Constipation in children- Management

A brief overview of the current management of functional constipation in children.

FAECAL IMPACTION TREAT WITH MACROGOL 1ST LINE AND THEN C/O MAINTENANCE THERAPY

Faecal impaction is defined as a hard mass in the lower abdomen identified on physical examination or a dilated rectum filled with a large amount of stool on rectal examination or excessive stool in the distal colon on abdominal radiography NICE recommends to use a combination of history and physical examination to diagnose to diagnose faecal impaction -take note of overflow soiling and / or faecal mass palpable abdominally and / or rectally if indicated 30-75 % of constipated children suffer with impaction More than 90 % of children with faecal incontinence also suffer with impaction Treatment of impaction may initially increase the symptoms of soiling and abdominal pain - forewarn about this and ensure that the child has easy access to a toilet

Maintenance therapy- Start promptly Usual agents used for maintenance dose include osmotic laxatives , lubricants and stimulants NICE recommends a macrogol ( Movicol® Paediatric Plain or Movicol® ) first lineEvidence supports use of PEG - more effective compared with lactulose , milk of magnesia , mineral oil or placebo Dosing◘ use escalating...