Before we start, let’s first understand the basic principles of treatment.
1. The goal of constipation treatment is to relieve fecal incarceration, to prevent fecal re-adduction, and to maintain painless bowel movements.
Releasing the fecal incarceration is necessary for rectal administration or oral administration for laxative purposes; and avoiding incarceration requires basic treatment combined with various drugs for maintenance treatment; and long-term follow-up to ensure long-term efficacy.
2. Children’s Functional Constipation (FC) Parental education is as important as medication during treatment.
Parents should know that functional constipation can be treated safely and effectively, but it takes time; it is necessary to correctly understand the restrained defecation behavior of constipation children; and correctly understand the importance of basic treatment in constipation treatment.
3. The treatment focus varies at different ages:
<6 months of infants in the clinical symptoms of constipation, may not be treated for continued breastfeeding observation;
> 6 months of functional constipation in infants and young children, treatment to relieve fecal incarceration, softening stools;
Preschool and older children can be treated with behavioral interventions (such as DHP) on the basis of the above.
How to treat functional constipation?
It is broadly divided into basic treatment, medical treatment, micro-ecological treatment and other ancillary treatments.
I. Basic treatment
1. Increase dietary fiber intake
Dietary fiber (DF) intake is one of the important basic treatments for children with FC. Dietary fiber is divided into soluble and non-soluble:
■ Non-soluble dietary fiber mainly achieves the purpose of improving FC by absorbing water and softening manure;
■ Soluble dietary fiber is produced by the intestinal flora to produce short-chain fatty acids and gases, which promote intestinal motility and improve the purpose.
However, excessive intake of dietary fiber can also cause side effects, including problems that may lead to gastrointestinal discomfort, bloating, gas production, and affecting minerals, especially calcium absorption.
Therefore, the safe intake of dietary fiber for children is recommended to be: 0.5 g / kg.d. Although additional vitamin and mineral intake is required, the above dietary fiber intake is sufficient to maintain normal bowel movements and prevent chronic constipation.
Mixed-feeding children can be supplemented with soluble dietary fiber, such as CFOS / GOS formula.
2. Defecation habit practice (DHP)
DHP refers to regular intensive training for children to form a bowel habit. It is one of the important basic treatment methods for constipation. We can use the following methods to help children with regular bowel movements:
Infancy defecation is a reflexive defecation. Early childhood defecation training can quickly enter the conscious defecation, making it defecate on time, regularizing life, preventing constipation and fecal incontinence;
During training, it is necessary to pay attention to the gradual progress. The training process is mainly for children. According to children’s interests, the ability to gradually train, usually starts after 27 months;
The toilet can be prepared and placed in an easy-to-use position. The height of the toilet should be such that the knees are higher than the buttocks, and the feet can be placed on the ground for exertion;
Guide the children to learn how to use the defecation method (Valsalva technique), and learn to coordinate the internal and external sphincter movements of the anus.
The specific training time needs to be arranged according to the gastric colon reflex, 30~60min after meal, and 5~10min each time is more suitable. Be careful not to have a long time of defecation.
In addition, the DHP process may encounter failure or retreat, such as strong tolerance of feces, this is a normal phenomenon in training, parents should understand and give psychological support and comfort, do not have to worry or put pressure on children.
3. Water intake and increased exercise
Adequate drinking water and proper exercise are the basic treatments for children with FC, but there is no clear evidence to support it. Adequate water intake can improve the symptoms of constipation. Therefore, only children with FC who have insufficient water intake are advised to ensure adequate drinking water. Excessive intake of water is not recommended.
The daily intake of water depends on age, weight and activity.
II. Drug treatment
Many parents start to be afraid when they hear about medication. They worry that if they are so small, they will cause harm if they take medicine. In fact, drug treatment is not a simple and rude use of laxatives, but through different drugs to achieve different purposes, and ultimately complete bowel movements.
First, let’s take a look at the drugs that treat functional constipation:
Volumetric laxative: polyethylene glycol
Lubricant: Kailuo, paraffin oil
Stomach motility drugs: erythromycin, cisapride
Let’s take a look at how these drugs should be used:
1. Drugs that relieve fecal incarceration
Softener/lubricant: It is a rectal administration method, which can stimulate colon contraction and soften stool, and relieve fecal incarceration. It is a temporary treatment. It can be dependent on long-term application and should not be used for a long time.
