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Functional constipation: Your child's treatment planFFunctional constipation: Your child's treatment planFunctional constipation: Your child's treatment planEnglishGastrointestinalPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Large Intestine/Colon;RectumLarge intestine;Rectum;AnusNon-drug treatmentCaregivers Adult (19+)Constipation2021-03-02T05:00:00Z7.9000000000000065.80000000000001372.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Functional constipation happens when a child has infrequent stooling which is difficult and often painful to pass. Stool withholding behaviours can also be seen. Find out what causes it to happen and how it can be treated.</p><h2>What is functional constipation?</h2><p>The rectum has two sets of muscles - the internal and external anal sphincters - that allow stool (poo) to pass out of the body. Normally, when stool enters the rectum, the muscles in the internal anal sphincter relax (stretch), telling your brain that you need to pass stool. You are not able to control the muscles of the internal anal sphincter. A person has an urge to pass stool when it reaches the external anal sphincter. You can control the muscles of the external anal sphincter, so if your child relaxes the external sphincter stool can leave their body.</p><p>In functional <a href="/article?contentid=6&language=english">constipation</a>, children withhold their stool by tightening their external sphincter and their buttock muscles (gluteal muscles) pushing stool back into their body, which makes them lose the urge to pass stool. This leads to stool building up in the rectum and relaxing (stretching) the internal anal sphincter, so it is always telling the brain that you need to pass stool. As the internal anal sphincter is always stretched, your brain ignores this message. <br></p><h2>Key points</h2><ul><li>Functional constipation is not a result of a medical problem. It happens when a child withholds stool, usually because they are afraid of the pain linked to passing hard stools or have a fear of the toilet.</li><li>Treatment involves a disimpaction (cleanout) phase and a maintenance phase.</li><li>Give your child a diet that is high in fibre, vegetables and fruit, and has lots of fluids.</li><li>Treatment often involves medications and regular follow-up appointments for one or two years. Be patient and continue with the treatment plan advised by your child's doctor. </li></ul><h2>How is functional constipation treated?</h2><p>If your child has functional constipation along with accidental soiling, they will need to follow a treatment plan. The goal of this treatment is for your child to have a smooth, easy-to-pass, bowel movement (type 3 on the chart below) at least once a day without soiling.</p> <figure class="asset-c-80"><span class="asset-image-title">Modified Bristol Stool Form Scale for children</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_stool_types_EN.jpg" alt="Stool form scale showing types one through five" /><figcaption class="asset-image-caption">This chart helps parents and children check for constipation or diarrhea. Stool that is a type 3 or 4 on the scale shows that the digestive system is healthy.</figcaption></figure> <p>Your child's treatment has two phases, or parts:</p><ol><li>a disimpaction (clean out) phase</li><li>a maintenance phase</li></ol><h3>Disimpaction phase</h3><p>During this phase, your child should drink lots of fluids and stay near a toilet. Make sure that these fluids include water and drinks containing electrolytes (sports drinks e.g. Gatorade, apple juice, orange juice).</p><p>To help your child empty their bowel, you will need to give them one or both of the following medicines:</p><ul><li>PEG3350</li><li>Pico Salax</li></ul><p>Your child's health-care provider will tell you exactly how much to give your child each day. You can make a note of these instructions below. </p><p> <strong>PEG3350</strong></p><p>Give ______grams _____ a day for _____ days. </p><p> <strong>Pico Salax</strong></p><ul><li>In the morning, have your child drink ____ sachet(s) diluted with 150 mL (5 oz) of water.</li><li>____ hours later, have your child drink _____ sachet(s) diluted with 150 mL of water.</li></ul><h3>Maintenance phase </h3><p>Once the bowels are empty, you need to continue the medicine prescribed by your child's health-care provider.</p><p> <strong>PEG3350</strong></p><p>Give ____ grams ____ a day.</p><p>Continue maintenance for at least ______ month(s).</p><h2>When can my child stop taking their medications?