anus if used excessively. Do not use strong oral laxatives without asking your physician because they can cause cramps and become habit-forming.

CALL YOUR PHYSICIAN IMMEDIATELY IF:

• You develop severe rectal or abdominal pain.

CALL YOUR PHYSICIAN DURING OFFICE HOURS IF:

• You do not have a bowel movement after 3 days on the nonconstipating diet.
• You have other concerns or questions.

RELATED TOPIC

Anal Fissure