The 10 Myths on Constipation

Felizardo N. Gatcheco, MD, MSc, FPPS, FPSPGHAN

• Pediatric Gastroenterologist & Clinical Epidemiologist
• Associate Professor & Attending Pediatric Gastroenterologist. Manila Central University College of MEdicine & Hospital Metro Manila, Philippines

Constipation, etiologically, may be: organic in nature (i.e. due to anatomical causes like Hirschsprung's disease, endocrine causes like hypothyrodism); or may be, to a larger extent functional in nature (there is no identifiable specific anatomical, biochemical or physiological abnormally identified).

The biggest challenge is in the management (prevention, diagnosis and treatment) of childhood constipation. The aims of treatment are to soften stool, promote gut mobility and address psycho-social factors.

Several guidelines have been published which can help healthcare professionals in the diagnosis and management of functional constipation.

Even with the publication of such guidelines, there are a lot of unproven management strategies, thus complicating and prolong the agony of the constipated child and even aggravating the worries and anxieties of parents or their caregivers.

This article can help debunk, and in the long run, finally eliminate these issues from the minds and behaviors of healthcare professionals and parents.

Here are the 10 most common myths on constipation 

1. Babies have to pass stools everyday.
Babies and even children may pass stools every other day or even 2-3 times a week. For as long as they are comfortable and thriving well and the stools are not hard, this can still be considered as normal and acceptable.

2. Plain film of the abdomen should be requested as part of the routine work-up of a constipated child.
The routine use of an abdominal radiograph to diagnose functional constipation is not indicated. However, it may be used in a child in whom fecal impaction is suspected and when physical examination is unreliable or not possible.

3. Increased water intake can help treat constipation.
Unfortunately, this practice has never been proven to be effective. Current guidelines recommend to just maintain normal water intake for age even among constipated children.

4. Constipation may be treated by increasing their fibre intake.
The age old advice, surprisingly, has not been validated yet to be effective. A normal intake of fiber for age is recommended.

5. As a treatment modality for a formula fed constipated infant, dilution of formula may be advisable.
This strategy has not been proven to be both safe and effective. It may jeopardize the nutritional intake of such infants.

6. Suppositories can be inserted regularly to induce defecation.
This may be dangerous and may cause dependence and can also be traumatic. It can help disimpact retained fecal materials but cannot be used on an everyday basis.

7. Regular use of laxatives (lactulose) can cause dependence and is therefore dangerous.
Lactulose - if given at the right dose and duration - is safe and effective. It can be given for long periods of time until such a time that constipation is resolved.

8. Probiotics can cure constipation.
Unfortunately, this issue has not been validated yet so this practice is not yet recommended. To date, the evidences are not solid yet to warrant its routine use, either as an adjunct or primary modality.

9. Constipation is dangerous because it can lead to either gut perforation or toxin absorption which can lead to death.
These "potential" consequences of constipation have never been proven to occur and may cause unnecessary fear, anxiety and mismanagement of the problem.

10. Toilet training as early as one year of age is recommended to prevent constipation.
Although toilet training is important in the prevention of functional constipation, doing it routinely for all children at one year of age may even be detrimental.

The start of toilet training is dictated upon by the developmental readiness of the child. It may occur roughly between the ages of 2-4 years old wherein the presence of several motor and behavioral parameters in the child may already be present
 

MESSAGE to HCPs

It is very important that we include demystification of the problem of constipation as part of the overall management strategies aside from the rational and correct diagnosis and treatment of the disorders.

Education and counseling are crucial and the health care professional should intelligently and scientifically address the sources of anxieties and confusion of the caregivers of the affected infant or child