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The effective treatment of childhood constipation according to NICE guidelines.



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Hello, I'm here to talk to you about the treatment of childhood constipation.

If this problem is not treated appropriately outcomes can be poor and

this can have an impact on the lives of children and young people for years to come.

This presentation is based on NICE

guidelines which we know are often not implemented in practice. I'll run through

them now. First-line treatment at presentation is a Macrogol solution

this will soften the stool by ensuring fluid is retained in the colon which is

then absorbed by the stool. 1 to 2 sachets should be an adequate maintenance dose,

the effectiveness of the Macrogol treatment should be reviewed after 6 weeks.

If at presentation the history is prolonged, there is soiling and an

abdominal examination reveals a palpable mass then disimpaction is recommended

this involves taking increasing doses of a peadiatric Macrogol solution to a

maximum daily dose of 8 sachets for children aged 5 and under and 12 sachets

for children over 5 years. This equates to a daily total of 500 ml and

750 ml respectively when correctly reconstituted according to

manufacturer's instructions. This should be divided between three or four drinks

throughout the day. It's worth mentioning here that the soiling may get worse

before it gets better but it's important that the disimpaction regime is not

stopped until the stool is watery without any hard lumps like brown and

inoffensive. The stool should remain in this state for 48 hours before the dose

of paediatric Macrogol solution is reduced to a maintenance dose of 2

sachets. There is no need to reduce the dose gradually but the child should be

reviewed on completion of the disimpaction regime to ensure that the

process is complete.

Following disimpaction, due to physical changes to the rectum that occurs in

long-term constipation most children will need both daily paediatric Macrogol

solution to soften the stool and a stimulant medication such as Senna or

Sodium Picosulphate to encourage full emptying of the bowel. For the child who

does not require disimpaction it may still be necessary to introduce a

stimulant medication in addition to paediatric Macrogol solution if this

alone does not result in a bowel motion more than four times a week after six

weeks of treatment. Rectal preparations should not be used as first-line

treatment and ideally their use in children should be avoided outside of

the hospital setting. The child should also be encouraged to sit on the toilet

after meals to promote a regular bowel habit and of course a healthy diet and

adequate clear fluid intake should also be promoted. If there is poor progress

with this plan after three months it is recommended that children are referred

to a specialist service for management of their constipation.