How to get regular bowel movement: Avoid constipation for the Bowel
Normal Bowel Movement Why it is Important For Your Health
How do I know if I have normal potty habits?
When talking about potty habits (known in high society as bowel habits), your “normal” is whatever is normal for you. Confused? You’re not alone.
Many well-meaning people will tell you what they think are supposed to be normal bowel habits. However, studies show having a bowel movement happens at a different frequency for everyone. If, for most of your life, you have a bowel movement every day, that’s YOUR normal. Some people have a bowel movement about three times a week, while others, only once a week. So, after all these years, you should know what’s normal for you. (Please note: there ARE some “unhealthy normals” discussed later in this article.)
Healthy bowel movements are those that allow you to empty your colon (sometimes called your intestines) often enough that you don’t feel bloated or in pain, and you don’t have to strain hard to get the job done. There’s even a chart describing what you should see before you flush the toilet (called the Bristol Stool Scale). Don’t worry! It’s alright if you don’t want to have to look at this visually-stimulating chart.
Here is the summation: if your poop looks like pebbles, you’re constipated (if you aren’t an infant), and if your poop is practically a liquid, you have diarrhea. What you want is soft, easy-to-push-out poop (hereafter referred to as “stool”).
I just realized I only experience unhealthy bowel movements!
So, what if you DO have abdominal pain and bloating, and constipation, and this is how it’s been for years. Talk to your doctor. You may just need to add a laxative to your routine, and this will help you get to a comfortable, new “normal.”
You may need to also adjust your lifestyle to get into a healthier routine (more about this later in this article). Your doctor will also advise you on whether medical testing should be done to rule out diseases affecting bowel movements. Some of these colon diseases are only inconvenient, while others can be life-threatening, so don’t delay talking to your doctor.
Why have things changed for me?
Now that you know the normal frequency for your bowel movements, what should you do if your bowel movements become abnormal?
There are a lot of things that can upset your colon. First, let’s be sure we’re all talking about the same body part. Where is your colon?
The colon is in the lower part of your abdomen, and it’s the last place the food you eat travels before it exits the body. If you look at the picture, you’ll see where the colon (large intestine) is compared to where your stomach sits. Most of us know where the stomach is if we’ve gone for a while without eating.
Food poisoning or eating a lot of an unfamiliar food (especially high-fiber foods) can cause colon irregularity for a while. But if neither of these things are the problem, there are several easy-to-determine things that can cause your colon problems. Vacations and other types of traveling often cause changes in your bowel habits. This is because you are often eating a lot of different types of food instead of your “at home” diet, and you may not be drinking as much water as you usually do.
Additionally, if you’re hurrying around having fun, you might not be taking time for a good, old-fashioned “rest” in the restroom. So don’t be surprised if you lose your “normal.” The good news is, when you get back to your work and home life, you’ll soon revert back to your normal self.
Another common reason for changes in your bowel movements are new medications. Many medications have a side -effect of constipation. On the other hand, antibiotics are commonly associated with diarrhea. If either of these happen, consult with your doctor so you can get back to normal.
What diseases and disorders can give me abnormal bowel movements?
Many diseases and disorders can cause abnormal bowel movements. In the following examples, your “normal” is actually “abnormal,” and you should see a doctor if you have any of the following:
- Blood in your stool
- Inability to have a bowel movement for seven to 10 days (this may actually be a “normal” for you, but you should talk to your doctor to be sure)
- Being constipated, then having diarrhea, then experiencing the same cycle over and over, when there’s no obvious cause for these changes
- Severe pain in the very end of your large intestine (the anus)
- Diarrhea that lasts for more than a few days, especially when accompanied by vomiting
What can I do to increase my colon health?
The most important way to be sure your colon is healthy, especially if you’re over the age of 50 and/or have a family history of colon disease, is to get a colonoscopy. Before and after the age of 50, there are many studies on how to avoid cancer of the colon or at least reduce your risk factors. However, one of the most frequently asked questions is: Does a colon detox work, and if so, how does it cleanse your colon? The answer is: We really don’t know. There haven’t been enough scientifically-broad studies on the effect of a colon cleanse.
Before using any of the following scientifically-studied suggestions, consult your doctor to see if any of your medical conditions would prohibit you from following these rules provided by the American Heart Association:
- Eat fruits and vegetable that are high in fiber to help your colon move waste products out of your system. Eat about two cups of fruit and three cups of vegetables daily. Good sources of fruits and veggies with high fiber include (but aren’t limited to): artichokes, apples, pears (with skin), berries (blackberries, blueberries, raspberries), dates, figs, prunes, beans (baked, black, lima, pinto), broccoli, chick-peas, lentils, parsnips, peas, pumpkin, winter squash. This list was provided by American College of Gastroenterology.
- Eat a lot of high-fiber grains (about three servings a day). Also, eat another three servings of quality grain products, such as pasta and oatmeal.
- Eat two to three servings of low-fat dairy products, especially yogurt with an “active culture.” This active culture helps the natural bacteria in your digestive system do its job, and the calcium in the dairy products helps increase colon health.
- Exercise (at least a brisk walk for 30 minutes five times a week). Interestingly enough, when we move our muscles, it helps our colon move waste products as well.
- Lose weight, as needed.
- Drink lots of water.
- Don’t use tobacco of any type.
Maintaining good colon health is easy, and important, because not only can it help you avoid preventable colon issues, but the things that are good for your colon are also good for your heart, brain, kidneys, liver, skin, hair, and overall well-being. Keeping your colon healthy is really a one-size-fits-all recommendation for almost all bodily functions – even those that aren’t as awkward to talk about.
Constipation (for Parents) – Nemours Kidshealth
What Is Constipation?
Kids might have constipation if they:
- have fewer than three bowel movements (BMs) in a week
- have trouble having a bowel movement
- have stool (poop) that’s hard, dry, and unusually large
Constipation is a very common problem in kids. It usually isn’t a cause for concern. Healthy eating and exercise habits can help prevent it.
What Are the Signs & Symptoms of Constipation?
Different kids have different bathroom habits. A child who doesn’t have a bowel movement every day isn’t necessarily constipated. One child might go three times a day, while another might go once every 1–2 days.
Generally, signs of constipation in kids include:
- going less than usual
- having trouble or pain when going to the bathroom
- feeling full or bloated
- straining to poop
- seeing a little blood on the toilet paper
It’s also common for kids with constipation to sometimes stain their underwear with bits of stool.
What Causes Constipation?
Constipation can be due to a diet that doesn’t include enough water and fiber, which help the bowels move as they should. Kids who eat lots of processed foods, cheeses, white bread and bagels, and meats may become constipated fairly often.
Sometimes, medicines like antidepressants and those used to treat iron deficiencies can cause constipation. Constipation can happen in babies as they move from breast milk to baby formula, or from baby food to solid food. Toddlers who are toilet training sometimes can become constipated, especially if they’re not ready.
Some kids avoid going to the bathroom, even when they really have the urge to go. They might ignore internal urges because they don’t want to use a restroom away from home, stop playing a fun game, or have to ask an adult to be excused to go to the bathroom. Ignoring the urge to go makes it harder to go later.
Stress also can lead to constipation. Kids can get constipated when they’re anxious about something, like starting at a new school or problems at home. Research has shown that emotional upsets can affect how well the gut functions and can cause constipation and other conditions, like diarrhea.
Some kids get constipated because of irritable bowel syndrome (IBS), which can happen when they’re stressed or eat certain trigger foods, which often are fatty or spicy. A child with IBS may have either constipation or diarrhea, as well as stomach pain and gas.
In rare cases, constipation is a sign of other medical illnesses. So talk to your doctor if your child continues to have problems or if the constipation lasts for 2 to 3 weeks.
How Can We Prevent and Treat Constipation?
To prevent and treat constipation:
- Give your child more liquids. Drinking enough water and other liquids helps stools move more easily through the intestines. The amount kids need will vary based on their weight and age. But most school-age kids need at least 3 to 4 glasses of water each day. If your infant is constipated during the move from breast milk or to solid foods, try serving just a few ounces (2–4) of apple, pear, or prune juice each day. If the constipation lasts or upsets your child, a health problem could be the cause, so call your doctor.
- Serve more fiber. High-fiber foods (such as fruits, vegetables, and whole-grain bread) can help prevent constipation. Fiber can’t be digested, so it helps clean out the intestines by moving the bowels along. A diet full of fatty, sugary, or starchy foods can slow the bowels down. When adding more fiber to your child’s diet, do so slowly over a few weeks and make sure your child also drinks more liquids.
Fiber doesn’t have to be a turn-off for kids — try apples, pears, beans, oatmeal, oranges, ripe bananas, whole-grains breads, and popcorn. Adding flax meal or bran to homemade fruit smoothies is another way to slip fiber into a child’s diet.
- Make sure kids get enough exercise. Physical activity nudges the bowels into action, so encourage your kids to get plenty of exercise. It can be as simple as playing catch, riding bikes, or shooting a few hoops.
- Develop a regular meal schedule. Eating is a natural stimulant for the bowels, so regular meals may help kids develop routine bowel habits. If necessary, schedule breakfast a little earlier to give your child a chance for a relaxed visit to the bathroom before school.
- Get kids into the habit of going. If your child fights the urge to go to the bathroom, have him or her sit on the toilet for at least 10 minutes at about the same time each day (ideally, after a meal).
These small changes help most kids feel better and get the bowels moving the way they should. Talk with the doctor before giving your child any kind of over-the-counter medicine for constipation.
Constipation (for Kids) – Nemours Kidshealth
What Is Constipation?
Constipation (say: con-stuh-PAY-shun) is not having a bowel movement (pooping) as often as you usually do or having a tough time going because the poop is hard and dry. Normal poop is sort of soft and easy to pass, so it shouldn’t be too hard to have a bowel movement.
