Pediatric Constipation and Pediatric Encopresis – Pediatrics

00:01 Our topic here is constipation in the young.

00:05 Infrequent passage.

00:06 Now, here will be true pathology.

00:10 Earlier when we talked about diarrhea, high in the differential in a child will be infections for obvious reasons.

00:18 Constipation, more systemic issues, we’ll talk about congenital as well.

00:22 Here, because of constipation, you can expect the stool obviously not to be watery but hard and dry.

00:28 It could be functional and, even with functional, many of you have probably noticed or maybe even memorized that, “Oh, functional type of constipation, that means that the intestine isn’t working properly.” And many of you would jump down to an answer choice and choose Hirschsprung's disease Be careful, do not do that.

00:48 Remember as a child, how often did you like to go poop or, you know, go the bathroom? You’re playing with your friends, you didn’t want to go to the bathroom.

00:56 so it’s actually voluntary holding on to the stool.

01:02 So functional, most common cause will be something like a voluntary withholding very much keep that in mind.

01:09 There might be absolutely nothing wrong with your child.

01:11 Why do investigations and invade the child with doing tests when you know that it could be just the fact that the child wants to play? Functional.

01:21 Other causes: Meconium ileum, once you’ve ruled out functional type of constipation and other causes.

01:28 For example, cystic fibrosis, extremely common in young Caucasian children.

01:34 With cystic fibrosis, you know what there isn’t enough chloride channels that properly lubricate the stool.

01:40 Meconium ileus is when the babys first stool (the meconium) causes the bowel obstruction.

01:47 In addition, anterior displaced anus, Hirschsprung's disease is here botulism, and hypothyroidism are possible differentials for pediatric constipation.

01:58 You go step by step by step and every time you do so, you should be able to figure out, well, what’s causing the vomiting? What’s causing the diarrhea? or in this case, what’s causing the constipation.

02:11 Liquid stool may pass around the hard stool mass and give a false impression of diarrhea, know as, well, encopresis.

02:17 In other words, encopresis would be the incontinence that the child is exhibiting.

02:24 And I’ll walk you through encopresis in a little bit where we start talking about greater than 4 years age and that might be more of a psychological issue as well.

02:33 But remember, no matter what, the body’s trying to evacuate the toxin, okay? And even if there is constipation and there is a hard stool in the intestine, at some point in time, these toxins have to get out.

02:49 So therefore, there’s every possibility that the loose stool might pass around the hardened stool So it’s kind of like taking a detour and then out it comes, giving you the false impression of diarrhea when your child is actually suffering from constipation.

03:10 Diagnosis.

03:11 X-ray.

03:12 All right. So we’d take a look at an abdominal x-ray and you notice here that we have a few bubbles, enlargement, unclear at this point.

03:20 All that you know is the fact that on abdominal x-ray, there’s going to be constipation, but what’s the cause? Well, you’d go through the different differentials.

03:29 Is it functional? Is it the lack of your neural crest cells migrating down to develop your enteric nervous system so on and so forth.

03:36 Obviously, I’m referring to Hirschsprung.

03:39 Also, consider, thyroid function studies.

03:43 Sweat test.

03:44 For what? Cystic fibrosis.

03:47 And electrolytes as indicated.

03:51 Management of functional constipation: you treat it with diet, stool softeners and perhaps counselling.

03:58 Remember, if the child psychologically is fearful for whatever reason of going to bathroom.

04:06 Or if it is something like functional constipation, then you want to ease the stool to pass, so therefore, you’re recommending fiber.

04:18 Our topic now brings us to pediatric encopresis.

04:22 What is it? It is fecal incontinence.

04:25 Incontinence is an important topic on your boards, either in the young or in the elderly.

04:34 Fecal incontinence after the age of four years of age is the definition of pediatric encopresis.

04:41 More common in boys, 6:1 ratio or 4 to 6:1 ratio.

04:47 Much more common in boys than in girls.

04:51 Greater than four years of age, this is incontinence.

04:56 Leakage of loose stool around an obstruction are possible signs and symptoms.

05:02 Address the constipation in terms of management or perhaps the child is seeking attention and/or there might be something else going on at home, just keep that in mind.

05:15 And so therefore, psychotherapy is also part of your management.

05:21 But most likely, it might be constipation in which the stool is passing around the constipation.