|
Constipation is a common condition, affecting up to one in three UK children.1,2 Constipation can develop for a number of reasons and does not normally mean there is anything physically wrong with your child. The signs and symptoms of constipation are rarely recognised but if spotted early, and with the right treatment, problems can often be resolved quickly and simply. NICE GUIDELINEIn May 2010, the National Institute for Health and Clinical Excellence (NICE) published the first ever national guideline on the diagnosis and treatment of constipation in children and young people. Whilst the NICE guideline is issued so that healthcare professionals can deliver the best level of care, it also allows parents and carers to better understand and manage their child’s constipation. In fact, NICE has issued a summary for parents in everyday language, which you can find here.
It is always important to speak with a healthcare professional. They will first consider your child’s bowel habits and history to make an assessment. If your child needs treatment for their constipation, the NICE guideline recommends a gentle children’s laxative (the first choice is normally Macrogol 3350 + electrolytes) along with encouragement and dietary management. A doctor may choose to change this laxative, or add another laxative, if the child's constipation is not fixed with the first choice.
The NICE guideline should give parents confidence that, in most cases, their child’s constipation can be well treated.
You can access the NICE guideline here.
To learn more about childhood constipation, use the toilet tool. - REFERENCES
- 1. http://guidance.nice.org.uk/CG99 Last accessed 26 May 2010
- 2. http://www.statistics.gov.uk/cci/nugget.asp?id=6 Last accessed 26 May 2010.
If your child has ongoing or chronic constipation, try not to worry as there are various treatments that can help. However, these treatments can take a while to work, so try to be patient and follow the advice of your doctor.
The ideal way to treat constipation is to identify and if possible eliminate the cause of the constipation.
Your doctor or nurse can also give you advice about how to help your child maintain healthy bowel function and help avoid constipation in the future.
Your doctor will give you simple advice to help your child but may also need to prescribe them laxative medicines to help their bowel work normally. Often these laxative medicines need to be taken regularly for some time (often several months) before your child’s bowels return to normal.
There are various types of laxatives available which can be divided into different types depending on how they work:
Macrogol Osmotic Agents
- This type of laxative includes Macrogol 3350 and electrolytes
- A solution of macrogol 3350 and electrolytes delivers water to the large bowel, increasing the bulk of the stool which triggers the muscles of the bowel to contract and produce a bowel movement. The water in macrogol 3350 and electrolyte solution softens and lubricates the stools to promote comfortable bowel movements.
Other Osmotic Agents
- Inorganic osmotic laxatives – e.g. magnesium hydroxide BP, magnesium sulphate BP and sodium sulphate BP work by drawing fluid from the body into the gut to add bulk to and soften the stool. They also promote the release of a natural enzyme which increases the movement of both the small and large intestine
- Organic osmotic laxatives e.g. lactulose can not be absorbed by the body. They work by drawing fluid from the body into the gut softening and increasing the bulk of the stool. These products can take up to 48 hours to act
Stimulant laxatives
- Stimulant laxatives e.g. senna and bisacodyl stimulate contractions of the muscles in the colon to reduce the time it takes for the passage of waste material through the bowel
- These tend to work within 8-12 hours. They can be given either orally or rectally because they work directly on the gut wall
- Senna-containing stimulant laxatives are often prescribed. Senna is a natural ingredient that has been used for centuries as a constipation remedy and its efficacy and tolerability are well documented. It usually works within 8-12 hours. Bisacodyl is a synthetic stimulant laxative
- Stimulant laxatives are often taken at night to produce an effect in the morning
Bulking agents
- This category includes bran and fibre in the diet and products containing plant fibre e.g. ispaghula husk
- Bulking agents should always be taken with plenty of fluids
- Bulking agents absorb water and expand to fill the bowel with soft non-absorbable residue. This makes the stools softer and bulkier and easier to push out
Faecal softeners
- As the name suggests, these products ease the process of defecation by softening the stool and/or lubricating its passage through the anus
- Commonly used agents include liquid paraffin and docusate
- Liquid paraffin can cause oily staining of the underclothes, particularly in prolonged use in high doses
|