- Parent counselling – Explain about the treatment plan and importance of adherence of therapy.
- Diet – Encourage diet rich in fibres with plenty of water & reduce milk intake.
- Toilet training – must sit on toilet seat for 3-5 minutes after every major meal.
- Pharmacotherapy : Aim at Disimpaction of stools loaded in rectum & Regular emptying of Rectum to avoid repeated rectal impaction
Dis-impaction: 50 – 70% of children with functional constipation have impacted stool at presentation. Impacted stool is diagnosed by digital rectal examination (hard stool in rectum) or palpable fecolith on abdominal examination. Dis-impaction is must in all patient with impacted stool for good outcome. It is done with Polyethylene glycol (PEG) .
Hospital based dis-impaction with PEG solution(made with 137.15 gm in 2 litres water) in dose of 25 mL/ kg/ h oral or by nasogastric tube if patient not able to take orally.
Home based dis-impactioncan be done in older child with PEG in a dose of 1.5-2 gm/ kg/ d in two divided doses for 3-6 days.
After dis-impaction child should be put on maintenance therapy, which should be continued for at least 3 to 6 months.
Lactulose(1-2 ml/kg/day of 20%) is the drug of choice in children less than 1 year and PEG(dose 0.8 to 1 gm/kg/day),in more than 1 year of age is the drug of choice for maintenance therapy.
Post drafted on inputs from Dr Mridul Das, Ex-Pediatric Gastroenterologist at BLK Centre for Child Health