</h2><p>Do not consider stopping medications until your child has been doing well for at least six to 12 months. Do not change your child's medication dose before speaking with your child’s health-care provider. Your child's health-care provider will reduce their medication dose slowly, usually by a quarter dose every three to six months. Slow tapering is necessary to ensure that good toileting, dietary, fluid intake habits can be established, and the bowels can shrink back down to normal size. </p><h2>Virtual care services for children<br></h2><p>Boomerang Health was opened by SickKids to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support bladder and bowel dysfunction, visit <a href="http://www.boomeranghealth.com/dr-jessica-malach/">Boomerang Health</a> powered by SickKids. <br></p><h2>Sources<br></h2> <p>NASPGHN (2006). Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for pediatric gastroenterology, hepatology and nutrition. Journal of Pediatric Gastroenterology and Nutrition, 43: e1-13.</p> <p>Margolis, I. (2010). Treatment of Chronic Constipation and Encopresis.</p> <p>Rowan-Legg, A. (2011). Managing functional constipation in children. Paediatric Child Health, 16(10):661-665.</p> <p>Lane, M., Czyzewski, D., Chumpitazi, B., Shulman, R. (2011). Reliability and validity of a modified Bristol Stool Form Scale for children. Journal of Pediatrics, 159:437-441.​</p>
Traitement de la constipation fonctionnelle chez votre enfantTTraitement de la constipation fonctionnelle chez votre enfantFunctional constipation: Your child's treatment planFrenchGastrointestinalPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Large Intestine/Colon;RectumLarge intestine;Rectum;AnusNon-drug treatmentCaregivers Adult (19+)Constipation2021-03-02T05:00:00Z1062.00000000000Health (A-Z) - ProcedureHealth A-Z<p>La constipation fonctionnelle survient quand un enfant a des selles peu fréquentes qui sont difficiles et souvent douloureuses à passer. Des comportements de rétention des selles sont aussi possibles. Renseignez-vous les causes et la façon dont elle peut être traitée.</p><h2>En quoi consiste la constipation fonctionnelle?</h2><p>Le rectum comprend deux muscles, à savoir les sphincters anaux interne et externe, qui permettent l’expulsion des selles hors de l’organisme. Normalement, quand les selles pénètrent dans le rectum, le sphincter anal interne se relâche (s'étire), communiquant à votre cerveau que vous devez évacuer des selles. Les contractions du sphincter interne ne dépendent pas de votre volonté. Le besoin d’évacuer les selles se fait ressentir quand celles-ci atteignent le sphincter anal externe. Vous pouvez contrôler le sphincter anal externe, alors si votre enfant relâche le sphincter externe comme il se doit, il sera capable d’évacuer ses selles.</p><p>Toutefois, s’il est atteint de <a href="/article?contentid=6&language=French">constipation</a> fonctionnelle, il les retiendra par contracter le sphincter externe et les muscles fessiers, ce qui fait remonter les selles dans l’intestin et lui fait perdre la sensation de besoin d’évacuer. Cela mène à l'accumulation des selles dans le rectum et le relâchement (l'étirement) du sphincter anal interne, ce qui fait qu'il communique toujours au cerveau que vous devez aller à la selle. Comme le sphincter anal interne est toujours étiré, le cerveau ignore ce message.</p><h2>À retenir</h2> <ul><li>La constipation fonctionnelle n’est pas le résultat d'un problème médical. Elle survient quand un enfant retient ses selles. Cela se produit habituellement parce qu’il craint d’éprouver les douleurs de l’expulsion de selles dures ou parce qu’il a peur de la toilette.</li> <li>Le traitement comporte une étape de fragmentation (nettoyage) des fécalomes (masse de matières fécales durcies) pour vider l’intestin et une étape de maintien.</li> <li>Assurez-vous que le régime de votre enfant est riche en fibres et qu’il comporte quantité de légumes, de fruits et de liquides.</li> <li>Le traitement exige souvent la prise de médicaments et des rendez-vous de suivi réguliers chez le médecin durant une année ou deux. Soyez patient et poursuivez le traitement que recommande votre médecin.</li></ul><h2>Comment la constipation fonctionnelle est-elle traitée?</h2><p>Si votre enfant souffre de constipation fonctionnelle accompagnée de pertes de selles involontaires, il aura besoin d’un traitement. Ce dernier vise à ce que votre enfant évacue des selles lisses et faciles à expulser (type 3 dans le diagramme ci-dessous) sans pertes à une fréquence d’au moins une fois par jour.