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Constipation and Incontinence

What is constipation?

Constipation in children is a very common health problem. Constipation is defined as slowing of bowel movements and/or beading, hard and dry poop. In children who usually complain of constipation, severe intestinal pain and/or pain in and around the anus during defecation are also observed. What is poop incontinence, what is its relationship with constipation? Many children with constipation also suffer from poop incontinence. Although they are seen as contradictory conditions in terms of meaning, they are two health conditions that are very closely related to each other. Hardened and dried poop accumulates at the end of the large intestine (rectum) and settles in that area. Old poops cover the inner surface of the rectum, causing a decrease or disappearance of the rectal sensation that feels like new poops are coming. In this way, the child does not feel that new poops are coming, and misses poops that are smaller and softer than the old poops.

Staining, which is usually seen in the underwear of constipated children, is a sign of incontinence (fecal incontinence). Families often confuse this with diarrhea. Anatomically, the rectum is not suitable as a storage place for poop, but only as a passageway. In chronic (long-lasting) constipation, the rectum loses its natural anatomical structure and begins to enlarge and lose its sensitivity. When hard poop accumulated in the rectum exceeds the capacity that the anal sphincters (muscles around the anus) can hold, it can also cause larger poop to escape in the form of overflow. In addition to constipation, the presence of any neurogenic condition can cause poop incontinence. What are the causes of poop incontinence? In addition to constipation, other conditions that should be investigated are as follows.

  • Genetic predisposition
  • Loss of muscle control in the anus
  • retention of stool
  • toilet phobia
  • Psychological traumas
  • Hard and excessive discipline in toilet training
  • Attention deficit/hyperactivity disorder (ADHD) and developmental disorders
  • Cognitive and mental developmental delay

How is constipation diagnosed? Patient history and complaints are very important in clinical decision making. It is important to find that the frequency of pooping is less than 3 times a week and the consistency of the poop is hard and in the form of small pieces. In addition, the presence of increased rectal diameter on ultrasound is a significant criterion for diagnosis. How common is it? It is seen in 3% of the patients who apply to the pediatric outpatient clinic. Which children are in the risk group? Children with the following conditions are more likely to suffer from constipation.

  • Inactivity
  • Not consuming enough fiber foods
  • not drinking enough fluids
  • side effects of some drugs
  • Presence of a medical condition affecting the anus or rectum
  • Presence of a neurological disorder

What are the symptoms of constipation? A decrease in the frequency of defecation, abdominal pain and hard stools are the symptoms of constipation. Accompanying constipation lasting more than two weeks;

  • Having a high body temperature
  • Loss of appetite
  • Having blood in the stool or around the anus
  • Poop stains or incontinence in the form of contamination on underwear
  • Daytime urinary incontinence, urgency to urinate and/or urinary tract infection
  • Excessive straining during defecation
  • Presence of poop holding and procrastination behavior
  • Feeling of incomplete emptying of the bowel
  • Abnormal swelling in the abdomen
  • Presence of pain before, during and after defecation
  • Bad smell
  • Conditions such as the presence of any tissue protruding from the anus (rectal prolapse, hemorrhoids) should be considered important and a doctor should be consulted without delay.

What are the causes of constipation? Constipation in children occurs due to organic (congenital) or functional (acquired) causes. However, it should be known that as little as 5% of constipation is of organic origin. 95% of it was acquired afterwards. Organic causes;

  • anatomical disorders
  • Intestinal nerve and muscle disorders
  • Presence of abnormal abdominal muscle
  • Metabolic and gastrointestinal disorders
  • Genetic predisposition

Functional reasons;

  • Postponement of poop
  • Not drinking enough fluids
  • Not eating enough fiber foods
  • Inactivity
  • Functional disorders in the pelvic floor muscles
  • Failure to learn effective pushing skills
  • Changes in life routines
  • Giving toilet training at a very early age
  • side effect of drugs
  • Psychological traumas
  • Lactose intolerance (sensitivity to milk and dairy products)

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