Constipation_CD[1] - Constipation Pediatric-Definition"a...

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Constipation Pediatric -Definition: "a period of 8 weeks with at least 2 of the following symptoms: defecation frequency less than 3 times per week, fecal incontinence frequency greater than once per week, passage of large stools that clog the toilet, palpable abdominal or rectal fecal mass, stool withholding behavior, or painful defecation.” - OFTEN, childhood constipation develops when the child begins to associate pain with defecation, then the child begins to withhold stools in an attempt to avoid discomfort. As stool withholding continues, the rectum gradually accommodates and enlarges, and the normal urge to defecate gradually disappears. The infrequent passage of very large and hard stools reinforces the child's association of pain with defecation, resulting in worsening stool retention and progressively more abnormal defecation dynamics with anal sphincter spasm. Chronic rectal distension ultimately results in both loss of rectal sensitivity, and loss of the urge to defecate, which can lead to fecal incontinence. -COMMON DIFFERENTIAL DIAGNOSES IN CHILDREN: Hirschsprung disease (ie, congenital megacolon), spinal or neuromuscular abnormalities, hypothyroidism, anal stenosis, anal fistula, anterior displacement of the anus, allergy or sensitivity to cow's milk, and celiac disease. General Definition: a delay or difficulty in defecation, present for 2 weeks or more, and sufficient to cause significant distress to the patient." Physiology of Constipation: As food moves through the colon, the colon absorbs water from the food while it forms waste products, or stool. Muscle contractions in the colon then push the stool toward the rectum. By the time stool reaches the rectum it is solid, because most of the water has been absorbed. Constipation occurs when the colon absorbs too much water or if the colon’s muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. Types of Constipation 1. Functional constipation: bowel is healthy, but not functioning properly a. colonic inertia constipation: decreased muscle activity in the colon b. delayed transit constipation: decreased muscle activity in the colon *both may affect the entire colon or may be confined to the lower, or sigmoid, colon. c. Pelvic floor dysfunction is caused by a weakness of the muscles in the pelvis surrounding the anus and rectum 2. NORMAL-TRANSIT CONSTIPATION In normal-transit constipation, stool travels along the colon at a normal rate. Patients with normal-transit constipation may have misperceptions about their bowel frequencies and often exhibit psychosocial distress. Some patients have abnormalities of anorectal sensory and motor function. Whether increased rectal compliance and reduced rectal sensation are effects of chronic constipation or contribute to the failure of the patients to experience an urge to defecate is unclear. Most patients, however, have normal
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