Some people think they’re constipated if they don’t poop every day, but everybody’s bathroom habits are different. One kid might go three times a day, and another kid might only go once every 3 days. So the real sign of whether you’re constipated is if you’re going less than you normally do, or if it’s hard to poop.
What Are the Signs & Symptoms of Constipation?
Besides pooping less often or having a hard time going, you may feel full and have less of an appetite if you’re constipated. Your belly may stick out a little too. When you do go to the bathroom, you may feel like you have to work really hard to get the poop out, and it might hurt a little to go.
If your poop is hard and dry, pushing it out may cause tiny tears in the skin of your anus (where the poop comes out). If this happens, you might see a bit of blood on the toilet paper when you wipe. After you’re done, you may have only gone a little and feel like you still have to go.
Sometimes when a kid’s really constipated, some watery poop like diarrhea might leak out around the hard poop that’s still inside. This can cause a messy accident, even for kids who stopped having accidents a long time ago.
Why Do Kids Get Constipated?
Constipation is pretty common and different things can cause it. Here are some reasons why kids get constipated:
- Unhealthy diet. If you fill your diet with fatty, sugary, or starchy foods and don’t eat enough fiber, your bowels may slow down. Fiber — found in fruits, vegetables, and whole grains like oatmeal, popcorn, and whole-wheat bread and pasta — can keep your poop from getting hard and dry. So reach for a pear!
- Not enough exercise. Moving around helps food move through your digestive system. If you don’t get enough active playtime — like running around outside — you could get constipated.
- Not enough liquids. Drinking water and other liquids keeps poop soft as it moves through your intestines. When you don’t drink enough, the poop can get hard and dry and you might get stopped up.
- Not going to the bathroom when you need to. Sometimes kids don’t go to the bathroom when they have to. Maybe they don’t want to use the bathroom at school or maybe they just don’t want to stop what they’re doing right then. But ignoring your body’s signals that it’s time to go might make it harder to poop later on.
- Stress. Kids might get constipated when they’re anxious about school or something at home. This can happen from something like being worried about going to a new school, or having a lot of homework and tests coming up. Being away from home for more than a few days may make you feel a little stressed too. If you think stress is plugging things up for you, talk to an adult you trust about it.
- Irritable bowel syndrome. Some kids have a condition called irritable bowel syndrome (IBS). It can act up when they’re stressed or when they run into some triggers, like fatty or spicy foods. A kid who has IBS may have constipation sometimes and diarrhea sometimes, as well as belly pain and gas.
How Is Constipation Treated?
If you’re constipated, you probably won’t need any special treatment. Chances are you’ll soon start going regularly again on your own. If your doctor decides you should come in for a visit, they might suggest a change in diet or some medicine to get you going. But don’t take any medicine for your constipation unless your doctor recommends it.
Usually constipation is just constipation. You eventually poop and feel better.
What Can I Do to Help Myself?
You can follow these steps when you’re constipated and even when you’re not!
- Drink plenty of water. This can keep your poop from getting too hard and dry.
- Eat more fiber. Fruit, vegetables, and whole grains add fiber to your diet. And fiber can keep things moving.
- Ask your parents to use olive oil and other healthy oils in their cooking. This can help make you pass poop more easily.
- Exercise. Throw a ball with your friends, ride your bike, or shoot a few hoops. Activity helps you go to the bathroom regularly. In other words, if you get moving, your bowels will too!
Constipation – Symptoms and causes
Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.
Constipation is generally described as having fewer than three bowel movements a week.
Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause people to strain excessively in order to have a bowel movement.
Treatment for chronic constipation depends in part on the underlying cause. However, in some cases, a cause is never found.
Signs and symptoms of chronic constipation include:
- Passing fewer than three stools a week
- Having lumpy or hard stools
- Straining to have bowel movements
- Feeling as though there’s a blockage in your rectum that prevents bowel movements
- Feeling as though you can’t completely empty the stool from your rectum
- Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum
Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.
When to see a doctor
Make an appointment with your doctor if you experience unexplained and persistent changes in your bowel habits.
Get the latest health information from Mayo Clinic delivered to your inbox.
Subscribe for free and receive your in-depth guide to
digestive health, plus the latest on health innovations and news. You can unsubscribe at any
Learn more about Mayo Clinic’s use of data.
To provide you with the most relevant and helpful information, and understand which
information is beneficial, we may combine your email and website usage information with
other information we have about you. If you are a Mayo Clinic patient, this could
include protected health information. If we combine this information with your protected
health information, we will treat all of that information as protected health
information and will only use or disclose that information as set forth in our notice of
privacy practices. You may opt-out of email communications at any time by clicking on
the unsubscribe link in the e-mail.
Thank you for subscribing
Your in-depth digestive health guide will be in your inbox shortly. You will also receive
emails from Mayo Clinic on the latest health news, research, and care.
If you don’t receive our email within 5 minutes, check your SPAM folder, then contact us
at [email protected] com.
Sorry something went wrong with your subscription
Please, try again in a couple of minutes
Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry. Chronic constipation has many possible causes.
Blockages in the colon or rectum
Blockages in the colon or rectum may slow or stop stool movement. Causes include:
- Tiny tears in the skin around the anus (anal fissure)
- A blockage in the intestines (bowel obstruction)
- Colon cancer
- Narrowing of the colon (bowel stricture)
- Other abdominal cancer that presses on the colon
- Rectal cancer
- Rectum bulge through the back wall of the vagina (rectocele)
Problems with the nerves around the colon and rectum
Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:
- Damage to the nerves that control bodily functions (autonomic neuropathy)
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury
Difficulty with the muscles involved in elimination
Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:
- The inability to relax the pelvic muscles to allow for a bowel movement (anismus)
- Pelvic muscles that don’t coordinate relaxation and contraction correctly (dyssynergia)
- Weakened pelvic muscles
Conditions that affect hormones in the body
Hormones help balance fluids in your body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:
- Overactive parathyroid gland (hyperparathyroidism)
- Underactive thyroid (hypothyroidism)
Factors that may increase your risk of chronic constipation include:
- Being an older adult
- Being a woman
- Being dehydrated
- Eating a diet that’s low in fiber
- Getting little or no physical activity
- Taking certain medications, including sedatives, opioid pain medications, some antidepressants or medications to lower blood pressure
- Having a mental health condition such as depression or an eating disorder
Complications of chronic constipation include:
- Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.
- Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.
- Stool that can’t be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
- Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.
The following can help you avoid developing chronic constipation.
- Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran.
- Eat fewer foods with low amounts of fiber such as processed foods, and dairy and meat products.
- Drink plenty of fluids.
- Stay as active as possible and try to get regular exercise.
- Try to manage stress.
- Don’t ignore the urge to pass stool.
- Try to create a regular schedule for bowel movements, especially after a meal.
- Make sure children who begin to eat solid foods get plenty of fiber in their diets.
Constipation care at Mayo Clinic
June 29, 2019
- Constipation. National Digestive Diseases Information Clearinghouse. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/all-content. Accessed June 4, 2019.
- Chumpitazi CE, et al. Soap suds enemas are efficacious and safe for treating fecal impaction in children with abdominal pain. Gastroenterology. 2016;63:15.
- Bharucha AE, et al. Chronic constipation. Mayo Clinic Proceedings. In press. Accessed June 6, 2019.
- Kellerman RD, et al. Constipation. In: Conn’s Current Therapy 2019. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed June 4, 2019.
- Ferri FF. Constipation. In: Ferri’s Clinical Advisor 2019. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed June 4, 2019.
- 2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://health.gov/dietaryguidelines/2015/guidelines. Accessed June 4, 2019.
- Wald A. Etiology and evaluation of chronic constipation in adults. https://www.uptodate.com/contents/search. Accessed June 4, 2019.
- Wald A. Management of chronic constipation in adults. https://www.uptodate.com/contents/search. Accessed June 4, 2019.
- Constipation and defecation problems. American College of Gastroenterology. https://gi.org/topics/constipation-and-defection-problems/. Accessed June 7, 2019.
- Constipation. American Gastroenterological Association. https://www.gastro.org/practice-guidance/gi-patient-center/topic/constipation. Accessed June 7, 2019.
- Ohkusa T, et al. Gut microbiota and chronic constipation: A review and update. Frontiers in Medicine. 2019;6:1. https://www.frontiersin.org/articles/10.3389/fmed.2019.00019/full. Accessed June 10, 2019.
- Crockett SD, et al. American Gastroenterological Association Institute guideline on medical management of opioid-induced constipation. Gastroenterology. 2019;156:218.
A guide to healthy bowel movements
We’re going there…today we’re talking about poop. If you’re wondering what healthy bowel movements look like, we’ve asked our experts at Hamilton Health Sciences to take a modification of the Bristol Stool Chart and show us using chocolate! The Bristol Stool Chart was developed in 1997 by Heaton, K. and Lewis, S. at the University of Bristol. It was created to categorize different types of stool, ranging from constipation to diarrhea.
What do healthy bowel movements look like?
A healthy bowel movement should fall under Type 3, 4, and 5 on the Bristol Stool Chart. Types 1 and 2 are considered constipation while types 6 and 7 are considered diarrhea. See where your stool fits on the scale with the video above.
Bristol Stool Chart
• Type 1: Separate hard lumps which can look like rocks or marbles
• Type 2: Sausage shaped, but stuck together hard lumps
• Type 3: Sausage shaped with some cracks in the surface
• Type 4: Sausage shaped, smooth and soft
• Type 5: Soft blobs, with clear edges
• Type 6: Mushy stool, flakes of stool with lots of liquid
• Type 7: Entirely liquid, watery, no solid pieces
Healthy daily routines
Healthy bowel movements are key to your child’s well-being. That’s why it’s important to look into the toilet bowl and see what’s inside, or at least have the “toilet talk” with children. The ideal frequency of bowel movements is 1 or 2 times per day. The goal is to have bowels completely emptied. Bowel movements should be soft and easy to pass, with no pain, straining or stool leakage.
