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It is only for medical professionals to read.
Can Kaiserlu be used casually? Constipation not only troubles adults, but is also one of the common digestive problems in children
.
Recently, the Annual Meeting of Pediatrics of the Chinese Medical Association was held in Wuhan
.
At the meeting, Professor Wang Baoxi from Tangdu Hospital of the Air Force Military Medical University shared the topic of "long-term management of functional constipation in children"
.
Let's learn together! What is functional constipation? The definition of constipation includes decreased frequency of bowel movements, dry and hard stools, difficulty in defecation (difficulty defecation, difficulty in defecation, painful defecation, etc.
), fecal overflow or fecal incontinence when stool is incarcerated
.
Functional constipation (FC) refers to the exclusion of intestinal or systemic organic diseases and constipation caused by drug-related factors, accounting for about 90% to 95% of constipation in children
.
Chronic constipation occurs when the course of the disease exceeds 6 months
.
In a 2018 systematic review and Meta analysis report, the prevalence of FC in children ranged from 0.
5% to 32.
2%, and the global prevalence of FC in children was 9.
5%
.
FC significantly affects the quality of life of children
.
How to diagnose FC? FC Rome IV diagnostic criteria (0 to 4 years old) requires at least the following 2 conditions and lasts for 1 month: defecation ≤ 2 times a week; a history of large amounts of fecal retention; a history of pain or difficulty in defecation; a history of large stools History; there is a huge fecal mass in the rectum; for children who can control defecation, the following 2 conditions are also included: at least one fecal incontinence per week; history of thick feces blocking the toilet
.
If children have constipation, they will have the following signs: Table 1 Potential warning signs of constipation in children Anal function tests have a direct guiding role in the classification of constipation, including: colonic transit time; X-ray dynamic defecation imaging; balloon expulsion test; rectal anus Tube vector manometry; anorectal sensory examination; anal sphincter electromyography
.
How to manage children's FC for a long time? The long-term management principles of children's FC include four points: attach importance to health education; follow scientific drug treatment; cultivate good bowel habits; adhere to good eating habits
.
Among them, drug treatment (Table 2) includes two aspects of fecal impaction removal and maintenance treatment, which is a long-term process
.
Table 2 Common treatment drugs for children with FC can be used to relieve fecal impaction by oral high-dose polyethylene glycol (PEG) or rectal enema.
There is no difference in effectiveness between the two methods
.
Because the enema is an invasive operation and the children have poor acceptance, the first choice is to recommend oral administration of PEG
.
It should be noted that oral high-dose PEG will increase the risk of fecal incontinence
.
After the fecal impaction is lifted, FC treatment drugs need to be maintained for a period of time to help soften the stool and maintain a comfortable bowel movement, generally lasting 1 to 2 months
.
FC drug reduction should have a gradual decrease process to avoid recurrence or recurrence
.
1PEG is not absorbed by the intestinal tract.
It has water binding capacity and can soften stools
.
Commonly used types are PEG3350 (with electrolyte) and PEG4000 (for children over 2 years old)
.
The usual maintenance dose is 0.
3~0.
8 g/(kg·d), and the dosage to relieve fecal incarceration is slightly larger, which is 1~1.
5 g/(kg·d), and the continuous use does not exceed 7 days
.
2 Lactulose has the characteristics of high permeability, forms a hypertonic state in the colon, softens stool, and can also promote the proliferation of bifidobacteria and lactobacilli
.
The usual dose is 1 to 3 ml/kg, 1 to 2 times a day
.
Lactulose is suitable for children of all ages.
When PEG is not available clinically, it can be used as the drug of choice
.
3 The evidence for the application of probiotics to FC needs to be expanded, and a single strain or a combination of strains cannot be recommended at present
.
Probiotics may increase the frequency of bowel movements in children, but larger randomized trial (RCT) evidence is needed
.
However, clinically, significant differences in intestinal flora between constipation patients and healthy people have been observed
.
The effect of probiotics on constipation may lie in increasing the frequency of stool, improving stool characteristics and alleviating the symptoms of FC
.
4 Fecal bacteria transplantation (FMT) is a special mode of probiotics used to treat FC
.
Intestinal flora and its metabolites can affect intestinal transmission, and the reconstitution of intestinal flora in constipation patients through FMT can improve the clinical phenotype
.
Improving the intestinal microenvironment may be one of the new strategies for the treatment of chronic constipation
.
5 Gastrointestinal motility drugs include dopamine antagonists, serotonin agonists and motilin receptor agonists
.
Such drugs are only effective for slow colonic transit, and the safety, effectiveness, indications and adverse reactions of children's medications all need further research and verification
.
The application of gastrointestinal motility drugs in the field of children is greatly restricted
.
For the drug treatment of children with constipation, it is necessary to choose the type of drug according to the specific situation, generally volumetric laxative and osmotic laxative are the main ones
.
Carefully use laxatives with strong irritation and adverse reactions, because constipation is a chronic disease and treatment takes a long time, and long-term use of some drugs can cause intestinal motility and intestinal sensory disorders
.
