Bir çocuk cerrahı olarak en sevmediğim konunun bu kabızlık konusu olduğunu söyleyebilirim. Belki de pediatristler ve pediatrik gastroenterologlardan seken, zor olgularla biz çocuk cerrahları uğraşmak zorunda kaldığımız için, ya da bir cerrah olarak tedavinin sonucunu hızlıca görmeye alıştığımdan ciddi, kronik kabızlığı olan çocuklarla uğraşmak zor geliyor. Daha önce “Çocuğum neden kabız oldu? Nasıl Tedavi edebilirim?” ve “Kabızlık mı ana fissürden yoksa anal fissür mü kabızlıktan kaynaklanıyor?” başlıklı videolar çekmiştim. Üzerlerine tıklayarak videoları seyredebilir, veya sitemden arama butonuna “kabızlık” yazarak ilgili blogları okuyabilirsiniz.
As a pediatric surgeon, I can say that constipation is one of my least favorite topics. Perhaps it’s because we pediatric surgeons often deal with challenging cases that are referred by pediatricians and pediatric gastroenterologists, or maybe it’s because, as a surgeon, I’m used to seeing the results of treatments quickly, making it particularly difficult to deal with children who have serious, chronic constipation. I’ve previously recorded videos titled “Why Is My Child Constipated? How Can I Treat It?” and “Does Constipation Cause Anal Fissures, or Do Anal Fissures Cause Constipation?” You can click on the titles to watch the videos or search for “constipation” on my website to read relevant blog posts.
In this section of the Pediatric Surgeon’s Journal, I’ve written some suggestions to help prevent constipation in children, so they don’t experience it and we don’t end up with difficult cases in our clinic.
Once a child becomes constipated, treatment becomes challenging. Constipation causes the stool to harden, which makes it painful to pass; this pain causes the child to hold it in, leading to even harder stools, which makes passing stool even more painful. And so, the vicious cycle continues.
To prevent this vicious cycle, I have two key recommendations: diet and toilet habits.
Dietary Suggestions
Children should drink plenty of fluids during the day, and it’s important to remember that water is the healthiest option. Alternatives include ayran (a yogurt-based drink) and warm milk with honey or olive oil, but carbonated and caffeinated beverages like cola, tea, coffee, energy drinks, and others should be avoided. For breakfast, include foods like green olives, dried apricots, walnuts, boiled eggs, cheese, and fruits such as apricots, plums, pears, and apples (with the skin on). For meals, I recommend lean meats, bulgur pilaf, whole-grain pasta, whole-grain rice, vegetable dishes, and legumes (e.g., beans, chickpeas, lentils), prepared using baking, boiling, or grilling methods.
Since dairy products and protein sources like meat, poultry, and fish are low in fiber, balance them with fruits, vegetables, and legumes. Always include plenty of salads with meals, as raw foods are beneficial. As snacks, dried fruits (e.g., apricots, figs, raisins, cranberries) and raw nuts (e.g., almonds, hazelnuts) are great options. When consuming bread, opt for whole-grain, rye, or multigrain bread and rotate between these types. Foods like kefir, yogurt, tarhana (a fermented soup base), boza (a fermented millet drink), pickles, and turnip juice are indispensable.
Foods to Avoid
Avoid white bread, biscuits, white rice pilaf, plain pasta, pastries, processed packaged foods, processed meats (e.g., sausages, salami), fried or spicy foods, chocolate, pizza, toast, hamburgers, and all forms of potatoes (fried, mashed, chips, etc.). Fruits like peaches, bananas, peeled apples, and carrots should also be avoided. However, keep in mind that they are children, so occasional small bites of a banana or chocolate are acceptable, but don’t hand them an entire banana or a full chocolate bar.
Toilet Habits Suggestions
The most crucial aspect is establishing a regular toilet routine. When we eat, the food in our stomachs triggers the gastrocolic reflex, causing movement in the intestines. This reflex should be utilized by encouraging children to sit on the toilet every morning and evening, ideally at the same times, following the dietary recommendations mentioned earlier. After meals, have the child sit on the toilet within 5 minutes. Excuses like “I don’t feel like it,” “I want to play,” or “my friend is waiting” should not be accepted. Set a body rhythm and follow it consistently.
Toilet posture is equally important. The environment should be comfortable, not too hot or cold. The child’s feet should touch the ground while sitting, and ideally, their knees should be 10–15 cm higher than their hips. Elbows can rest on the knees, but they shouldn’t lean forward excessively, and their legs should be slightly apart.
It’s unnecessary to strain immediately after sitting on the toilet. Simply wait patiently and comfortably; the stool will pass naturally. Straining too much can unintentionally close the passageway. Encourage children to avoid distractions like sitting cross-legged or on their heels to hold in stool and direct them to the toilet instead.
Finally, regarding urination, children should be encouraged to urinate first thing in the morning and to go every 2–3 hours while at school. Boys, in particular, should be encouraged to urinate while sitting, as described earlier. It’s essential to teach children the importance of going to the toilet as soon as they feel the need, without delaying or holding it in.
Let’s conclude this journal entry here. Stay healthy and happy!
Prof. Dr. Egemen Eroğlu
September 2024