</p> <figure><span class="asset-image-title">Échelle modifiée de la forme des selles de Bristol chez les enfants <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_stool_types_FR.jpg" alt="Échelle de la forme des selles montrant les types un à cinq" /><figcaption class="asset-image-caption">Cette échelle permet de déterminer si un enfant est atteint de constipation ou de diarrhées. Elle est utile tant aux parents qu’aux enfants. Les selles de type 3 ou 4 de l’échelle révèlent que l’appareil digestif fonctionne bien. </figcaption> </span></figure> <p>Le traitement de votre enfant comportera deux étapes :</p><ol><li>une étape de fragmentation des fécalomes (masse de matières fécales durcies) pour vider l’intestin,</li><li>une étape de maintien.</li></ol><h3>Étape de fragmentation des fécalomes</h3><p>À cette étape du traitement, votre enfant doit boire de grandes quantités de liquides et demeurer près d’une toilette. Assurez-vous d’inclure de l’eau et des boissons renfermant des électrolytes (des boissons sportifs comme Gatorade, le jus de pomme, le jus d'orange) dans son alimentation.</p><p>Pour aider votre enfant à se vider l’intestin, vous devrez lui donner une des médicaments suivants, ou les deux :<br></p><ul><li>PEG3350</li><li>Pico Salax<br></li></ul><p>Le fournisseur de soins de santé de votre enfant vous précisera la quantité exacte que vous devrez administrer à votre enfant quotidiennement. Vous pouvez consigner ces instructions ci-dessous.</p><p> <strong>PEG3350</strong></p><p>Donnez ______grammes _____ quotidiennement pendant _____ jours. </p><p> <strong>Pico Salax</strong></p><ul><li>Le matin, donnez ____ sachet(s) du médicament dilué dans 150 mL (5 onces) d’eau.</li><li>____ heures plus tard, donnez _____ sachet(s) du médicament dilué dans 150 mL (5 onces) d’eau.</li></ul><h3>Étape de maintien</h3><p>Une fois que votre enfant se sera vidé l’intestin, vous devez continuer de lui donner les médicaments que lui a prescrits le fournisseur de soins de santé.</p><p> <strong>PEG3350</strong></p><p>Donnez ____ grammes ____ par jour.</p><p>Continuez de donner cette dose de maintien pendant au moins ______ mois.</p><h2>Quand mon enfant pourra-t-il cesser de prendre ses médicaments?</h2><p>N’envisagez pas de cesser l’administration des médicaments avant que votre enfant se porte bien durant six à 12 mois. Ne modifiez pas la dose de ses médicaments sans avoir consulté le fournisseur de soins de santé de votre enfant. Ce dernier vous indiquera de réduire lentement les médicaments, ce qui se fait habituellement par quart de dose à des intervalles de 3 à 6 mois. Ceci est nécessaire pour faire certain que les habitudes de toilette et de consommation de liquides sont établis et que les intestins peuvent rétrécir à leur taille normale.</p><h2>Sources</h2> <p>NASPGHN (2006). Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for pediatric gastroenterology, hepatology and nutrition. Journal of Pediatric Gastroenterology and Nutrition, 43: e1-13.</p> <p>Margolis, I. (2010). Treatment of Chronic Constipation and Encopresis.</p> <p>Rowan-Legg, A. (2011). Managing functional constipation in children. Paediatric Child Health, 16(10):661-665.</p> <p>Lane, M., Czyzewski, D., Chumpitazi, B., Shulman, R. (2011). Reliability and validity of a modified Bristol Stool Form Scale for children. Journal of Pediatrics, 159:437-441.​</p>

 

 

 

 

Functional constipation: Your child's treatment plan960.000000000000Functional constipation: Your child's treatment planFunctional constipation: Your child's treatment planFEnglishGastrointestinalPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Large Intestine/Colon;RectumLarge intestine;Rectum;AnusNon-drug treatmentCaregivers Adult (19+)Constipation2021-03-02T05:00:00Z7.9000000000000065.80000000000001372.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Functional constipation happens when a child has infrequent stooling which is difficult and often painful to pass. Stool withholding behaviours can also be seen. Find out what causes it to happen and how it can be treated.</p><h2>What is functional constipation?</h2><p>The rectum has two sets of muscles - the internal and external anal sphincters - that allow stool (poo) to pass out of the body. Normally, when stool enters the rectum, the muscles in the internal anal sphincter relax (stretch), telling your brain that you need to pass stool. You are not able to control the muscles of the internal anal sphincter. A person has an urge to pass stool when it reaches the external anal sphincter. You can control the muscles of the external anal sphincter, so if your child relaxes the external sphincter stool can leave their body.