Establish a bowel routine and set aside time to go in private, at the same time every day. Go when your bowel is most active (first thing in the morning and after meals) and when you feel the urge. Don’t hold it or ignore your body’s message. Relax, don’t strain, your muscles, and ensure your feet are flat on the floor or on a small foot stool for support. Good hydration and water intake (a warm glass of water can help with constipation), staying active, and eating high fiber foods regularly all contribute to healthy bowel movements.
There are many factors that can contribute to constipation. Some people feel unable to go in public places, when there’s a change of routine or time zone such as on holidays, when there are other health conditions that affect bowel movements, or simply, when they’re not getting enough fiber, water, or exercise.
Constipation can cause problems like abdominal pain and distention, hemorrhoids and anal fissures, difficulty passing stool, urinary tract infections, and bladder problems.
If bowel movements are infrequent or difficult to pass, talk with your doctor or nurse practitioner. Seek medical attention if your child has abnormal stools, stool soiling/incontinence, painful pooping, blood in stools or infrequent bowel movements.
To encourage regular and healthy bowel movements, children should:
• Drink 1-1.5 liters of fluids per day.
• Consume 20-25 grams of fiber per day.
• Sit on the toilet for five minutes, 1-2 times per day as designated toilet time.
• Ensure feet are well supported on the floor or on a foot stool if they’re dangling.
• Only take medication (laxatives) as prescribed by a doctor or nurse practitioner.
• Eat regularly and don’t skip meals. Consume a healthy bowel diet with fresh fruit, raw vegetables, whole grains, legumes, and other high fiber foods.
Watch Dr. Elyanne Ratcliffe, pediatric gastroenterologist at HHS, give a chocolate demonstration of the Bristol Stool Chart on CHCH Morning Live.
How to Make Yourself Poop
On a perfect race morning (before the pandemic) or prior to a hard workout, you’d wake up, have breakfast, and use the bathroom—at least once, maybe twice—and then start your event or training run, not worrying whether you’ll have to stop along the way for an emergency Number 2.
Runner’s World How to Make Yourself Poop: And 999 Other Tips All Runners Should Know
But sometimes, your routine fails you. Maybe you’re traveling and in a different time zone, maybe your diet’s been a little off, or maybe you’ve just got a nervous stomach. Some mornings, you just can’t go, no matter how much you know it’s essential for a good run. Or, you know you have to start soon, but you’re stuck wondering how to make yourself poop.
So what do you do now? We looked at the research and talked with Felice Schnoll-Sussman, M.D., a gastroenterologist at the Weill Medical College of Cornell University and a New York City Marathon finisher, to find out. Here’s what science says about how to get yourself to go.
1. Sip and Sit
Jonathan RH via Flickr and licensed under Creative Commons Attribution
Many of us swear by our morning cup of joe to get our bowels moving—and although scientists aren’t sure exactly why coffee works this way, at least one study has found that it does seem to induce “a desire to defecate.” (It’s unlikely that caffeine is responsible, because even decaf coffee had this effect.)
But Schnoll-Sussman says that any warm beverage can help stimulate a bowel movement, including a cup of tea or even hot water. “The warm liquid acts as a vasodilator,” she says. “It widens blood vessels in the digestive system and helps increase blood flow and GI activity. ”
Schnoll-Sussman advises runners to drink a hot beverage in the morning and then sit on the toilet for a while. “Just the act of sitting there for few minutes can bring on the urge to go, even if you don’t feel like you have to right away.”
2. Get Moving
Maria FuchsGetty Images
Physical activity can bring on a bathroom break, which is one reason a warmup can be so important before a race. “Before you head out the door for a hard workout, I would suggest exercising lightly to help stimulate a bowel movement,” Schnoll-Sussman says.
If you’re trying to unload in the comfort of your own home or hotel room, try jogging up and down the stairs or doing some jumping jacks or dynamic stretches. Already at the race start? Warm up with some strides while you’re still near the porta-potties.
[Build your personalized and adaptive training plan for FREE with Runcoach.]
Wake Up Earlier
Matt Dutile/Getty ImagesGetty Images
“Make sure you’re getting up early enough on race morning to go through your whole morning routine, including time for the bathroom,” Schnoll-Sussman says. People racing in a different time zone, she adds, should try to stay as close to their body’s natural schedule as they can.
If you’re from New York and you’re racing in Portland, that might mean getting up and having your breakfast on East-Coast time—even if it’s a few hours before your race. On the other hand, if you’re a Californian racing Boston, you’ll already be waking up several hours earlier than you’re used to. “That’s a little bit trickier,” Schnoll-Sussman says, “but in this case it’s also important to wake up with plenty of time to spare, so that your body has extra time to digest your breakfast and feel the urge to go. ”
4. Try a Massage
A UCLA study suggests that putting gentle pressure on the perineum—the area between your genitals and anus—may help break up and soften stools for people who have been suffering from constipation.
While it’s not yet a common treatment prescribed by doctors (and it wouldn’t be her first line of advice for runners who don’t typically have pooping problems), Schnoll-Sussman says that it may be helpful for people with specific types of blockages or medical conditions. “It might be worth a try if you’re in a bind,” she says—and while it will probably be a bit awkward, it certainly can’t hurt.
5. Or Glycerin Suppositories
Takahiro Yamagiwa via Flickr and licensed under Creative Commons Attribution
Some runners confess to using glycerin suppositories on particularly desperate race mornings. But Schnoll-Sussman would not recommend this, especially if you have never tried one before.
“The time it takes for a suppository to take effect is very variable from person to person,” she says. “It could work in 15 or 20 minutes, or it could take several hours—so if you do it race morning, you risk having to start the race before it works.” If a runner did want to use one, Schnoll-Sussman would suggest using it the night before a race, or at least not trying it for the very first time on race morning.
6. Focus on Food
Isabelle Rozenbaum & Frederic CirouGetty Images
If you’re worried about taking a quick-fix supplement, or other methods just aren’t doing the trick, turn to foods like raspberries which have 8 grams of fiber per cup. Grab a handful of almonds on the go. The powerhouse nuts contain magnesium—which researchers found may help relieve constipation. Or, reach for the age-old cure of prunes. Packed with fiber, they’ve been proven to help you go. One study found that eating about 10 prunes every day for three weeks improved stool frequency, so adding them to your diet well before race day might help avert a crisis.
What to Know for Next Time
Dennis MacdonaldGetty Images
Getting enough fiber is important in the days and weeks before a race for keeping digestion regular and preventing constipation. But on race day, consuming more fiber than usual can cause diarrhea, so don’t eat (or drink) large amounts the morning of, especially if you’re not used to it.
Staying hydrated is also key—especially if you’re flying on a plane or otherwise traveling. “Constipation occurs when the stool is too dry to move through the body easily, so drinking plenty of water can always help move things along,” Schnoll-Sussman says. Filling up on h3O the days before your race, and drinking that warm beverage first thing in the morning, is the best way to make sure you’re able to go when you need to.
Fuel Up to Finish Strong!
Get the Ultimate Guide to Building a Nutrition Plan to Conquer Your Running Goals.
This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io
Causes, Symptoms and Treatment Options
Medically reviewed by Drugs.com. Last updated on March 17, 2021.
What is Constipation and Impaction?
Normally, people have bowel movements at fairly regular intervals, and stool passes out of the body easily without much straining or discomfort. Although the normal frequency of bowel movements varies from person to person, about 95% of healthy adults have a pattern that ranges from three times a day to three times a week.
In constipation, bowel movements either occur less often than expected or the stool is hard, dry and difficult to pass. Most of the time, constipation is not related to an illness or digestive disorder. Instead, the problem is caused by diet, lifestyle, medications or some other factor that hardens the stool or interferes with the stool’s ability to pass comfortably. Some common triggers of constipation in adults include:
- A diet low in fiber — You need about 25 grams to 30 grams of fiber every day to soften the stool and encourage proper bowel function. Most American diets contain less than half that amount.
- Inadequate fluid intake — To help prevent stools from becoming dry and hard, your daily diet should include at least six to eight “servings” of water. “Servings” can include full glasses of milk, juice and other beverages, but you also can count the water content in fruits, soups, stews and solid foods.
- A sedentary lifestyle — Because regular exercise is necessary to promote normal muscle contractions in the bowel wall, having a sedentary job or rarely exercising puts you at high risk of constipation.
- Ignoring the urge to defecate — If you have your bowel movements right after you feel an urge to defecate, this reinforces a normal nerve reflex that helps you to pass stool easily. Sometimes, because of a busy schedule or limited access to restrooms, a person ignores the urge to defecate. If you repeatedly postpone bathroom trips until a more convenient time, this can lead to constipation problems.
- Travel and scheduling factors — Travel can promote constipation by changing your diet, interfering with the normal timing of your meals, and limiting your access to restrooms.
- Laxative overuse — Long-term, regular use of laxatives can teach your bowel to rely on these medicines for help with bowel movements. Eventually, a laxative habit can contribute to your constipation, making you dependent upon continued laxative use.
- A side effect of medications — Constipation is a side effect of many prescription and nonprescription medications. Common problem medicines include iron supplements and vitamins that contain iron; calcium supplements; antacids that contain aluminum; antidepressants; drugs to treat schizophrenia or hallucinations; narcotic pain killers; general anesthesia; diuretics; muscle relaxants; and certain prescription drugs used to treat seizure disorders, Parkinson’s disease, overactive bladder, and hypertension.
- Local pain or discomfort around the anus — An anal fissure or hemorrhoids can make bowel movements painful or uncomfortable. (An anal fissure is a small tear in the skin around the anus, and a hemorrhoid is a bulge from a vein in the anus.) To avoid pain, a person with one of these problems sometimes resists the urge to defecate. This can cause symptoms of constipation.