The drug treatment of constipation is generally divided into 3 stages: to clear the retained stool in the intestine, the dose of the drug is gradually increased, so that the retained stool in the intestine is completely emptied; maintenance treatment, gradually reduce the drug dose, maintain defecation, and prevent the recurrence of stool retention in the intestine; stop; Observation of drugs, children with repeated illnesses should take the drugs again
.
Cultivating good bowel habits Good bowel habits are an important factor for the consolidation and maintenance of FC treatment effects.
Different methods should be adopted for different age groups to supervise the development of bowel habits
.
Pre-school children should receive health education to understand the impact of deliberate tolerance of bowel movements on their health and urge them to defecate daily
.
Defecation habit training (DHP) helps preschool and young children to develop defecation habits
.
DHP is a regular intensive training for children to form a bowel habit.
It is an important basic treatment for constipation
.
Infant defecation is reflex defecation.
DHP in early childhood can quickly enter into conscious defecation, so that children can develop the habit of defecation on time
.
DHP precautions: for gradual training, gradually training according to children's interests and abilities, generally starting after 24 months (must be determined according to the children's own abilities); prepare the toilet and place it in an easy-to-use position, the height of the toilet should be at the knees Higher than the buttocks, the feet can touch the ground in order to exert force; instruct children to learn how to force defecation (Valsalva technique), and learn to coordinate the movement of the internal and external sphincter muscles in the anus; according to the gastro-colon reflex, it is generally scheduled for 30 to 60 minutes after a meal, 5 each time ~10 minutes is appropriate to avoid prolonged squatting; the DHP process may fail, and retreat may occur, such as forcing the stool to be puzzled, which is normal
.
Parents should understand and give psychological support, without anxiety or pressure on children
.
Adhere to good eating habits Good eating habits also have an effect on FC treatment, including intake of appropriate food, appropriate dietary fiber, appropriate water intake, and reasonable dietary structure
.
The NICE guidelines point out that there is no evidence that increasing fiber-rich foods is effective in treating or controlling constipation, and adding too much dietary fiber to a healthy diet may be harmful, causing gastrointestinal discomfort and affecting the absorption of minerals, especially calcium
.
Hold the same view on water intake, only need to take in daily water needs, too much water intake will not improve stool characteristics
.
Finally, Professor Wang Baoxi gave the management process for children with constipation and no response to the ejaculation (Figure 1, 2)
.
Figure 1 The management process of children with constipation Figure 2 The management process of children with chronic constipation who do not respond to ejaculation
Can Kaiserlu be used casually? Constipation not only troubles adults, but is also one of the common digestive problems in children
.
Recently, the Annual Meeting of Pediatrics of the Chinese Medical Association was held in Wuhan
.
At the meeting, Professor Wang Baoxi from Tangdu Hospital of the Air Force Military Medical University shared the topic of "long-term management of functional constipation in children"
.
Let's learn together! What is functional constipation? The definition of constipation includes decreased frequency of bowel movements, dry and hard stools, difficulty in defecation (difficulty defecation, difficulty in defecation, painful defecation, etc.
), fecal overflow or fecal incontinence when stool is incarcerated
.
Functional constipation (FC) refers to the exclusion of intestinal or systemic organic diseases and constipation caused by drug-related factors, accounting for about 90% to 95% of constipation in children
.
Chronic constipation occurs when the course of the disease exceeds 6 months
.
In a 2018 systematic review and Meta analysis report, the prevalence of FC in children ranged from 0.
5% to 32.
2%, and the global prevalence of FC in children was 9.
5%
.
FC significantly affects the quality of life of children
.
How to diagnose FC? FC Rome IV diagnostic criteria (0 to 4 years old) requires at least the following 2 conditions and lasts for 1 month: defecation ≤ 2 times a week; a history of large amounts of fecal retention; a history of pain or difficulty in defecation; a history of large stools History; there is a huge fecal mass in the rectum; for children who can control defecation, the following 2 conditions are also included: at least one fecal incontinence per week; history of thick feces blocking the toilet
.
If children have constipation, they will have the following signs: Table 1 Potential warning signs of constipation in children Anal function tests have a direct guiding role in the classification of constipation, including: colonic transit time; X-ray dynamic defecation imaging; balloon expulsion test; rectal anus Tube vector manometry; anorectal sensory examination; anal sphincter electromyography
.
How to manage children's FC for a long time? The long-term management principles of children's FC include four points: attach importance to health education; follow scientific drug treatment; cultivate good bowel habits; adhere to good eating habits
.
Among them, drug treatment (Table 2) includes two aspects of fecal impaction removal and maintenance treatment, which is a long-term process
.
Table 2 Common treatment drugs for children with FC can be used to relieve fecal impaction by oral high-dose polyethylene glycol (PEG) or rectal enema.
There is no difference in effectiveness between the two methods
.
Because the enema is an invasive operation and the children have poor acceptance, the first choice is to recommend oral administration of PEG
.