</p><p>In functional <a href="/article?contentid=6&language=english">constipation</a>, children withhold their stool by tightening their external sphincter and their buttock muscles (gluteal muscles) pushing stool back into their body, which makes them lose the urge to pass stool. This leads to stool building up in the rectum and relaxing (stretching) the internal anal sphincter, so it is always telling the brain that you need to pass stool. As the internal anal sphincter is always stretched, your brain ignores this message. <br></p><h2>What are the signs of functional constipation?</h2><p>You might recognize the signs of functional constipation if you see your child regularly:</p><ul><li>squatting</li><li>rocking</li><li>walking stiffly on their tiptoes</li><li>crossing their legs</li><li>sitting with their heels pressed against their perineum (the area just in front of their anal opening)</li></ul><h2>Is functional constipation harmful?</h2><p>When your child withholds stool, their rectum and lower colon can stretch. This can lead your child to keep in stool much longer than normal. The longer the stool remains in the rectum, the more water it loses and the harder it becomes. The stool can then become "impacted" or packed into the rectum.</p><p>At the same time, your child's rectum can only hold onto a certain amount of stool. If the stool is impacted in the rectum, your child may experience accidental overflow soiling. This is when a small amount of stool which is often quite loose leaks out around the impacted stool and into the underwear. This is called encopresis. Your child cannot actually sense this is happening, as the stool is leaked out not pushed out. Naturally, this can be distressing for you and your child. </p><p>Constipation is common cause of lower urinary tract symptoms including incontinence, urinary tract infections and bedwetting. </p><h2>Key points</h2><ul><li>Functional constipation is not a result of a medical problem. It happens when a child withholds stool, usually because they are afraid of the pain linked to passing hard stools or have a fear of the toilet.</li><li>Treatment involves a disimpaction (cleanout) phase and a maintenance phase.</li><li>Give your child a diet that is high in fibre, vegetables and fruit, and has lots of fluids.</li><li>Treatment often involves medications and regular follow-up appointments for one or two years. Be patient and continue with the treatment plan advised by your child's doctor. </li></ul><h2>Does my child need to follow a special diet as part of their treatment?</h2><p>Your child does not need to follow a special diet as part of their treatment, but they should eat a balanced diet including whole grains, vegetables and fruit. This will give your child the <a href="/Article?contentid=964&language=English">fibre</a> they need to help with passing stool. You should also make sure that your child drinks plenty of fluids.</p><h2>How can I stop my child withholding stool in the future?</h2><ul><li>Encourage "toilet time" three times a day for three to five minutes </li><li>Toilet time is often most successful within 20-30 minutes after a meal so schedule these following breakfast, lunch and dinner.</li><li>Depending on your child's age, make toilet time as comfortable as possible by having good foot support (e.g. foot stool) available while your child sits.</li><li>You can help your child “bear down” (push) while trying to pass a stool by having them blow on a pinwheel or blow up a balloon. </li><li>Do not give your child distractions during toilet time such as toys or tablets. Instead, during this time they should be encouraged to focus on actively bearing down. Younger children who may not understand the instruction to push while on the toilet can blow up balloons, blow bubbles or blow on a pinwheel to help them bear down. </li><li>Keep a record of how often your child passes stool.</li><li>Do not punish your child if they do not pass stool during toilet time. Instead, set up a reward system for your child when they practice desired behaviours like sitting on the toilet for the entire toilet time, taking medications, drinking fluids and helping to clean their buttocks or diapers. The aim is to reinforce good behaviour and ignore soiling.</li><li>Maintain a consistent, positive and supportive attitude right through your child's treatment. </li></ul><h2>How is functional constipation treated?</h2><p>If your child has functional constipation along with accidental soiling, they will need to follow a treatment plan. The goal of this treatment is for your child to have a smooth, easy-to-pass, bowel movement (type 3 on the chart below) at least once a day without soiling.