Less often, constipation may be a symptom of an illness or condition that affects the digestive tract, the brain or the spinal cord. Some examples include irritable bowel syndrome, intestinal obstruction, diverticulitis, colorectal cancer, hypothyroidism, abnormally high blood calcium levels (hypercalcemia), multiple sclerosis, Parkinson’s disease and spinal cord injury. Constipation can also be caused by abnormal positioning of pelvic organs (for example, sagging of the uterus, called “uterine prolapse”), or abnormal contraction of muscles in the pelvis.
Constipation is a very common problem that affects at least 80% of people at some time during their lives. In the United States, treatment for constipation accounts for more than 2.5 million visits to doctors’ offices each year, with at least $800 million spent annually for laxatives. Although adults of all ages can suffer from constipation, the risk of this problem increases dramatically after age 65 in both men and women.
Occasionally, long-term constipation develops into fecal impaction, which is a blocked colon from a mass of stool that can’t be moved by colon contractions. Fecal impaction can cause pain and vomiting, and a person with fecal impaction may require emergency treatment or hospitalization. Fecal impaction is a fairly common complication of long-term constipation in the elderly and bedridden, occurring in about 30% of all nursing home residents.
Symptoms of constipation include:
- Fewer than three bowel movements per week
- Small, hard, dry stools that are difficult or painful to pass
- The need to strain excessively to have a bowel movement
- A feeling that your rectum is not empty after a bowel movement
- Frequent use of enemas, laxatives or suppositories
Symptoms of fecal impaction include:
- Liquid stool (the stool is leaking around the impacted mass of feces and can be mistaken for diarrhea)
- Abdominal pain, especially after meals
- A persistent urge to move the bowels
- Nausea and vomiting
- Poor appetite, weight loss
- Malaise (a generally sick feeling)
- If the problem is not treated, dehydration, rapid pulse, rapid breathing, fever, agitation, confusion and urinary incontinence
Most people with simple constipation can diagnose and treat themselves. If you have constipation, begin by examining your lifestyle. Review your current diet, your level of daily exercise, and your bowel habits. In particular, do you often ignore the urge to have a bowel movement because it is inconvenient? Then take preventive measures, such as adding fiber to your diet, drinking plenty of fluid, and getting regular exercise. If this does not relieve your problem, contact your doctor.
If you have constipation together with rectal bleeding, abdominal pain or abdominal distention (bloating), contact your doctor immediately. It is best in this case for your doctor to evaluate you, including a physical exam and digital rectal examination.
If your symptoms indicate you might have fecal impaction, your doctor can confirm the diagnosis by examining your abdomen and by checking for a mass of impacted feces during the digital rectal exam. You may need other tests, including blood tests, plain abdominal X-rays, a barium enema or sigmoidoscopy (in which a special instrument is used to view the lower colon).
Constipation can be a symptom of colon cancer. The risk of colon polyps and colon cancer increases with age. People age 50 and older should be sure that they are up-to-date with screening for polyps and cancer (by colonoscopy or
How long constipation lasts depends on its cause. In most otherwise healthy adults, constipation improves gradually within a few weeks after they increase their intake of dietary fiber and fluid and begin exercising regularly. However, constipation in bedridden people with neurological problems can be persistent and is a risk factor for fecal impaction.
In many cases, you can prevent constipation by taking the following steps:
- Add more fiber to your diet — Set a dietary goal of 25 grams to 30 grams of fiber daily. Choose from a variety of high-fiber foods such as beans, broccoli, carrots, bran, whole grains and fresh fruits. To avoid bloating and gas, add these foods gradually over a period of several days.
- Drink adequate amounts of fluid — For most healthy adults, this is the equivalent of six to eight glasses of water daily.
- Begin a program of regular exercise — As little as 20 minutes of brisk walking daily can stimulate your bowels.
- Help train your digestive tract to have regular bowel movements — Schedule a 10-minute period to sit on the toilet at approximately the same time each day. The best time to do this is usually right after the morning meal.
- Do not postpone having a bowel movement until the time is more convenient — Respond to the urge without a delay.
- Use an over-the-counter stool softener or fiber supplement — This may prevent occasional constipation. Always follow the dosage instructions exactly as written on the labels of these medications.
If you have uncomfortable symptoms of constipation, the first step is ensure you are drinking enough fluids, and to increase your fiber intake. The fiber content of your diet by adding cereal grains, fruits and vegetables, or daily doses of a fiber supplement (for example, Metamucil or Citrucel). If constipation persists, it is reasonable to use a laxative treatment to help your bowel expel the stool. There are many laxatives available without a prescription, and they are safe for occasional use.
Salt-based or carbohydrate-based (“osmotic”) laxatives use natural salts, magnesium salts or undigested sugars to help loosen stool by drawing water through the bowel wall into the bowel. Examples are milk of magnesia, lactulose, and polyethylene glycol (Miralax)
Stimulant laxatives, such as laxatives that contain senna, cascara or bisacodyl, are less gentle. Stimulant laxatives cause the colon muscles to contract more frequently or more aggressively.
Laxatives are available in forms that can be swallowed or inserted into the rectum as a suppository.
Enemas also can relieve constipation and are available at pharmacies without a prescription. A traditional enema is done with a bag of liquid (usually a mixture of salt and water) attached to a plastic tube with a tapered tip. The enema fluid can be emptied into the rectum after the tip is inserted into the anus. The fluid is emptied when you lift the bag several inches and allow the fluid to move with gravity. An enema loosens stool in the rectum and triggers the rectal muscles to squeeze as a reaction to their being stretched.
If you have fecal impaction, your doctor may remove part of the fecal mass by hand, by using a lubricated, gloved finger inserted in the rectum. The rest of the mass usually can be removed with an enema. Rarely water irrigation through a sigmoidoscope is needed to clear a fecal impaction. Once the impacted stool is removed, your doctor will have you follow a high-fiber diet and may recommend a stool-softening medication or laxative to promote regular bowel movements.
When To Call A Professional
Call your doctor immediately if your bowel movements stop and you develop abdominal pain or distention. Also contact your doctor immediately if you have any bleeding from your rectum.
Call your doctor for milder symptoms if you want advice, or if constipation continues for longer than a couple of weeks, or if you need laxatives more than two or three times per week to help you move your bowels.
Most people with constipation can achieve normal bowel function through diet and lifestyle changes.
The outlook for most people with fecal impaction is good. However, it is common for fecal impaction to return if constipation is not improved with additional treatment. A long-term program of mild laxatives, periodic enemas or both may be necessary.
National Institute of Diabetes & Digestive & Kidney Disorders
American College of Gastroenterology (ACG)
American Gastroenterological Association
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
90,000 Constipation in children. Prevention. Diet therapy
Constipation is widespread among both adults and children (5-30% depending on diagnostic criteria). Symptoms become chronic in more than 30% of patients, cause not only discomfort and pain to the child himself, but also disrupt the quality of life of his family.
Constipation is a condition manifested by an increase in the intervals between bowel movements (compared to the individual norm) or systematically delayed, difficult and / or insufficient bowel movement. Constipation also includes stool with “gruel”, but after bowel movements were absent for up to 3 days.
Constipation can be associated with functional or organic causes (abnormalities, inflammation). In children, in 90-95%, constipation is functional. The peak incidence of functional constipation occurs at 2-4 years, when the child begins to potty / toilet train.
The main causes of functional constipation
- Incorrect diet for a nursing mother
- Insufficient drinking regime of a child with artificial feeding
- Insufficient drinking regime of a breastfed child with the introduction of complementary foods
- Early transfer of a child to artificial feeding
- Quick transfer of the baby from one formula to another (less than 7 days)
- Poor nutrition of the child (for a long time the child receives food with a large amount of proteins, fats and insufficient dietary fiber, abuse of drinks containing a large amount of astringent substances – tea, coffee, cocoa)
- Excessive use of children’s hygiene products or the development of an allergic reaction of the skin of the perianal region
- Consequences of perinatal damage to the nervous system
- Rickets, vitamin D deficiency
- Thyroid dysfunction (failure – hypothyroidism)
- Food allergy, primarily cow’s milk protein allergy
- Forced potty training, a period of adaptation to new conditions (nursery, kindergarten)
- Physical inactivity – sedentary lifestyle
- Mental trauma or stress
- Systematic suppression of the urge to empty the bowels, associated, for example, with the start of attending kindergarten, school, etc. p.
- Taking some drugs
- Constipation in family members
Frequency of defections in children of different ages
|Age||The number of bowel movements per week||The number of bowel movements per day|
0 – 3 months
5 – 40
5 – 20
|6 – 12 months||5 – 28||1.8|
|1 – 3 years||4 – 21||1.4|
|4years and older||3 – 14||1.0|
In addition to stool frequency, attention should be paid to its nature.For a more objective assessment, the “Bristol scale of feces forms” is convenient, since it is the form of feces, and not the frequency of stools, that corresponds to the time of intestinal transit to a greater extent.
Bristol Feces Scale
In accordance with this scale, 3 and 4 the form of feces is regarded as normal, and 1 and 2 indicate delayed transit (constipation). Quite often, in practice, there are situations when a child has a defecation frequency within the normal range, but the stool is dense, fragmented, in a meager amount.These signs indicate incomplete bowel movement and are considered constipation manifestations.
The consistency in newborns and infants should be mushy. From 6 months to 1.5 – 2 years, feces can be either formalized or mushy. From the age of two, the chair should be decorated.
