Idiopathic Constipation Parent Edu
Idiopathic Constipation Parent Edu
Idiopathic Constipation Parent Edu
Fig. 1 At this point, many parents go to their pediatricians who perform a rectal examination; this is, of course, another painful maneuver which may reopen a fissure. When stool stays inside the rectum longer than 24 hours, the rectum enlarges in order to accommodate a large amount of stool. When this problem continues for long periods of time, the rectum and colon grow enormously. This condition is referred to as "megarectosigmoid." There is scientific evidence which shows that when a piece of bowel (rectum and sigmoid) becomes very dilated, it loses its' efficiency to pass stool. Peristalsis is disturbed when the bowel is dilated beyond a certain point. In other words, constipation provokes megarectosigmoid, which in turn provokes more constipation. Idiopathic constipation is a self-aggravating problem. It is important for parents to understand this in order to help their child. (Fig. 2)
Fig. 2 Fecal impaction occurs when a patient carries a large amount of stool inside his / her rectum. As a result, he / she passes tiny amounts of solid stool accidentally through the anus. This is also called encopresis. This causes constant soiling of the underwear. When this occurs at school, it becomes a very serious problem which makes the child feel socially unaccepted. At this point, the child develops more serious secondary psychological problems because of rejection by his / her classmates. The child becomes accustomed to having underwear dirty with stool. The smell is very obvious to everyone around the child, but the child gets used to the odor.
Diagnostic
A rectal exam is performed to rule out any conditions, such as an anal narrowing, which might require surgical treatment. This is rare. A rectal exam also allows the physician to feel for any stool sitting in the anus. An empty rectum in a patient with severe constipation is frequently a manifestation of another condition called Hirschsprung's disease. A study called contrast enema without barium is ordered and usually shows a very dilated colon (megarectosigmoid). In a typical case of idiopathic constipation, the megarectosigmoid extends all the way down to the anal margin. This is completely different from Hirschsprung's disease in which one can see a rather narrow rectum and the megasigmoid is located above inside the abdomen. (Figures 3 and 4)
Fig. 3 Idiopathic constipation It is also important to rule out other conditions which may provoke constipation such as metabolic disorders (hypothyroidism), spinal disorders, spina bifida, presacral tumors and sacral abnormalities. For this we usually take more specialized tests. The overwhelming majority of patients with constipation belong to the category of idiopathic, meaning there is no recognizable problem causing constipation.
Fig. 5
Surgical Options
Patients with severe intractable constipation are given the option of an operation called sigmoid resection (Figure 6) which alleviates the problem of constipation or at least helps reduce the amount of laxatives that the patient needs.
Fig. 6