The ideal laxative would (1) be nonirritating and nontoxic, (2) act on only the descending and sigmoid colon, and (3) produce a normally formed stool within a few hours, after which its action would cease and normal bowel activity would resume. Because no currently available laxative precisely meets these criteria, proper selection of a laxative depends on the etiology of the constipation. Agents used to treat constipation have been classified according to their chemical structure and site, intensity, or mechanism of action. The most meaningful classification is by mechanism of action, including bulk-forming, emollient, lubricant, saline, hyperosmotic and stimulant agents. None of these laxative agents should be taken for more than 1 week without consulting a primary care provider. Bulk-Forming Agents Most bulk-forming laxatives are derived from natural sources such as agar. plantago (psyllium) seed, kelp (alginates) and plant gums (e.g.. tragacanth, chondrus, karaya [Sterculia]). Guar gum is a natural product found in the bean cluster plant (Cyamopsis tetragonolobus); it is most useful today Read more [...]

The patient should attempt nondrug measures initially to relieve constipation and help prevent recurrences. Constipation associated with an underlying medical condition or use of medications should be referred to a primary care provider to evaluate the need for further medical treatment or to adjust therapy of constipating medications. At a minimum, successful therapy for constipation should return the patient to the preconstipation frequency, consistency, and quantity of stool. Pharmacotherapy should restore usual function using the lowest effective dosage without producing adverse effects. Treatment Goals The primary goals of treatment are to (1) relieve constipation and reestablish normal bowel function, (2) establish dietary and exercise habits that aid in preventing recurrences, (3) promote the safe and effective use of laxative products, and (4) avoid the overuse of laxative products. General Treatment Approach In general, constipation should be initially managed by adjusting the diet to include foods high in fiber and increasing fluid intake, accompanied by some form of exercise. Pharmacologic Read more [...]

If frequency of bowel movements decreases or difficult passage of hard stools occurs, other symptoms of varying degrees of severity may develop, including anorexia, dull headache, lassitude, low back pain, abdominal discomfort, and abdominal distention The frequency of bowel movements in humans is quite variable but generally ranges from three times a day to three times a week. Persons in the latter category can be symptom-free and do not have any specific abnormality related to their individual pattern of defecation. Therefore, constipation cannot be defined solely in terms of the number of bowel movements in any given period. Regularity is what is "regular" or typical for the individual who experiences none of the classic symptoms of constipation. In some instances, self-care is inappropriate and medical referral is necessary, including all situations typified by so-called red flagoralann symptoms: (1) sudden changes in stool, (2) recent weight loss, (3) presence of abdominal pain, (4) blood in the stool, (5) fever, (6) anorexia, (7) nausea and vomiting. Other factors suggesting more than Read more [...]

Causes of constipation are numerous and include various medical conditions and medications; psychological and physiologic conditions (e.g., menopause or dehydration); and lifestyle characteristics. Some population groups are more susceptible to developing constipation as a result of one or more of the defined causes. Two distinct disorders of colorectal motility are characterized by constipation: slow-transit constipation (slower than normal movement of fecal contents) and pelvic floor dysfunction (storage of fecal contents for prolonged time in the rectum). Constipation of recent onset suggests a possible disease-related or drug-induced cause. If a disease is the underlying cause, referral for proper diagnosis and medical treatment will be necessary. Painful lesions of the anal canal such as ulcers, fissures, and thrombosed hemorrhoidal veins can lead to constipation if patients suppress defecation to avoid pain. Pain from various causes, including gallbladder disease, appendicitis, and regional ileitis, may inhibit gastrointestinal retlexes, leading to functional and acute symptomatology. Drugs Read more [...]

Constipation is a common gastrointestinal complaint. However, the complaint is viewed differently by health care providers and patients. Medical practitioners generally describe constipation as a decrease in the frequency of fecal elimination characterized by the difficult passage of hard, dry stools. It usually results from the abnormally slow movement of feces through the colon, resulting in their accumulation in the descending colon. Patients may describe constipation as (1) straining to have a stool; (2) the passage of hard, dry stool: (3) the passage of small stools: (4) feelings of incomplete bowel evacuation: or (5) bloating or decreased stool frequency. Although constipation is a common reason for visiting a primary care provider, it also is a common reason for undertaking self-care. A laxative is often the treatment of choice for constipation. Laxative sales in the United States exceed S750 million and are projected to top 1850 million by 2010. Despite numerous recognized indications for when to use laxatives, many patients use them inappropriately to alleviate what they incorrectly Read more [...]

