FUNCTIONAL CONSTIPATION AND SOILING
Constipation is decreased frequency of bowel movements, usually associated with a hard stool consistency. The occurrence of pain at defecation frequently accompanies constipation. Functional constipation implies that there is no identifiable causative organic condition.
Encopresis is the regular, voluntary, or involuntary passage of feces into a place other than the toilet after 4 years of age.
Soiling is the involuntary passage of stool and often is associated with fecal impaction. The normal frequency of bowel movements declines between birth and 4 years of age, beginning with greater than four stools per day to approximately one per day.
Slow gastrointestinal transit time for neurologic
Withholding stool due to fear of using the toilet (especially when away from home) or because stools are painful
Not wanting to interrupt play or other activities
Not drinking enough fluids
Drinking too much cow’s milk or an intolerance to cow’s milk
Premature, difficult or conflict-filled toilet training
Changes in the child’s life, such as dietary changes, toilet training, starting school or schedule changes
Emotional stressors, for example, the divorce of a parent or the birth of a sibling
Using medications that may cause constipation, such as cough suppressants
Attention-deficit/hyperactivity disorder (ADHD)
Autism spectrum disorder
Anxiety or depression
Tiny tears in the skin around the anus (anal fissure)
Leakage of stool or liquid stool on underwear, which can be mistaken for diarrhea
Constipation with dry, hard stool
Passing fewer than three stools a week
Having lumpy or hard stools
Straining to have bowel movements
Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum
Passage of large stool that clogs or almost clogs the toilet
Avoidance of bowel movements
Long periods of time between bowel movements
Lack of appetite
Problems with daytime wetting or bedwetting (enuresis)
Repeated bladder infections, typically in girls
Hemorrhoids- Straining to have a bowel movement may cause swelling in the veins in and around your anus.
Anal fissure- Hard stool can cause tiny tears in the anus.
Fecal impaction- Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
High-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and green leaf, nuts, millets.
Eat fewer foods with low amounts of fiber such as processed foods, and dairy and meat products.
Drink plenty of fluids.
Try to manage stress.
Don’t ignore the urge to pass stool.
Avoid junk food ,cakes, confectionery .
Avoid starting too early or being too forceful in your methods of toilet training. Wait until your child is ready, and then use positive reinforcement and encouragement to help make progress.
Behavioral training involves establishing a positive routine of sitting on toilet for passing stools after meals regularly (2-3 times per day for 5-10 min) and documenting all stool passage. Embarrassment or punishment should be avoided.