Constipation

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
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