Signs and symptoms of constipation
- abdominal pain, often bursting, aching, sometimes colicky
- changing the shape and consistency of the chair
- excessive flatulence
- unpleasant smell of gas and stool
- there may be pain during bowel movements
- straining during bowel movements
- there may be blood in the stool – on the surface of feces or in the form of traces on a napkin (indicates an anal fissure)
If you do not eliminate constipation and do not establish a bowel movement, then there is a risk of coprostasis (the formation of fecal stones) and fecal intoxication:
- loss of appetite
- lack of energy
- general malaise
- depression, irritability
- nausea, vomiting
- skin symptoms – dryness, rash, peeling
- fecal incontinence, spotting stool
- retention and incontinence of urine due to pressure from the overflowing intestine on the bladder
- bleeding from cracks, hemorrhoids
Constipation treatment includes the following goals:
one. Normalization of stool consistency (soft, painless stools)
2. Regularity of bowel movements (prevention of re-accumulation of feces)
Constipation treatment is a sequential, complex, individualized process and consists of several stages:
- child and parent education
- correction of nutrition and drinking regime
- elimination of existing coprostasis with medication
- maintenance therapy
It is necessary to exclude factors that provoke and contribute to constipation (normalization of motor and food regimes, discontinuation of medications that can cause constipation, identification of a food allergen, exclusion or confirmation of neuromuscular disease, celiac disease, etc.).NS.).
Lifestyle normalization includes:
- conditioned reflex development
- active lifestyle
- light abdominal massage skills training
- for small children – laying out on the stomach, bending the legs towards the stomach.
Education is the first step in the treatment of functional constipation.It must be remembered that the episodes of calamification and encopresis (fecal incontinence) are not arbitrary and should not be blamed on the child, who may already be frightened and disoriented. In some cases, when the intra-family situation is difficult, the help of a family psychologist may be needed.
It is important to understand that the treatment of functional constipation can be lengthy, based on trust in the doctor, partnership and requires patience. Modern laxatives allowed in children will not make the intestines “lazy”, will not cause “addiction”, they enter the bloodstream in minimal amounts or are not absorbed at all and are safe when taken for a long time.
Correction of the behavior of a child with constipation is based on the development of a toilet visit regime in order to achieve regular bowel movements. Defecation should be at the same time every time. The urge to defecate is based on the gastrocecal reflex, which manifests itself in the morning 1 hour after eating. A child with constipation needs to spend 3-10 minutes in the toilet (depending on age). It is necessary to put the child on the potty or offer to visit the toilet after each meal.
A prerequisite for effective bowel movements is to provide good support for the legs (a low bench on which the child can place their feet), which contributes to an increase in intra-abdominal pressure.
If defecation fails, the child should never be punished and vice versa. The daily frequency of bowel movements can be recorded in a diary, which can be reviewed during routine visits to the doctor.
Treatment of constipation should begin with lifestyle changes that include adjustments in diet, drinking regimen, and physical activity.
Calculation of fluid volume for healthy children
Children under 1 year old should drink at least 100 ml of water per day.
For healthy children weighing from 10 to 20 kg the need for water is calculated using the formula:
100 ml (volume of water for children under 1 year old) + 50 ml for each kg with a body weight over 10 kg.
For example, with a mass of 12 kg: 100 ml + 2 x 50 ml = 200 ml.
A child weighing 20 kg should drink water: 100 ml + 50 x 10 = 600 ml
For children weighing over 20 kg the following formula is proposed for calculating:
600 ml (volume of water for a child weighing 20 kg) + 20 ml for each kg with a weight over 20 kg.
For children over 3-5 years old you can use the calculation of the amount of water: 30 ml / kg mass
Principles of Diet Therapy for Constipation:
- satisfaction of physical needs for nutrients and energy
- elimination of excessive consumption of proteins and fats, which can inhibit intestinal motility
- dietary fiber fortification
- normalization of intestinal microflora with pro- and prebiotics
If the child is breastfed, then the mother’s nutrition is corrected (restriction of foods that contribute to gas formation). With artificial feeding, special mixtures are shown. In case of constipation associated with an allergy to cow’s milk protein, medicinal mixtures are prescribed if the child is artificially fed. If the baby is breastfed, cow’s milk and products based on it are completely excluded from the mother’s diet.
After the introduction of “thick” complementary foods – boiled water is necessary for all children, regardless of the type of feeding.
For older children, it is recommended to eat foods rich in plant fiber.We do not recommend “greasy food”, puree, “snacks”, “food on the go”. Food should be crumbly, meat / poultry / fish – “piece”. A “bulky” breakfast is required to stimulate the “gastrocecal reflex”.
The main source of coarse fiber vegetable fiber, which contains a large amount of dietary fiber, is cereal bran, rye bread, as well as a number of vegetables and fruits. According to the principles of evidence-based medicine, there was a statistically significant increase in stool frequency and improvement in stool consistency with the use of fiber compared to placebo.
Bran, as the main source of vegetable fiber, is recommended to be added to the second and third dishes, after pouring it with boiling water and settling for 20 minutes. Bran can also be used between meals with plenty of liquid. For school-age children, the total amount of liquid when taking bran should be at least 1.5-2 liters per day, otherwise they perform mainly the role of sorbents, absorbing liquid from the intestines, thereby increasing constipation.The dose is selected individually, it is recommended to start with 1 teaspoon 2-3 times a day, with a gradual increase to 40 g per day. When the effect is achieved, the dose is reduced and limited to one dose.
The American Academy of Pediatrics (2009) recommends a fiber intake of 0.5 g / kg / day (maximum 35 g / day) for all children. Fiber intakes below the minimum recommended value have been shown to be a risk factor for chronic constipation in children.
However, long-term intake of a large amount of plant fiber due to fermentation by the intestinal microflora is naturally accompanied by bloating and flatulence.
Children with constipation are shown taking cool liquid on an empty stomach (drinking and mineral water, juice, compotes, kvass); honey, xylitol or sorbitol may be added to enhance the laxative effect. It is very beneficial for the intestines to increase the intake of juices containing sorbitol / sorbitol, such as juice from plums, pears, apricots, peaches and apples,
In case of “sluggish” bowel function (hypomotor constipation), cool mineral water of medium and high mineralization is used, such as Essentuki 17, Batalinskaya, Arzni, Donat Magniya, etc. with spastic constipation (hypermotor constipation, the shape of the stool is often type 1) – warm and low mineralization (Essentuki 4).Calculation of mineral water – 3-5ml / kg per day.
You should limit milk in its pure form and in dishes, as flatulence may occur with the appearance or intensification of abdominal pain. It is better to replace whole milk with sour milk products – kefir, acidophilus, yogurt, yoghurts, etc.
The diet of children with constipation includes dishes rich in vegetable fiber – salads from fresh vegetables, greens 2-3 rubles per day, baked apples, stewed vegetables, diluted vegetable and fruit juices with pulp.Food is prepared mainly in unmilled form, steamed or boiled in water.
It is preferable to take raw vegetables and fruits (in the absence of contraindications). Tomatoes, squash, pumpkin, carrots, beets, leafy lettuce, cauliflower, apples are especially recommended. Dried fruits (prunes, dried apricots, figs) are given soaked and as part of cooked dishes. White cabbage, young green beans, green peas are allowed if tolerated.It is good to add parsley, dill, celery to various dishes and salads.
If, after reading the article, you still have questions or you do not understand how to apply the recommendations in your particular case, we invite you and your child to be examined by a pediatric gastroenterologist at the DDC. For the convenience of parents, you can make an appointment with a pediatric gastroenterologist at the Pediatric Diagnostic Center on weekdays and Saturdays.
We will be happy to help!
Back to list
90,000 A modern view of functional constipation in young children: feeding characteristics and principles of non-drug correction
Article published on p.140-148
Among the common symptoms that cause concern for parents and attract the attention of doctors from the very first days of a child’s life, a leading role belongs to a variety of stool disorders. The period of adaptation to external conditions is closely related to the nature of physiological functions, therefore, any violations of normal physiological acts, in particular defecation, are of enormous importance, having a negative effect on the growth and development of the child’s body and significantly affecting the quality of life.Meanwhile, one of the most frequent complaints of parents, both in the neonatal period and in any other age period, are complaints of violations or difficulties in defecation, the most frequent of which is constipation. In the first decade of the 21st century, only in the United States, the incidence of constipation in the entire population increased by 4 times, the largest number of visits to a doctor was recorded in children under the age of 15; patients diagnosed with constipation were prescribed 5.4 million prescriptions, which indicates the growing urgency of this problem in children around the world .
Every seventh inhabitant of our planet has difficulty defecating. According to epidemiological studies, from 5 to 21% of the adult population (on average 14%) suffer from constipation, although only 3-5% go to the doctor . According to pediatric gastroenterologists, about 70% of the child population suffers from chronic constipation , but it should be noted that the true frequency of constipation in children remains unclear, since not all cases of diseases are recorded due to the low prevalence of parents, especially at the initial stage of the disease.This often leads to self-medication, improper and irrational use of laxatives and enemas, which, in turn, leads to aggravation of constipation, disturbances in the digestive process, and even the development of certain complications. The existing opinion that children “outgrow” the problem of constipation is not supported by long-term observations: in 30–52% of children, symptoms persist for the next 5 years, about 25% of children continue to suffer from constipation in adulthood. According to a number of authors [5, 10, 15, 16], the significant prevalence of constipation in the adult population is largely due to insufficient attention of pediatricians to the problem of chronic constipation in children.
Despite the obvious high social significance and extremely widespread prevalence of this pathology, to this day, pediatricians from different countries of the world cannot agree, let alone a single definition of this condition – it is still not clearly defined even what frequency of defecations is considered normal, and what – pathological. This is due primarily to the age and individual characteristics of defecation, as well as to the fact that the nature and frequency of bowel movements are directly dependent on the type of feeding the child.
It cannot be denied that constipation in infants is of particular concern to parents, and such children do not always receive medical help in a timely manner, which is largely due to the fact that many parents and even pediatricians understand the concept of constipation in different ways. Some consider constipation a difficulty in the act of defecation or too dense consistency of feces even with daily stools, others – irregular stools, regardless of its consistency, or a small amount of feces with regular bowel movements.
In the broadest sense of the word, constipation (constipation, obstipation) – literally “congestion” – is a dysfunction of the intestine, expressed in an increase in the intervals between acts of defecation compared to the individual physical norm or systematic insufficient bowel movement. Normally, the frequency of stool fluctuates within significant limits (children have individual characteristics of the excretory function of the colon, in addition, occasional episodes of short-term stool retention are possible) and depends on many factors: in young children, this is primarily the nature of nutrition and drinking regimen.