</p> <figure class="asset-c-80"><span class="asset-image-title">Modified Bristol Stool Form Scale for children</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_stool_types_EN.jpg" alt="Stool form scale showing types one through five" /><figcaption class="asset-image-caption">This chart helps parents and children check for constipation or diarrhea. Stool that is a type 3 or 4 on the scale shows that the digestive system is healthy.</figcaption></figure> <p>Your child's treatment has two phases, or parts:</p><ol><li>a disimpaction (clean out) phase</li><li>a maintenance phase</li></ol><h3>Disimpaction phase</h3><p>During this phase, your child should drink lots of fluids and stay near a toilet. Make sure that these fluids include water and drinks containing electrolytes (sports drinks e.g. Gatorade, apple juice, orange juice).</p><p>To help your child empty their bowel, you will need to give them one or both of the following medicines:</p><ul><li>PEG3350</li><li>Pico Salax</li></ul><p>Your child's health-care provider will tell you exactly how much to give your child each day. You can make a note of these instructions below. </p><p> <strong>PEG3350</strong></p><p>Give ______grams _____ a day for _____ days. </p><p> <strong>Pico Salax</strong></p><ul><li>In the morning, have your child drink ____ sachet(s) diluted with 150 mL (5 oz) of water.</li><li>____ hours later, have your child drink _____ sachet(s) diluted with 150 mL of water.</li></ul><h3>Maintenance phase </h3><p>Once the bowels are empty, you need to continue the medicine prescribed by your child's health-care provider.</p><p> <strong>PEG3350</strong></p><p>Give ____ grams ____ a day.</p><p>Continue maintenance for at least ______ month(s).</p><h2>When can my child stop taking their medications?</h2><p>Do not consider stopping medications until your child has been doing well for at least six to 12 months. Do not change your child's medication dose before speaking with your child’s health-care provider. Your child's health-care provider will reduce their medication dose slowly, usually by a quarter dose every three to six months. Slow tapering is necessary to ensure that good toileting, dietary, fluid intake habits can be established, and the bowels can shrink back down to normal size. </p><h2>Points to note </h2><h3>Medications</h3><ul><li>Medications for constipation are safe as long as your child’s health-care provider monitors your child. They will not make your child's bowel "lazy".</li><li>Follow your health-care provider’s advice and remember that labels on the products are for general use, not for each person's individual needs.</li><li>Most children need the adult dose or even a higher dose of the medication for them to be able to pass stool properly. </li></ul><h3>Constipation</h3><ul><li>You have the best chance of treating constipation by having your child empty their bowel at least once a day without rushing.</li><li>It is common for children to experience constipation again, even after successful treatment. Some children might have difficulty with passing stool into their teen years or as adults. </li></ul><h3>Soiling</h3><ul><li> <a href="/article?contentid=3&language=English">Soiling</a> is accidental. It is not a sign that your child is deliberately being bad.</li><li>Soiling may get worse when treatment starts and can last for 12 to 24 months.</li></ul><h3>Follow-up</h3><p>You will only treat soiling successfully if you continue to follow up regularly with your child's health-care provider. For example, speak to your child's health-care provider if you feel your child's treatment needs to be changed.</p><h2>Virtual care services for children<br></h2><p>Boomerang Health was opened by SickKids to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support bladder and bowel dysfunction, visit <a href="http://www.boomeranghealth.com/dr-jessica-malach/">Boomerang Health</a> powered by SickKids. <br></p><h2>Sources<br></h2> <p>NASPGHN (2006). Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for pediatric gastroenterology, hepatology and nutrition. Journal of Pediatric Gastroenterology and Nutrition, 43: e1-13.</p> <p>Margolis, I. (2010). Treatment of Chronic Constipation and Encopresis.</p> <p>Rowan-Legg, A. (2011). Managing functional constipation in children. Paediatric Child Health, 16(10):661-665.</p> <p>Lane, M., Czyzewski, D., Chumpitazi, B., Shulman, R. (2011). Reliability and validity of a modified Bristol Stool Form Scale for children. Journal of Pediatrics, 159:437-441.​</p><img alt="" src="https://assets.aboutkidshealth.ca/AKHAssets/functional_constipation.jpg" style="BORDER:0px solid;" />https://assets.aboutkidshealth.ca/AKHAssets/functional_constipation.jpgFunctional constipation: Your child's treatment planFalse

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