Paraffin oil: softening stool can be administered orally, with a dose of 1~3 ml / kg.d and a maximum dose of 90 ml / d.
Polyethylene glycol (PEG): It is a volumetric laxative. It enters the intestinal tract and absorbs water to form a soft gel, which softens the stool and effectively relieves the incarceration of the feces. The PEG used to relieve fecal incarceration is PEG 4000, with a dose of 1~1.5 g /kg.d, which can be used continuously for 6 days.
Both softener and PEG can effectively remove fecal incarceration, but since PEG is an oral preparation, and it is more convenient and easy to use, it is more recommended as a drug.
2. Maintenance of medications to soften stools
PEG: the recommended long-term maintenance treatment drug, the dose is 0.2~0.8 g/kg.d;
Lactulose: suitable for all ages, safe, suitable for cases where PEG is not available, the recommended dose is 1~2 g / kg.d;
Gastrointestinal motility drugs: cisapride and erythromycin are not recommended for children.
The advantage of PEG is that it can soften stools, stimulate bowel movements, and achieve the purpose of improving FC. At the same time, it will not be decomposed by bacteria in the colon, and there will be no side effects such as bloating and flatulence caused by cellulose or other laxatives, and it will not cause disorder of water and salt metabolism. Both domestic and foreign studies have shown that PEG has a better effect in improving the frequency of defecation, the shape of feces, and the relief of abdominal pain compared with lactulose.
It usually takes at least 2 months for the drug to be used for maintenance treatment. If it is necessary to stop the drug, it needs to be gradually reduced. Once the toilet training is successful, try stopping the medication.
III. Microecological treatment
Patients with FC often have disorders of intestinal flora, but a good intestinal micro-ecological environment can help with bowel movements. Therefore, the role of micro-ecological treatment in the treatment of functional constipation has received increasing attention, including probiotics and prebiotics. Prebiotics), Synbiotic applications, and fecal microbiota transplantation (FMT).
Supplementation of probiotics can improve the intestinal micro-ecological environment, thereby improving the symptoms of constipation, but the intake of probiotics is not permanently colonized, and is greatly affected by strains and doses. The effects of different strains, different doses, and different combined consumption methods on the human body are simply different, so this is a problem that needs attention.
The main mechanism of probiotics for the treatment of constipation is to improve the flora and intestinal environment and promote neuroendocrine and enteric nervous system (ENS) functions.
Specific probiotic strains or strains can affect intestinal motility. A meta-analysis of the efficacy of probiotics on FC suggests that probiotics can significantly shorten gastrointestinal transit time, increase bowel movement frequency, and improve stool shape in FC patients.
However, the existing research still has certain limitations, the sample size is small, and the continuous observation time is short. There are still problems with the strains of the probiotic bacteria, the selection of the strain, the therapeutic dose, the treatment time, etc., and the use of the probiotics still needs to be cautious.
IV. Other adjuvant treatment
In addition to these treatments, there are biofeedback or physical therapy.
1. Biofeedback therapy
This treatment is suitable for children with psychological factors or functional outlet obstruction type FC. It needs to be used by children and is used for larger children. Infants are generally not used.
This method uses sound or visual image feedback to stimulate the brain to regulate body function, thereby training the patient to learn to control or prevent the occurrence of a phenomenon. From the current experimental point of view, biofeedback therapy is beneficial for some FC children, but the long-term efficacy still needs further evaluation.
2. Surgical treatment
Yes, constipation can also use surgical treatment, but only limited to:
In children with constipation caused by organic lesions, surgical intervention is required. For example, children with suspected Hirschsprung’s disease need to undergo a rectal biopsy to confirm the diagnosis.
Surgical procedures may be considered in children with refractory constipation. Studies have shown that for children with refractory constipation, anal sphincter injection of botulinum can achieve the same effect as anal internal sphincterotomy.
In short, the most important thing for children with constipation is to do basic treatment.
The second is to relieve the incarceration of feces, to maintain soft stools, and to maintain the comfort of bowel movements is especially important for children. Don’t let children leave bowel movements is a painful impression.
It is also very important to not listen to the remedies. If the child has constipation, go to the doctor first and use the correct treatment with the help of the doctor. Otherwise, it may be counterproductive.