Therefore, if in children over 3 years of age, the frequency of bowel movements should normally be at least 2 times a week, and a delay in bowel movement of more than 36 hours should already be considered as a tendency to constipation, then in children of the first 3 years of life (especially the first year of life), the frequency of stool still varies within a fairly wide range.
At the present stage, it is generally accepted that with artificial feeding, the frequency of stool normally does not exceed 1 time per day and should be at least once every 24 hours, while with natural feeding, especially in the first months of a child’s life, once every few days or coincides with the number of feedings (but should not exceed 6 times a day).In the future, as the age increases, the frequency of stools gradually decreases and by the time of the introduction of complementary foods (ie, when the child reaches the age of 6 months), defecation is usually carried out 1-2 times a day. It should be remembered that stool frequency cannot be the only and sufficient criterion for constipation: in the work carried out by A. Koch et al.  to assess the sensitivity of symptoms in various types of chronic constipation, the importance of excessive straining as the most sensitive sign of constipation was confirmed (sensitivity 94% ).The most significant ancillary criteria for constipation were the feeling of incomplete defecation and hard, lumpy stool. A similar conclusion was reached by international experts who participated in the formulation of the Rome Consensus III: in addition to their definitions of functional constipation, an important thesis was included that constipation is spoken of even in cases of daily bowel movements, if it is accompanied by painful sensations, straining, changes in character stool (large fecaloma diameter, fragmented feces).
Thus, if the normal stool of a breastfed child has a mushy consistency, then with constipation in young children, changes in the nature of the stool are noted, as well as painful sensations, straining, crying and anxiety during the act of defecation. Most children have all of these signs, but some of them may be absent or occur sporadically. Undoubtedly, all these symptoms are unpleasant in themselves, bother the child and his parents, affect sleep, behavior and appetite, and certainly require elimination.This should be borne in mind, since in recent years in the literature there have been reports (albeit related to constipation in adults), in which they try to refute the possibility of intestinal intoxication in chronic constipation [4, 9]. The authors base themselves on the fact that toxins absorbed from the intestines have never been identified and there is no way to confirm this experimentally. From this point of view, it is concluded that it is often unnecessary to achieve regular bowel movements. From the pediatric standpoint, this judgment seems to be incorrect.First, with chronic constipation, especially lasting several days, the phenomena of chronic nonspecific intoxication are always observed: lethargy or anxiety, lack of appetite, headache, which cannot be associated with other causes; secondly, even if there are no pronounced symptoms of intoxication, with chronic constipation, symptoms associated with a violation of the motor-evacuation function of the intestine, especially abdominal pain, are noted. Therefore, the elimination of painful manifestations in chronic constipation is necessary at any age period, especially in young children, regardless of whether there are or are not symptoms of intestinal intoxication, which, according to some authors, should not be present with constipation.
Despite the fact that in the modern International Classification of Diseases of the 10th revision under the heading K.059.0, constipation is distinguished as an independent nosological form, it is more correct to talk about the symptom complex of chronic constipation , since it is caused by various etiological factors, has different mechanisms of development, often is just one of the symptoms of any disease and requires differentiated approaches to correction. This determines the need to find out in each case the cause of constipation and highlight its main characteristics (parameters).
It is generally accepted that in childhood, functional constipation, that is, dysregulation of the gastrointestinal tract (GIT), is considered the main reason for the abnormal functioning of the colon, which is manifested by rare independent defecations or their absence. This is evidenced by the official statistics of the American Association of Pediatricians, according to which 95% of children with constipation have no organic pathology . In addition, many etiological factors of functional disorders of the gastrointestinal tract in children of the first year of life are closely related to the anatomical and physiological features of its development.So, during this period, the child’s body length increases by an average of 25 cm, which is accompanied by certain clinical symptoms, the formation of physiological dolichosigma, one of the manifestations of which is a predisposition to constipation.
Our long-term observations of children suffering from defecation disorders confirm that in the overwhelming majority of cases, chronic constipation in young children is of an alimentary nature and is associated with disorders of the motor-evacuation function of the colon as a result of discoordination of tonic and propulsive contractions of the intestinal wall [12-14 ]. Such discoordination can be either spastic (proceed as hypermotor dyskinesia, that is, accompanied by the appearance of fragmented, dense, “sheep” feces and cramping abdominal pain), and hypokinetic (hypomotor dyskinesia, accompanied by the formation of large fecaloma, significantly exceeding the diameter of the size of the anal sphincter, and aching pains of a diffuse nature). Risk factors for the development of functional constipation in young children are different and most often, in cases of breastfeeding, they are associated with an improper diet and nutritional pattern of a nursing mother, and with artificial feeding, with an insufficient drinking regime, a quick one-step transition to artificial feeding, a forced transition from one mixtures to another and using milk mixtures with a poorly adapted fat component.
The diagnosis of functional constipation in accordance with the Rome III criteria (functional constipation, G7) is established in children under 4 years of age if at least 2 of the following signs are present for a month: two or fewer bowel movements per week; at least one episode of fecal incontinence per week after hygiene training; the presence of episodes of delayed bowel movements; painful bowel movement or hard stool type 1 or 2 on the Bristol stool scale; a large amount of fecal matter in the rectum; the formation of fecal stones, which can make it difficult to defecate. The presence of these signs is usually accompanied by irritability, decreased appetite and / or early satiety. These signs disappear immediately after the act of defecation. Of course, it must be emphasized that these criteria can only be applied in cases where no structural or biochemical changes that can explain the intestinal disorder are detected [6, 9].
In addition to the well-known Bristol stool scale, with which it is now customary to determine the nature of the stool, there is the Amsterdam stool rating scale – the Bekkali scale, specially developed for young children, which describes the amount (4 points), consistency (4 points) and color chair (in 6 categories).The scale is convenient for use in both full-term and premature infants . According to this scale, the frequency of stool in children is considered normal if 7-1 acts of defecation per day occur at the age of 4 months, 3-1 from 4 months to 2 years, at the age of 2 years, the norm is allowed from 2 times a day to 1 once every 2 days.
In our opinion, the distinction between constipation according to the principle of “functional – organic” is the most significant parameter of the classification of chronic constipation, proposed by us back in 2001 .Moreover, such a distinction is not only decisive from the point of view of understanding the mechanism of development of the process, but also serves as a guideline (criterion) for determining the principles of differentiated therapy.
Organic constipation is associated with congenital or acquired anomalies in the development or position of the colon (intraluminal) or with anorectal anomalies and diseases (extraluminal). In contrast to them, functional constipation is not caused by structural lesions of the intestine (there are no anatomical defects of the intestine), but by disturbances in the mechanisms of regulation of the motor activity of the gastrointestinal tract.It is quite obvious that both the approaches to therapy and the volume of diagnostic studies for functional and organic constipation in children are, if not fundamentally different, then, in any case, have their own characteristics.
The next important category of classification is the predominant topography of constipation – cologenic or proctogenic. This division, in our opinion, is quite justified, despite the fact that in some cases, constipation can be coloproctogenic in nature. Reflecting the localization of the process, these terms largely determine the mechanism for the development of constipation – slowing down passage through the colon with cologenic and violation of the act of defecation with proctogenic constipation.Different genesis determines the features of the clinical course and the principles of correction of cologenic and proctogenic constipation, of course, taking into account other characteristics: the presence or absence of organic matter and the nature of tone and motility.
It is very important to assess the motor disorders of the colon, which determine not only the clinical manifestations of the disease, but also the principles of the therapy. Movement disorders are usually limited to assessing the state of kinetics – hypomotor (hypokinetic), hypermotor (hyperkinetic) and mixed. However, such an assessment is often insufficient, since it does not include the characteristics of the initial bowel tone (hypotension, hypertension, normotonia). Our studies  indicate that movement disorders in chronic constipation are usually combined in the form of various kinds of dyskinesias and dystonia, which are observed in various variants, with a predominance of hypotonic dystonia and hypokinetic dyskinesia. Therefore, we consider it appropriate to distinguish 4 main types of movement disorders in chronic constipation, reflecting the state of both kinetics and tone of the colon: hyperkinetic dyskinesia – hypertensive dystonia, hyperkinetic dyskinesia – hypotonic dystonia, hypokinetic dyskinesia – hypertensive dystonia, hypokinetic dyskinesia – hypotonic dystonia.This approach makes the prescription of prokinetics more justified when slowing down motor function and weakening the bowel tone and intestinal antispasmodics – with increased motility and intestinal hypertension.
The above categories were the basis for the classification of chronic constipation in children, which, in our opinion, reflects the main etiological factors and pathogenetic mechanisms of the symptom complex of chronic constipation and determines the principles of its correction (Table 1).
Thus, despite the unconditional prevalence of functional constipation, especially in early childhood, the first stage of diagnosis aimed at identifying possible causes of constipation is the exclusion or confirmation of its mechanical and organic causes.Ideally, the clinical examination of children with constipation should be comprehensive, while the direction of research, the content of which is determined in each case, should be from simple to more complex. The most important diagnostic technique when examining a child with chronic constipation is a superficial approximate and deep sliding palpation of the abdomen. When palpating the abdomen, it is necessary to establish the presence of pain along the colon or only the sigmoid part of it, pay attention to the spasm of the sigma, the presence of rumbling along the colon.
Particularly informative is palpation of the sigmoid colon, which in chronic constipation is often filled with feces, sometimes spasmodic, sensitive or painful on palpation. The appearance of a rumbling indicates the presence of liquid contents and gases in the sigma. Thickening of the intestinal wall, strengthening and increasing its peristalsis, pain on palpation are associated with the accompanying inflammatory process of constipation. In the presence of fibrotic changes or neoplasms, the intestine may become lumpy.In the presence of adhesions or cicatricial changes in the mesentery, the mobility of the sigmoid colon is limited, and with congenital malformations, lengthening of the intestine and its mesentery, it increases, which sometimes makes it difficult to detect the sigmoid in its usual place.
