Here is another very popular topic. As a pediatric surgeon, it is actually my least favorite disease. Because when we surgeons treat something, we like to see the result right away, like a mechanic. However, constipation treatment does not take that short. Moreover, children who come to us are usually more difficult and resistant cases that have passed the filter of pediatricians and pediatric gastroenterologists. Just as the taxi driver does not have the right to choose his destination, we do not have the opportunity to choose a patient unless we have to.
I told you about chronic constipation in children in the pediatric surgeon’s journal. Of course, as much as I can, by trying to reduce a subject that is so long and differs according to age, to an understandable size and simplicity, as much as possible.
The main problem is this: In children with constipation, the poop is very hard and large, making it very difficult to push it out. Some children cannot go to toilet for days, while other children can go to the toilet every day. In other words, a child who can poop every day may also be constipated. If the routine of a child who has a settled routine starts to fail, if he/she poops hard and hard, if the frequency is reduced to less than twice a week, we can describe it as constipated. Even the size and shape of the poop are effective for us in classifying constipation.
Constipation can also show itself with other symptoms than just hard poop. For example, if it lasts for a long time and becomes chronic, some children may experience abdominal pain, loss of appetite, and nausea. When you can’t remove the real big poop inside, tiny tiny overflows from the edge may cause dirt in the panties, poop incontinence, and blood on the toilet paper. Even the functioning of the bladder can be impaired and urinary tract infections can be seen. The difficulty of the constipation is that it can show such different findings and be overlooked.
So at what age does constipation start? What happens as it continues?
According to my experience, when children start complementary foods at 6 months of age, during the years of getting rid of diapers at 2-3 years of age, and during the school starting period, their bowel patterns are disrupted and they poop hard. It hurts when they take this hard poop out. In addition, scared of missing the game or not being able to use the school toilets is added to this, they start to delay going to the toilet. Of course, this delay causes the poop to accumulate even more and harden. Poop accumulates in the last part of the large intestine, that area is where most water is absorbed. The longer you wait, the more water is absorbed and the harder the poop. This time it is both harder and more painful to remove. The result is a vicious cycle.
The habit of pooping is beginning to turn into a physical problem, while it was a behavioral problem at first. They can take some postures to hold their poop. As the poop accumulates in the intestine, the intestine begins to expand. As it slowly starts to lose its sensitivity, this time child no longer feels that the poop is coming. When he doesn’t feel his poop coming, the interval to go to the toilet begins to increase even more. The child, who runs around with kilos of poop in his stomach as if nothing is wrong, causes the problem to be overlooked by his parents. The bowel is now so enlarged that it loses too much muscle to push the poop out. From around the big poop inside, a liquidy poop starts to seep out and get dirty in the panties, which causes diaper rash and nasty odour. This time, a process of psychological deterioration begins due to reasons such as ostracism and embarrassment by their friends and environment.
How do we treat?
You’re starting to get sad, right? Don’t worry, there is a cure somehow. But as I said at the beginning, when you go to the doctor, you will not expect immediate recovery as if you were touched by a magic wand. Wherever you look, there is at least a 3-6 month treatment process that you need to take seriously.
First, we empty the large intestine well. For this, we give both oral and rectal medications. Regular and adequate use of laxatives is very important at this stage.
Then we keep the poop soft for a long time with drugs and diet. In this process, the tears formed in the breech begin to heal slowly, and the large intestine that has expanded and lost its elasticity begins to recover again. At this stage of the treatment, complaints such as abdominal pain, incontinence and seeing blood on the toilet paper begin to pass.
While the poop has softened, we give toilet training to the child, who has made a habit of holding poop, from the beginning and teach him to sit on the toilet regularly. In my opinion, this is the most important part of the treatment. The child must acquire the habit of sitting on the toilet. He should eat at the same times as possible and then sit on the toilet for 3-5 minutes. When we eat, the large intestine starts to move with the help of the gastrocolic reflex as the food descends into our stomach. They want to throw away the excess inside. That’s why we recommend sitting on the toilet after meals. Of course, in an appropriately sized toilet, and in the appropriate position with feet on the ground. At first, he may resist by saying that he has no poop, but remember, as the bowel regains its former elasticity, he will feel his poop again. As the tears on the side of the anus pass, the pain will begin to disappear. All we need is patience and stability. Although he states that he does not need to poop, we still need to make sure that he sits regularly and celebrate when he poops. Don’t be angry because he didn’t poop.
Another important point is to make the child forget about this issue. The whole issue at home should not be whether the child poops or sits on the toilet. You can talk to your partner about the treatment process from time to time, but never in front of the child. Believe me, they are very smart. This time they can start using this issue as a weapon.
After all, you can get rid of this annoying problem with patience, consistency and determination.
Let me end this annoying topic here. Please click like if you like to watch the video, follow us on Instagram.
And stay happy.
Prof. Dr. Egemen Eroglu
February, 2022