Psychogenic Constipation in Children

Psychogenic Constipation in Children

  Autor dr. Molfea Camelia Data: 06.04.2006

Psychogenic Constipation in Children
Constipation refers to the difficult and rare bowel movements (rarer thantwo days).

Usually, the constipation worries the family who considers it to be very severe. Typically, the parents of these children are anxious, overprotective and give too much attention to this disorder, to the frequency and consistency of their child stools. On another hand, the loss of small quantities of stool (the clothes get dirty) leads to conflicts between parents and children. The first cause of children constipation could be his decision to delay the stool, after an unhappy experience which caused a very difficult stool, and also caused discomfort, pain and even small anal tears (because of the large and hard stool). Actually, these children have no other disorder to explain the constipation, but a psychological one. Generally, these children have a normal colon motility (the bowel is normal) and the constipation is functional (not caused by structural changes). With time, the rectum (the last part of the intestine) becomes so dilated that it is unable to generate a such powerful contraction and a such high pressure to exceed the pressure of the internal anal sphincter (the dilation of the rectum is caused by the accumulation of feces because of the child's refusal to eliminate them; thus the pressure will be so high that the child cannot withhold the stool, and this leads to dirty clothes and to arguments, which will aggravate the problem even more). The child's decision to ignore the stool is conscious, but it becomes automatic, leading to a vicious circle. 
The constipation is difficult to treat especially because of the psychosocial factors which are hard to be influenced. The training of the anal sphincter and the education of the child to use the potty every day for a while, are very important also. 
The first therapeutic measure usually used is that of enriching the diet with vegetable fibers, fresh fruits and vegetables purees, with wholegrain bread, vegetables rich in fibers such as cauliflower, leek, cabbage, these ones being very helpful for the bowel, thus making the constipation less likely to occur. 
Another measure to be applied is the use of mild laxatives, mentioning that they are not officially authorized for children under 2, excepting some special recommendations when the pediatrician prescribes them. Under the action of the bacteria living in the gut, the lactulose (laxative) is broken down into organic acids with low weight, which help the gut peristalsis (the contraction of anal muscles to propel contents through the digestive tract) and ensure a softer stool. Lactulose can be given to infants too (one teaspoon per day) and the response will appear in 24-48 hours from the administration. 
The fear of painful stool which is the first step to a functional constipation, can be prevented by softening the stool with mineral oil and water, and by avoiding the use of enemas and suppositories in the anal area as much as possible. Sometimes, it is allowed to disimpact the feces with a mild enema with warm saline. This method is used in resistant constipation, but should not become a habit. 
It is true that many times, the constipation in children is not the sign of a very severe disease, often being psychological. However, this statement is not always valid, so if you have any reasons to think that there is another cause of the constipation, or if you observe other abnormal symptoms associated with the constipation, don't hesitate to take the child to the doctor, as there are many complex disease which have the constipation as a symptom. 




Read the English version of this article: Psychogenic Constipation in Children