Bowel percussion in children is used much less frequently. In healthy people, a percussion sound of various shades is determined above the abdomen. Strengthening of the tympanic sound is noted with flatulence, dullness – over the intestinal loops overflowing with feces with constipation, but the latter is possible only when the intestines are adhered directly to the anterior abdominal wall. Auscultation makes it possible to examine the motor function of the intestine. In a healthy child, 5–7 hours after eating, rhythmic noises are heard in the projection zone of the cecum. Enhanced intestinal motility can be observed with mechanical obstruction; with enterocolitis, it can be combined with loud rumbling.
The accumulated clinical experience and scientific research suggest that a well-collected history and a thorough clinical examination of the child (which, in addition to visual examination and palpation, must necessarily be accompanied by a rectal digital examination and examination of the perianal region) is usually sufficient to exclude an organic cause of constipation [12 , fifteen].In this situation, there is no need to carry out a complex set of examinations and laboratory tests before starting treatment. Only in the absence of improvement against the background of traditional therapy or in atypical cases with alarming clinical symptoms (the presence of pathological impurities (blood, mucus) in the feces, intestinal distention (an enlarged abdomen with chronic constipation suggests the organic nature of the disease – Hirschsprung’s disease, celiac disease) ; while the absence of an increase in the abdomen against the background of constipation indicates functional disorders of defecation), flatulence, low-grade fever, and other extraintestinal manifestations (scratching, age spots, allergic rashes, angulitis, angular stomatitis), further studies are shown, of which the coprogram, clinical blood test , in some cases – the study of the microbial landscape of the intestine. Instrumental examinations (ultrasound examination of the colon, rectoscopy, irrigography, colonoscopy, morphological examination of the intestinal mucosa, electrocolography, computerized balloonographic multichannel manometry, colonoproctodefecography, electromyography) are used only in certain cases for strict indications [14, 15].
Thus, the diagnosis of chronic constipation is established clinically, and paraclinical studies are aimed at establishing only its cause: the presence of organic pathology of the intestine and / or anorectal zone, inflammatory diseases of the colon; to assess the functional state of the large intestine and the state of the intestinal biocenosis.
The basis for the prevention of chronic constipation is, first of all, a balanced, rational, age-appropriate nutrition of the child and education of the culture of hygiene skills, including the act of defecation. It is these parameters that determine the normal functioning of the gastrointestinal tract and, as a result, the normal physiological functions of the body. Moreover, the implementation of these conditions should begin immediately after the birth of the child.
To prevent constipation in an infant, breastfeeding should be continued for as long as possible.It is generally known that breast milk is the most suitable food for a baby during the first months of life, uniquely adapted to his needs. An unjustified change of breast milk to an adapted milk formula or, even worse, the use of unadapted products based on cow (goat) milk can be fraught not only with a violation of the adaptation of the child’s digestive tract and manifestations of atopic reactions, but also with the formation of functional constipation. The reason for the slowing down of intestinal motility can be both the composition of the adapted milk formula itself (an increased level of proteins in relation to carbohydrates, the ratio of calcium and phosphorus, an unadapted or partially adapted fat component), and an allergy to cow’s milk proteins (BCM).In the latter case, constipation can also occur during breastfeeding if the mother consumes products containing unadapted cow (goat) milk protein. According to the pathogenetic mechanism, BKM-induced constipation is referred to as typically functional, associated with impaired mucus formation in the colon, which leads to a delayed passage of feces in the distal direction. The morphological basis of this pathology is lymphocytic infiltration, hypertrophy of lymphoid tissue, interstitial edema, eosinophilic infiltration of the lamina propria with intraepithelial “eosinophilic abscesses” .
For the normal development of a healthy child in the first half of a year of life, breast milk is quite enough, therefore, one should not strive for an early (up to 6 months) introduction of complementary foods. This is irrational due to the functional immaturity of the gastrointestinal tract; early complementary feeding can reduce the frequency and intensity of suckling and, as a result, the production of breast milk. Under such conditions, the introduced complementary foods will not so much supplement breast milk as partially replace it, which is physiologically unjustified. In addition, the premature introduction of complementary foods can cause constipation and other disturbances in the activity of the gastrointestinal tract in a child: a slowdown in intestinal motility with an early change in the qualitative composition of food is mainly due to enzymatic, regulatory and motor morphofunctional immaturity of the digestive tract in children of the first half of life. At the same time, too late the introduction of complementary foods (much later than 6 months) is also irrational, since later the child may have problems with the adaptation of the body to solid food, which will also indirectly contribute to the formation of alimentary constipation.
Regardless of the type of feeding (natural, formula, mixed), during the first year of a child’s life, breastfeeding (or formula) on demand should continue with the same frequency and intensity as during exclusive breastfeeding, and breast milk or an adapted formula should remain the main source of fluid, nutrients and energy.
The rational selection of products recommended as the first complementary food is also extremely important.The first food offered to a child should be mashed foods, consisting of one ingredient, soft consistency, without added sugar, salt or hot seasonings. According to the recommendations of the experts of the World Health Organization (WHO), the optimal introduction of cereals as the first complementary food (traditional cereal products that do not contain gluten – buckwheat, corn, oats; rice, and even more so semolina, in children with functional constipation in the first year of life highly not recommended) or vegetable puree (from zucchini, broccoli, cauliflower, potatoes, pumpkin, cabbage, carrots, later tomatoes and green peas), and breast milk or an adapted infant formula can be added to the mashed potatoes for softening.It is recommended to add 2-3 drops of unrefined vegetable oil to vegetable puree.
3-4 weeks after the introduction of vegetables and cereals into the child’s diet, the diet can be expanded – it is recommended to gradually introduce fruits and meat (turkey and rabbit are preferred as less allergenic varieties), carefully observing the child’s reaction and observing the order of the introduced products. Children suffering from functional constipation, as well as other children of the first year of life (according to the Order of the Ministry of Health of Ukraine No. 149), are highly discouraged from early introduction of juices into the diet (acquaintance with them is recommended after all other complementary foods have been introduced into the diet, not earlier than 12 months of age) and dairy products, especially cottage cheese (high-protein product devoid of ballast substances).Contrary to popular belief that fermented milk products help facilitate bowel movements, one should not strive for too early introduction of fermented milk products into the diet, especially kefir, which can potentially increase the risk of metabolic acidosis due to excess protein and high amino acid content, as well as the inability of the kidneys to excrete the obtained hydrogen ions.
Any new product should be included in the child’s diet very slowly and with the utmost care, starting with minimal doses (a few tablespoons followed by supplementation with the usual food – mother’s milk, formula). Attempts to force the introduction of products usually end with the formation of persistent obstinate constipation and the appearance of other functional gastrointestinal disorders. It should be remembered that the more gradual the introduction of any new product, the lower the risk of bowel dysfunction. Several new products should never be introduced at the same time. The adaptation time should be the longer, the younger the child, and averaged 7-14 days.
As the baby reaches one year of age, gradually decrease the volume and frequency of breastfeeding and increase the amount of solids and liquids.As the baby’s need for breast milk decreases, its secretion from the mother gradually decreases, which is usually not a cause for concern and allows you to gradually stop breastfeeding. It should be noted that in connection with the undoubted benefits of breast milk for a growing child’s body in general and the formation of the immune system in particular, WHO currently advises to keep breastfeeding as long as possible – up to 2 years.
If it is impossible to establish breastfeeding, lack or complete absence of breast milk, one has to resort to the appointment of artificial mixtures.
All produced mixtures are divided (conditionally) into 3 categories: basic (starting), the following formulas and non-standard formulas. Basic formulas with a high degree of adaptation are ideal for feeding children from birth to six months, the following are usually intended for children in the second half of life and older, non-standard – for feeding premature babies or children with hypotrophy. It is only necessary to switch from one mixture to another when there is a cause for serious concern – for example, the child stops gaining weight or the character of the stool is disturbed.Any change in diet carries the risk of disrupting adaptation, so stool problems are only exacerbated when parents start to feverishly change one mixture for another.
Currently, no one has any doubts that any dilutions of whole cow’s milk are inferior to modern adapted mixtures both in quality and in the degree of adaptation of protein, carbohydrate, fat components, and in the amount of amino acid composition, vitamins, microelements. In the course of research, the beneficial effects of all these products on the intestinal microflora and its excretory functions have been confirmed, not to mention the abundance of so-called special mixtures intended for feeding premature babies, low birth weight children, children with lactase deficiency, etc.Since in young children the main allergen is cow’s milk protein, the main principle of diet therapy in this group is not only the complete exclusion of cow’s milk and products based on it from the child’s diet or mother’s diet, as already mentioned above, but also the use of substitutes breast milk based on partial protein hydrolysis during artificial feeding. For the treatment of constipation caused by disaccharidase deficiency (transient lactase deficiency, common in children in the first months of life, in about 10% of cases occurs with constipation due to intestinal spasm caused by the acidic pH of the contents of the colon), children who are bottle-fed can be recommended milk formulas with various reduced lactose content .
Especially suitable for children prone to constipation, mixtures enriched with prebiotics – galactooligosaccharides and fructooligosaccharides. In addition to the fact that prebiotic fibers make a significant contribution to the formation of a healthy intestinal microflora, improving the trophism of epithelial cells, they contribute to the normalization of the peristaltic activity of the gastrointestinal tract and the formation of regular soft stools. The experts of the ESPGHAN committee (European Society of Pediatric Gastroenterology, Hepatology and Nutrition) in their systematic review on the efficacy and safety of the additional inclusion of prebiotics in milk formulas (2011) noted that milk formulas enriched with prebiotics significantly reduce the pH of feces, increase the frequency of bowel movements, soften stool, increase the number of bifidobacteria and lactobacilli in the intestinal microflora and their introduction into the diet of a child suffering from constipation of functional origin should begin from the moment of birth.
