Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be

talking to you about constipation in children. If you want to follow along with written notes on this

topic, you can follow along at zero definals.com slash constipation or in the gastroenterology section

of the Zero Definals Pediatrics book. So let's get straight into it.

Constipation is a very common problem in pediatrics. Most cases of constipation can be described as

idiopathic constipation or functional constipation, meaning there's not a significant underlying cause other than lifestyle factors.

It's important to think about possible secondary causes of constipation such as

Hirshsprings disease, cystic fibrosis or hypothyroidism whenever you see a new child with constipation.

Let's talk about the presentation.

How often somebody opens their bowels varies between individuals.

This is even more variable in breastfed babies, which can have as little as one stool

per week.

Someone opening their bowels daily may be constipated, whereas someone else, opening their bowel once or twice a week,

may not if that's normal for them.

Typical features in the history and examination that would suggest constipation are less than

three stalls a week, hard stools that are difficult to pass, rabbit dropping stools, straining or painful passage of

stalls, abdominal pain, holding an abnormal posture, which is referred to as retentive posturing,

rectal bleeding associated with hard stalls, fecal impaction which causes overflow soiling,

with incontinence of particularly loose smelly stools,

hard stools that may be palpable in the abdomen, and a loss of sensation of needing to open the boughs.

Encoparesis is the term used for fecal incontinence. And this is not considered pathological until four years of age.

It's usually a sign of chronic constipation where the rectum has become stretched and loses sensation.

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