Professional Documents
Culture Documents
• Haustral contractions
– Slow segmenting movements that
move the contents of the colon
– Haustra sequentially contract as
they are stimulated by distension
• Presence of food in the stomach:
– Activates the gastrocolic reflex
– Initiates peristalsis that forces
contents toward the rectum
• Last portion of the digestive tract
• Anatomic anomalies
• Functional anomalies
• Medical causes
ANATOMIC ABNORMALITIES
Neurologic malformations
Spina bifida – meningomyeloceles
Trauma to spinal cord
Cerebral palsy
Obstructive malformations
Hirschsprung’s disease
• Hypothyroidism
• Lead poisoning
• Functional fecal retention is the
most common explanation for
childhood constipation.
• “control” issue with unsuccessful toilet training
• the logical response to painful stools (anal
inflammation from fissures, perianal
streptococcal infection, perianal abscess)
• threatening event such as a television show,
birth of a sibling
• desire to avoid defecation in a strange toilet
when away from home.
• Some toddlers and older children are too
distracted to evacuate (mainly ADHD).
PATHOPHYSIOLOGY
Child voluntarily constricts anal sphincters and does
not evacuate his bowel
↓
Rectal ampulla stretches and accommodates
increasing amount of stool
↓
Water is mainly absorbed and stool becomes harder
↓
With passage of time rectal ampulla overstretches
↓
Overstretching reduces the urge to daefecate
↓
Stool is pushed into the anal canal also and starts
collecting there leading to soiling
• Enormous stools to the point of being “toilet-plugging-specials”
• Significant pain and a prepassage ritual of gluteal tightening and
posturing
• Early satiety, small meals all day, irritability, and unpredictable
spasms of abdominal pain usually located in the lower abdomen.
• Encopresis becomes increasingly frequent.
• Painless rectal bleeding after defecation.
• After the passage, symptoms generally resolve for a few days,
then recur.
• A rectal examination confirms
normal anal tone with a massive
rectal ampulla filled with formed
stool.
• prior surgery
• Thyroid functions
• Serum calcium, electrolyte levels,
magnesium and urea nitrogen.
• Urinalysis and urine culture
• The plain abdominal radiograph may
be of value in the child in whom an
abdominal examination is difficult or to
monitor compliance.
• Lumbosacral spine radiographs or
magnetic resonance imaging if
indicated.
• Unprepared barium enema for the
transition zone or strictures from
necrotizing enterocolitis.