Constipation

Differential diagnosis

• Hirschsprung’s, CF – meconium passed after 48hr
• Coeliac, Hypothyroid – faltering growth
• Fissure – anal pain, blood
• Overflow – loose, smelly stool, soiling
• UTI – dysuria
• Obstruction – abdominal pain, vomiting

Data gathering

• Red flags – see above
• Others – overflow soiling, anal pain, diet
• Examination – wt, height (centile), abdo, inspection of lumbo-sacral area + anus position

Clinical management

• Investigations
  • Bloods – FBC, TFT, Calcium, Coeliac

• Explanation
  • usually normal, treatment can sometimes take months

• Treatment
  • Diet – high fibre, more fluid, less fizzy drinks
  • Behaviour – scheduled toileting, reward system
  • Medications
    • Lactulose
      • if < 6 months old
    • Macrogol (Movicol Paediatric)
      • dose depends on age + disimpaction vs maintenance
    • Senna
  • PIL – ERIC
    • Disimpaction guide
    • Breastfed babies and constipation
    • Preparing Macrogol Laxatives

• Follow-up / Safety net
  • Health visitor