Constipation is one of the most common health problems in children. In general, the definition of constipation according to the North American Society for Pediatric Gastroenterology and Nutrition (NASPHGAN) is difficulty or delay in defecation for two weeks or more, and it is capable of causing stress to the patient. Thus, constipation can cause social and psychological problems in children.
In Indonesia is known as the inability to pass stool completely, which is reflected in the reduced frequency of bowel movements (BAB) than usual, the stools are harder, larger, and more painful than usual, and there is a mass of stool that can be palpated in the abdomen.
How do we know if a child is constipated?
In determining the presence of constipation, there are three aspects that need to be considered, namely the frequency of bowel movements, stool consistency, and findings on physical examination. In children aged the same or less than 4 years, the presence of constipation is determined based on the presence of at least one of the following clinical symptoms:
- Bowel movements less than 3 times a week,
- Pain during defecation,
- The body cannot expel feces through the anus because it is too large, dry, and hard
- There is a mass of feces in the stomach.
The criteria for children over 4 years old are slightly different, namely:
- The frequency of bowel movements is less or equal to twice a week without using laxatives (laxatives or constipation drugs),
- Two or more episodes of soiling (involuntary passing of small amounts of feces) and encopresis (involuntary passing of large amounts of feces) in a week, and
- A palpable fecal mass in the abdomen or anus on physical examination.
How to Treat Constipation?
In dealing with constipation, cooperation between doctors, parents, and children is very important. Doctors play a role in providing guidance and treatment, parents are responsible for children's compliance, provide a sense of security for children, and provide time for children to defecate comfortably, while children themselves must have a sense of responsibility to carry out treatment and must always make efforts to defecate. There are 3 things that must be considered when dealing with children with constipation, namely:
- In the early stages, we have to expel the feces that have accumulated for days in the large intestine. If the accumulated stool is not too much, evacuation can also be done at home by giving suppositories (drugs to soften feces that are inserted through the anus). However, if the stool is difficult to pass, evacuation needs to be done by taking action in the hospital.
- The second stage is maintenance treatment which aims to prevent the stool from being hard and break the vicious circle that makes the child hold his stool. This phase is carried out for at least 2 weeks, sometimes even months. This maintenance treatment is carried out by:
- Give enough fluids at least 1 liter a day, if necessary can be added milk
- The provision of adequate fiber can be with fruits other than bananas and apples. Fiber foods are highly recommended in children who suffer from constipation. Fiber can increase water retention so that it can soften stools, speed up transit time in the large intestine, and increase the frequency of bowel movements.
- Massage the abdomen in a clockwise direction to stimulate large bowel movements with telon oil or baby oil from the bottom right to the top right, then to the top left, and then the bottom left, regularly 15 times a day.
- Train children to defecate with toilet training. Ask the child to sit on the toilet at least twice a day, half an hour after eating, for 5-10 minutes at a time, and should be rewarded for each attempt to have a bowel movement. Toilet training can also be done on toys in the form of a toilet. At first, the child is not targeted to defecate during toilet training, because it will actually stress the child, the important thing is that the child can sit for a while, and do it regularly every day.
- Giving laxative drugs (laxatives or constipation) is safe in long term. Discuss with your doctor or other health workers regarding the choice of this drug.
3. The third step that is no less important is to find the cause of constipation.
In fact, constipation is more of a clinical symptom than a disease in itself. Hopefully, this article helps you when your child is constipated, Ladies!
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Sources:
Endyarni, B., & Syarif, B. H. (2016). Konstipasi fungsional. Sari Pediatri, 6(2), 75-80.
Kadim, M. (2015). Sembelit (Konstipasi) pada Anak. Ikatan Dokter Anak Indonesia. [online]. https://www.idai.or.id/artikel/klinik/keluhan-anak/sembelit-konstipasi-pada-anak