A High Fibre Diet A high fibre and fluid diet is a healthy diet that is suitable for all the family. You should encourage a regular meal pattern and increase the whole family's fibre and fluid intake at every meal. By doing this you will increase the water content of stools, making them softer and easier to pass. How to calculate how much fibre your child should be eating For children older than two years, calculate (Age) + 5 grams per day, e.g. if your child is seven years old, the calculation would be 7 + 5 = 12 grams per day. Food Portion size Fibre content (grams) Bread Wholemeal 1 small slice 1.5 Brown 1 small slice 0.9 Hovis 1 small slice 0.8 High fibre white 1 small slice 0.8 Wholemeal pitta bread 1 mini 1.8 Breakfast cereals All-Bran Average small bowl 7.2 Bran Buds Average small bowl 6.6 Mini Shredded Wheat Average small bowl 3.4 Bran Flakes Average small bowl 2.6 Sultana Bran Average small bowl 2.0 Fruit 'n' Fibre Average small bowl 1.4 Country Store Average Read more [...]

It is impressive that any human being can control a group of 30 or so children, let alone impart knowledge to them. Most of us have enough difficulty trying to do that with one or two. The task of running and organising a school is immense, and perhaps it is understandable that toilets are not always prioritised. However, they are an important part of a child's day, and schools can overlook a number of things. The main reason for this is that they do not always take into account the impact that health matters may have on school success. The two main areas that interest me are drinking and toilets. Drinking in school is a nuisance. It interrupts lessons, drinks get spilt over the work and it makes children need to go to the toilet more often, which causes further disruption. Toilets are even more of a problem. Most children hate them and will do their best not to use them - especially for a poo. They are often dirty and smelly, and offer little privacy. Unfortunately, the privacy issue is difficult to resolve, as staff have to be able to ensure the safely of children in the school toilets. Read more [...]

I would just like to highlight some of the conditions that I see most often. Cerebral palsy (CP) Stool withholding is seen quite often in children with CP. I think that it probably starts because babies with CP may have difficulty sucking and swallowing. Because of this their fluid intake is poor and their stool becomes hard. Being 'a bit constipated' hardly comes high on the problem list for these children and is easily overlooked. This is a shame. Apart from being easily treatable, the effort of withholding can cause pain and increased muscular spasm. A further issue is mobility. Children with CP may need special help or equipment to help them on and off the toilet. I don't have the answer as regards wiping. This is one of many activities of daily living for which we have few aids. You don't always want somebody else to do it for you. Wouldn't it be fantastic if somebody could design equipment that might help people with mobility problems get dressed, put shoes and socks on and wipe their own bottoms? Attention deficit hyperactivity disorder (ADHD) Some children with severe ADHD present Read more [...]

In an ideal world everyone loves everyone else and we all get on really well, The End. In the real world, there are many other factors that need to be taken into account. Which adults play a part in the child's life and which important adults don't? How much time do children have with their parents? How do the adults react to the child and the child's problems and how do they behave with each other? Do they have memories from their own childhood that make it difficult to deal with their child's problems? One boy had a stool-withholding problem for many years before coming to clinic. The reason for the delay was that his father had had the same problem as a child and remembers his weekly visit from the district nurse to administer an enema. He remembers the dread walking home from school on clear-out day, hoping that if he took his time, the nurse would lose patience and leave. But she was always there waiting for him. As a result he did not want to take his son to the doctor in case he had to go through that same hell. Actually, his son was easy to treat on medication. But I am not really Read more [...]

If Things Don't Go According to Plan – Theories and Strategies for Improving Results I know, it all sounds so simple. You have probably tried some or all of the things that I have suggested and maybe the problem is still there. Well, this is the bit that I find really interesting. It's a wonderful journey passing through child psychology, behaviour, family dynamics, social pressures and much else besides. All of the ideas have been tried and tested and I hope that you find some of them useful, but I realise that some of these things are very personal. Attention Let's get this straight from the start. I do not think that stool withholding counts as an attention-seeking behaviour. Certainly not at the beginning anyway. But there are many subtle connections to attention, which I have learned in the course of dealing with lots of different children. I think that the most important concept is the different views that children and parents have about attention. It seems that children think that their parents give them attention when they need it. By contrast, in a parent's mind, there would ideally Read more [...]