Dr. Bhaisara Baraturam Bhagrati
Pediatrics
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My son has had chronic constipation issues and this past week he was at the ER three times, two enemas were given and eventually, they hospitalized him and they inserted an EG tube to flush out his bowels.
I am trying to figure out the time frame it takes for a 4-year-old to become that backed up. He came home Saturday night (had not had a bowel movement on that day nor he drank his normal amounts of fluids), the next day he had a huge piece of stool come out with blood upon wiping, immediately after he pooped his pants with stool that had much softer consistency (not diarrhea), then he passed another hard piece of stool at night.
Monday night he passed a larger piece of stool once more and blood was noticed upon wiping, Tuesday morning he passed another large piece of stool and the toilet filled with blood and I took him to ER. I have all the summaries from the visits and X-ray results. I am trying to figure out if constipation started prior to Sunday or if he got constipated from Sunday through Tuesday. I need an opinion on this matter as I am trying to figure out the behavioral aspect of his constipation.
He is currently taking three Ex-lax chews at 6 PM daily, and 85 mg Miralax in 20 ounces of fluids every Friday for one month.
Hello,
Welcome to icliniq.com.
I understand your concern.
After going through the X-ray report (attachment removed to protect patient identity), it shows on the 7th no gross constipation noted. On 8th and 10th X-ray constipation noted with colon filled with stool. But, the actual problem has started from 7th.
1. Stool formation for 4 years old child usually takes 24 to 48 hours depending upon diet pattern. If low fiber intake and low water intake is there, constipation can happen.
2. Constipation can also occur secondary to local bowel inflammation.
Patient's Query
Thank you doctor,
He came home from vacation with hard stools. How does he have a hard BM with blood, softer BM on Sunday, a hard BM on Monday with blood Tuesday with blood, yet the problem began the 7th? I would think he came home constipated to begin with and then the problem compiled from there.
Hello,
Welcome back to icliniq.com.
Yes, there is a high probability that the problem begins before 7th. As very early X-ray may not pick up early inflammatory changes. Once constipation sets in it become a vicious cycle and getting worse over a period of time without medical intervention.
In most cases, childhood constipation develops when the child begins to associate pain with defecation. Once pain is associated with the passage of bowel movements, the child begins to withhold stools in an attempt to avoid discomfort. As stool withholding continues, the rectum gradually accommodates, and the normal urge to defecate gradually disappears. The infrequent passage of very large and hard stools reinforces the child's association of pain with defecation, resulting in worsening stool retention and progressively more abnormal defecation dynamics with anal sphincter spasm.
I hope this helps.
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Pediatrics
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