It should be noted that oral high-dose PEG will increase the risk of fecal incontinence
.
After the fecal impaction is lifted, FC treatment drugs need to be maintained for a period of time to help soften the stool and maintain a comfortable bowel movement, generally lasting 1 to 2 months
.
FC drug reduction should have a gradual decrease process to avoid recurrence or recurrence
.
1PEG is not absorbed by the intestinal tract.
It has water binding capacity and can soften stools
.
Commonly used types are PEG3350 (with electrolyte) and PEG4000 (for children over 2 years old)
.
The usual maintenance dose is 0.
3~0.
8 g/(kg·d), and the dosage to relieve fecal incarceration is slightly larger, which is 1~1.
5 g/(kg·d), and the continuous use does not exceed 7 days
.
2 Lactulose has the characteristics of high permeability, forms a hypertonic state in the colon, softens stool, and can also promote the proliferation of bifidobacteria and lactobacilli
.
The usual dose is 1 to 3 ml/kg, 1 to 2 times a day
.
Lactulose is suitable for children of all ages.
When PEG is not available clinically, it can be used as the drug of choice
.
3 The evidence for the application of probiotics to FC needs to be expanded, and a single strain or a combination of strains cannot be recommended at present
.
Probiotics may increase the frequency of bowel movements in children, but larger randomized trial (RCT) evidence is needed
.
However, clinically, significant differences in intestinal flora between constipation patients and healthy people have been observed
.
The effect of probiotics on constipation may lie in increasing the frequency of stool, improving stool characteristics and alleviating the symptoms of FC
.
4 Fecal bacteria transplantation (FMT) is a special mode of probiotics used to treat FC
.
Intestinal flora and its metabolites can affect intestinal transmission, and the reconstitution of intestinal flora in constipation patients through FMT can improve the clinical phenotype
.
Improving the intestinal microenvironment may be one of the new strategies for the treatment of chronic constipation
.
5 Gastrointestinal motility drugs include dopamine antagonists, serotonin agonists and motilin receptor agonists
.
Such drugs are only effective for slow colonic transit, and the safety, effectiveness, indications and adverse reactions of children's medications all need further research and verification
.
The application of gastrointestinal motility drugs in the field of children is greatly restricted
.
For the drug treatment of children with constipation, it is necessary to choose the type of drug according to the specific situation, generally volumetric laxative and osmotic laxative are the main ones
.
Carefully use laxatives with strong irritation and adverse reactions, because constipation is a chronic disease and treatment takes a long time, and long-term use of some drugs can cause intestinal motility and intestinal sensory disorders
.
The drug treatment of constipation is generally divided into 3 stages: to clear the retained stool in the intestine, the dose of the drug is gradually increased, so that the retained stool in the intestine is completely emptied; maintenance treatment, gradually reduce the drug dose, maintain defecation, and prevent the recurrence of stool retention in the intestine; stop; Observation of drugs, children with repeated illnesses should take the drugs again
.
Cultivating good bowel habits Good bowel habits are an important factor for the consolidation and maintenance of FC treatment effects.
Different methods should be adopted for different age groups to supervise the development of bowel habits
.
Pre-school children should receive health education to understand the impact of deliberate tolerance of bowel movements on their health and urge them to defecate daily
.
Defecation habit training (DHP) helps preschool and young children to develop defecation habits
.
DHP is a regular intensive training for children to form a bowel habit.
It is an important basic treatment for constipation
.
Infant defecation is reflex defecation.
DHP in early childhood can quickly enter into conscious defecation, so that children can develop the habit of defecation on time
.
DHP precautions: for gradual training, gradually training according to children's interests and abilities, generally starting after 24 months (must be determined according to the children's own abilities); prepare the toilet and place it in an easy-to-use position, the height of the toilet should be at the knees Higher than the buttocks, the feet can touch the ground in order to exert force; instruct children to learn how to force defecation (Valsalva technique), and learn to coordinate the movement of the internal and external sphincter muscles in the anus; according to the gastro-colon reflex, it is generally scheduled for 30 to 60 minutes after a meal, 5 each time ~10 minutes is appropriate to avoid prolonged squatting; the DHP process may fail, and retreat may occur, such as forcing the stool to be puzzled, which is normal
.
Parents should understand and give psychological support, without anxiety or pressure on children
.
Adhere to good eating habits Good eating habits also have an effect on FC treatment, including intake of appropriate food, appropriate dietary fiber, appropriate water intake, and reasonable dietary structure
.
The NICE guidelines point out that there is no evidence that increasing fiber-rich foods is effective in treating or controlling constipation, and adding too much dietary fiber to a healthy diet may be harmful, causing gastrointestinal discomfort and affecting the absorption of minerals, especially calcium
.
Hold the same view on water intake, only need to take in daily water needs, too much water intake will not improve stool characteristics
.
Finally, Professor Wang Baoxi gave the management process for children with constipation and no response to the ejaculation (Figure 1, 2)
.
Figure 1 The management process of children with constipation Figure 2 The management process of children with chronic constipation who do not respond to ejaculation
