Constipation Management in Children and Adults

Constipation in Children (0-17 years) | Constipation in Adults (18+ years) | Laxative Comparison | References

Constipation in Children (0-17 years)

Definition: Constipation in children is characterised by infrequent or painful defecation, hard stools, or incomplete bowel evacuation. It is common and can range from acute to chronic.

Aetiology

• Dietary factors: Low fibre intake, inadequate fluid intake.
• Toilet training issues: Avoidance due to pain or fear.
• Medications: Iron supplements, certain antacids.
• Underlying medical conditions: Hypothyroidism, Hirschsprung's disease.
• Psychological factors: Stress, anxiety, or changes in routine.

Signs and Symptoms

• Less than three bowel movements a week.
• Hard, dry, or painful stools.
• Abdominal pain, bloating.
• Stool withholding behaviours in young children.
• In severe cases, soiling (overflow incontinence).

Investigations

• History and Physical Examination: Assess for abdominal distension, masses, or palpable stool.
• Abdominal X-ray: Sometimes used to assess faecal loading, though not routinely required.
• Blood tests: If secondary causes are suspected (e.g., hypothyroidism, hypercalcaemia).

Management

First-line treatment for children includes lifestyle changes and appropriate laxative use based on age:

• Children under 1 year: Osmotic laxatives such as Lactulose (2.5-5 mL twice daily).
• Children aged 1-4 years: Macrogol 3350 (Movicol Paediatric) ½-1 sachet daily, titrated as needed. Lactulose (5 mL twice daily) as an alternative.
• Children aged 5-12 years: Macrogol 3350 (1-2 sachets daily). Add Senna (5-10 mL at night) or Bisacodyl if needed.
• Children aged 12-17 years: Macrogol 3350 (1-3 sachets daily) with Senna or Bisacodyl for stimulant effect if necessary.

When to Refer

Refer to a paediatric specialist if symptoms persist despite treatment or if there is a suspicion of underlying conditions (e.g., Hirschsprung's disease).

Constipation in Adults (18+ years)

Definition: Constipation in adults is defined as infrequent bowel movements, typically fewer than three per week, with hard or lumpy stools, straining, or a sense of incomplete evacuation.

Aetiology

• Dietary factors: Low fibre intake, dehydration.
• Medications: Opioids, iron supplements, calcium channel blockers.
• Medical conditions: Hypothyroidism, diabetes, IBS, neurological conditions.
• Sedentary lifestyle.

Signs and Symptoms

• Fewer than three bowel movements per week.
• Straining during bowel movements.
• Hard, dry stools.
• Abdominal discomfort or bloating.

Investigations

• History and Physical Examination: Assess diet, fluid intake, and activity level. Physical exam to assess abdominal masses.
• Colonoscopy: If there are alarm symptoms such as rectal bleeding or weight loss, to rule out malignancy.
• Blood tests: Check thyroid function, calcium levels, and blood sugar to rule out secondary causes.

Management

Initial treatment includes lifestyle changes (increasing fibre, fluid intake, and exercise) and appropriate laxatives:

• Osmotic laxatives: Macrogol 3350 (1-3 sachets daily) or Lactulose (15 mL twice daily).
• Bulk-forming laxatives: Ispaghula husk (Fybogel) 1 sachet twice daily.
• Stimulant laxatives: Senna (7.5 mg tablets at night) or Bisacodyl (5-10 mg at night).

Refer to a specialist if constipation persists despite treatment or if red flags are present (e.g., rectal bleeding, unexplained weight loss).

Laxative Comparison: Children vs Adults

Age Group	Osmotic Laxatives	Bulk-forming Laxatives	Stimulant Laxatives	Special Considerations
Children (0-17)	Macrogol, Lactulose	Not recommended for young children	Senna, Bisacodyl (depending on age)	Adjust doses based on age and weight.
Adults (18+)	Macrogol, Lactulose	Ispaghula husk	Senna, Bisacodyl	Ensure adequate fluid and fibre intake.
Pregnancy/BF	Macrogol, Lactulose	Ispaghula husk	Senna (consult a healthcare provider)	Non-drug methods preferred.
Opioid-induced	Macrogol, lactulose	Use bulk-forming laxatives cautiously	Stimulant laxatives may be required	Specialist advice for opioid cases.

References

1. NICE (2024). Constipation in Children and Young People. Available at: NICE Guidance NG56
2. NHS (2023). Constipation in Adults: Causes and Treatment. Available at: NHS Website
3. British National Formulary (2024). Laxative Use in Adults and Children. Available at: BNF