An extremely important issue in terms of preventing functional constipation is also the characteristics of the fat component presented in mixtures. It is known that both in breast milk and in its substitutes, approximately 45-50% of energy is accumulated in fats, which in modern formulas contain the same amount as in breast milk, but formulas differ significantly from the latter in the profile of fatty acids contained. In breast milk, the main saturated fatty acid, palmitic acid, is found in the physiological beta position of attachment to the triglyceride molecule, whereas conventional formulas often contain palmitic acid in the alpha position, which is essential for the digestion, absorption and subsequent metabolism of fat.If palmitic acid is in the alpha position, then it is released in the intestine under the action of pancreatic lipase, binds calcium and forms insoluble fatty acid soaps, which are subsequently excreted from the body along with feces. At the same time, the absorption of fats is significantly reduced, the energy value of the mixture decreases, the absorption of calcium decreases, which leads to a violation of bone mineralization. In addition, calcium soaps of fatty acids change the consistency of feces, significantly thickening and “cementing” the latter, which disrupts peristalsis and often leads to the formation of functional constipation.At the same time, palmitic acid, esterified in the beta position of the glycerol molecule, is effectively captured by enterocytes of the intestinal mucosa as a monoglyceride without preliminary cleavage, does not change the consistency of feces, helps to increase the absorption of calcium necessary for bone mineralization, and is used as an important energy substrate for baby food. (fig. 1).
Currently, fundamentally new innovative formulas have appeared on the market – mixtures that meet the recommendations of the European Union regarding nutrition for special medical purposes, combining several functional components at the same time, which makes it possible to solve the problem of functional constipation in young children who are bottle-fed.An example of such an innovative mixture is Nutrilon Comfort (manufactured by Nutricia, Holland). This mixture, not being a medical formula, contains all the necessary components, which makes it a complete breast milk substitute in the required proportions. And in addition, due to its multifunctional composition, it fully complies with all the requirements and recommendations of ESPGHAN for functional food products used for the treatment and prevention of constipation: it contains 100% partially hydrolyzed milk whey, a reduced amount of lactose, a complex of fructo- and galactooligosaccharides and a unique combination of fats with beta-palmitic acid.
Due to the prebiotic complex of fructo- and galactooligosaccharides contained in this mixture, on the one hand, a bifidogenic effect is provided and the growth of conditionally pathogenic and pathogenic flora is inhibited, on the other hand, short-chain fatty acids are formed from these substances under the influence of microflora, which are the main source of energy for colonocytes, which contributes to acidification of the environment and stimulates peristalsis, the formation of soft regular stools. Hydrolyzed protein is easier to digest in the child’s digestive tract, reduces intestinal colic physiological for young children.Beta-palmitic acid reduces the absorption of fat and the amount of calcium salts of fatty acids, which cause thickening of feces and slowing down of peristaltic waves. The lowered lactose content prevents the intestinal pH from shifting towards the acidic side and normalizes peristalsis.
After the introduction of solid food into the diet to prevent constipation, it is necessary that the child receives foods containing fiber (plant products) and dietary fiber (bread, meat, nuts).Food should not be mechanically, chemically and thermally gentle, on the contrary, it is desirable to include in the menu raw vegetables and fruits, salads, vinaigrettes, coarse cereals, vegetable soups, meat and poultry dishes, preferably in a piece. If you have a tendency to constipation, first of all, you should try to restore normal bowel function through nutrition, using foods that have a laxative effect: raw vegetables and fruits, melons (watermelon, melon), seaweed, stone fruits (plum, cherry, apricot), rough crumbly porridge (oatmeal, buckwheat, corn, pearl barley), wholemeal bread (rye, with bran), vegetable oil. At the same time, you should reduce the use of products with a strengthening effect (cottage cheese, rice, flour products). It is possible to use a contrast of temperatures: after a hot dish, drink a glass of cold juice, compote or mineral water. It is helpful to keep a food diary to identify the food that is causing your child to have stool problems, recording the foods that are eaten daily. Constipation can be caused by too much milk or other dairy products, bananas, rice, and applesauce.The child’s menu should be diversified as much as possible, including bran buns with raisins, vegetables such as carrots and celery between meals, more apples and pears, fruit and vegetable salads with the addition of vegetable oil.
A carefully balanced diet containing a sufficient amount of plant products and dietary fiber, adherence to the principles of a balanced diet are the most important conditions for the prevention of constipation at any age of the child.
Diet food should be combined with a proper drinking regimen. Adequate amount of fluid (at least 1-2 liters per day, depending on age) is necessary during all periods of growth and development of the child, but it becomes especially important if the child receives bran and foods high in fiber in the diet. The liquid softens the fiber in the intestines, which promotes the formation of soft, easy-to-pass stool.
It should be remembered that one of the important reasons for the development of constipation is physical inactivity and the associated muscle hypotonia.It is necessary to normalize the child’s motor regime. A healthy child should be active, walking, jogging, swimming are useful, from passive loads – general massage, which helps to strengthen muscles, especially in children with muscle hypotonia and slow formation of reflexes. At an older age, therapeutic physical culture is shown, aimed at strengthening the abdominal muscles.
In children of the first months of life, the reflex to emptying the intestines is still poorly developed, which leads to the development of constipation. In order to stimulate the reflex to defecate, it is advisable, shortly before feeding, to carry out a light (for 5–7 minutes) massage of the abdomen clockwise, supplemented by drawing the legs to the abdomen and laying them on the stomach. It is unacceptable to use laxatives for the prevention of alimentary constipation; it is highly undesirable for treatment!
In childhood, especially at an early age, the neuro-reflex connections are not yet perfect; the mechanism of defecation is developed gradually, depending on the environment and the individual characteristics of the organism.The bowel emptying skill begins to form from the first months of life and is fixed as a conditioned reflex. Therefore, the upbringing of a child plays an extremely important role in the prevention of the development of chronic constipation and proctological diseases, and the urgent problem of the prevention of conditioned reflex constipation is the solution of psychological and social issues, sometimes requiring the intervention of a child psychotherapist.
Many preventive measures for constipation in young children are at the same time therapeutic (dietary and water regimes, abdominal massage, stimulation of the reflex to defecate, etc.).etc.). To resort to the appointment of laxatives should only be in cases of complete failure of nonspecific measures.
The treatment of chronic constipation in a child during the first 3 years of life requires not only experience and appropriate medical knowledge, but also an individual approach for a particular child in specific conditions.
The prevention of constipation should be started immediately after the birth of the child, organizing a balanced diet and developing a conditioned reflex to the act of defecation.At an older age, these activities in no way lose their significance. Only the observance of these conditions will make it possible to solve a serious medical and social problem, which is represented by chronic constipation in children, which requires widespread medical propaganda among the population.
In addition to education, clear nutritional advice should be given, taking into account adequate drinking and fiber intake. Children over the age of 2 are advised to consume an amount of dietary fiber equal to the sum of the child’s age (in years) + 5 g / day.A case-control clinical study (level of evidence B) found an association between constipation and low fiber intake — odds ratio 4.1 (95% confidence; confidence interval 1.64-10.32) . It is necessary to increase the amount of consumed fresh fruits and vegetables, coarse fiber, fresh fermented milk products. It is advisable to carry out drug treatment only in the absence of the effect of diet therapy.
The ability to empty the bowels in a child begins to form from the first months of life, therefore this period is extremely important for further physiological development.At an early age, neuro-reflex connections have not yet been established, the defecation mechanism is developed gradually and depends on the child’s environment and the individual characteristics of the organism. The development of the skill of a daily morning one-step bowel movement is just as important as all hygiene skills (washing, brushing teeth, combing, etc.), and prevents the development of functional defecation disorders and proctological diseases that can leave an imprint on the rest of your life.
Thus, the treatment of children with constipation should be comprehensive and individually selected depending on the age of the child and the specific situation.It is recommended to resort to drug therapy only in the absence of the effect of diet therapy, which is not reduced to a strict diet or adherence to a certain medical table, but to a physiological diet, the basis of which in a young child is natural feeding or a properly selected full-fledged multicomponent and multifunctional breast milk substitute, which will prevent the formation of a difficult bowel movement or contribute to softening and frequent stool with existing functional constipation.
Normal digestion and absorption of food, as well as the elimination of waste from the body – these are the functions of the digestive system. These processes are essential for maintaining health and preventing various diseases. Healthy bowel function is an important condition for freeing the body of toxic substances.
Constipation , resulting in a lack of regular bowel movements and difficulty having a bowel movement, is not a disease but a symptom. Constipation can be caused by a variety of causes, both psychological and physical. Suppressing your natural urge to empty your bowels can lead to constipation. To the same result is the use of drugs that neutralize acidity, containing aluminum (for example, “Maalox”), antidepressants, analgesic drugs, drugs for lowering blood pressure from the group of drugs that prevent the outflow of calcium from the body. Various diseases, and primarily a decrease in the function of the thyroid gland, also lead to a deterioration in the functioning of the intestines.
There is no doubt, however, that the most common cause of constipation is an inadequate diet with inadequate fiber and fluid.
Constipation should not be viewed as an inconvenience. This problem entails disruption of the digestive system and the whole body. Chronic Constipation can cause a wide variety of illnesses and symptoms, ranging from general fatigue, high blood cholesterol to colon cancer.If food remains in the intestines for a long time, as occurs with insufficient intake of nutrient fibers and chronic constipation, pathogenic and carcinogenic processes develop. Long-term stay of food in the intestines leads to the assimilation of toxic substances contained in it (such as, for example, lead), which should not be absorbed by the digestive system. Different chemical compounds transform into toxic forms in different ways (for example, under the influence of bacteria in the digestive system).
Long-term drug treatment of constipation provides some relief. However, constipation is a symptom and treating the symptom does not solve the problem. Most constipation drugs lead to laxative dependence and to a decrease in the digestive system’s ability to empty the bowels normally.