Emerging Concern: Childhood Constipation and the Impact of Modern Lifestyle.

By Dr. Natwar Parwal

Back in the old days, loose motions were much more prevalent in India compared to constipation, which was more common outside India. However, as time passed and Western culture took root, constipation has become increasingly prevalent among Indian children, especially in the past decade. Recent studies have revealed that out of all the patients seen by pediatricians and pediatric gastroenterologists, 2-3% and 20-25%, respectively, come in with complaints of constipation.

What is Constipation?

A child who is over one year old usually passes semi-solid or soft stool 1-2 times a day. In simple terms, constipation occurs when a child over one year old does not pass stool at least once a day, finds it difficult to pass stool, or has to exert excessive force. In severe cases, a child may go without passing stool for 5-6 days, or when they do, it may be in a lumpy or pellet-like form, sometimes requiring the use of an enema.

The Harmful Effects of Constipation

Due to constipation or hard stool, the rectum (the lowermost part of the intestine where stool collects or is stored) gradually increases in size, taking on a balloon-like shape. This leads to decreased movement of the intestine, or peristalsis. It takes over 4-6 weeks to 4-6 months for this distended rectum to return to its original size once treatment in the form of laxatives is started. Because of this, a child suffering from constipation may take a significant amount of time to recover.

Causes or Types of Constipation

There are two primary types of constipation:

1. Non-organic or Functional (90%): This type is primarily due to eating and lifestyle habits.
2. Organic (10%): This is caused by anatomical or pathological reasons, such as celiac disease, hypothyroidism, Hirschsprung’s disease, or other anatomical abnormalities.

Constipation is a Vicious Cycle

This means that constipation can lead to further constipation. It’s a cycle. A constipated child, experiencing pain while passing hard stool, may develop a habit of avoiding defecating. This, in turn, leads to the hardening of stool, potentially causing cuts or fissures in the anal passage. The resulting pain is severe and unbearable, intensifying the child’s aversion to passing stool and exacerbating the condition.

Why is Constipation Becoming More Common?

Several factors related to modern lifestyles contribute to the increasing incidence of childhood constipation:

1. Proliferation of Junk Food: Processed foods, such as noodles, burgers, pizzas, and other food items made from refined all-purpose flour, have become more common in children’s diets.
2. Inadequate Intake of Fiber: Crucial green vegetables like spinach, fenugreek, cabbage, radish, beans, and cucumber are increasingly being neglected.
3. Sedentary Lifestyle: Reduced outdoor activities, coupled with increased screen time and indoor entertainment, lead to less physical exercise and limited intestinal movement.
4. Changing Parenting Dynamics: With both parents working, daily routines are disrupted, influencing children’s bowel habits.

How to Avoid and Treat Constipation:

1. Incorporate a Variety of Vegetables and Fruits: Focus on including more green leafy vegetables like spinach, fenugreek, cabbage, coriander, carrot, radish, cucumber, pea, and onion in meals. Try different salads with lunch and dinner, and increase fruit consumption.
2. Limit White Flour Products: Avoid foods made from white refined flour (maida) like pasta, burgers, pizzas, chowmein, and pavbhaji if your child is experiencing constipation.
3. Balance Milk Intake: If your child consumes more milk and less solid grains or fiber, reduce the amount of milk and increase the intake of solids, fibers, and salads.
4. Reduce Rice Consumption: Avoid excessive consumption of rice and rice-based products.
5. Cut Down on Processed Sweets and Snacks: Minimize consumption of cold drinks, biscuits made from white flour, chocolate, and chocolate milk powder.
6. Opt for Coarse Wheat Flour: Use coarsely ground thick wheat flour to increase fiber intake.
7. Encourage Sprouted Seeds and Whole Fruits: Incorporate more sprouted seeds and include whole fruits in the diet.
8. Promote Physical Activity: Encourage outdoor activities and exercises. Parents should actively engage with their children in outdoor play and discourage excessive indoor activities.
9. Allow Time for Morning Routine: Ensure there is at least one hour between waking up and going to school so that your child has enough time for their morning routine. Allow your child 10-15 minutes on the toilet without rushing them.
10. Provide Motivation and Rewards: Motivate your child, provide positive reinforcement, and offer rewards to encourage them in their efforts.
11. Morning Walks and Hydration: Take your child for a morning walk with a water bottle. Walk for 1-2 kilometers daily and ensure your child drinks at least 1-2 glasses of water according to their age, right after waking up.
12. Increase Liquid Intake: Include more liquids like vegetable soup, fresh fruit juice, lemonade etc. in the diet.

If Your Child is Constipated, remember:

1. Severity Increases with Age: The older the constipation, the more serious it is, and the longer it will take to recover. Generally, it takes 2-6 months to relieve constipation.
2. Consistent Medication: A constipated child should take medication at the prescribed times and adjust the dosage based on stool patterns. They should not stop medication without prior consultation.
3. Stick with One Doctor: It’s important to maintain consistent communication with one doctor and follow their instructions.
4. Maintain a Stool Diary: Keep a stool chart or diary to help the doctor adjust the dosage during follow-up appointments and to track improvements. Here is an example of stool chart the staff at my clinic uses.

Addressing Fissures: If there are any fissures in the perianal area or anus, they should be treated concurrently to ensure the patient’s comfort.

It’s important to note that the treatment of constipation involves modifications in lifestyle, diet, exercise, toilet training, etc., and is always more important than medication.

About the Author:

Dr. Natwar Parwal
Fellowship-Pediatric Gastroenterology & Hepatologist
(Medanta The Medicity Gurgaon)
Consultant-Pediatric Gastroenterologist and Hepatologist
Surya Hospital, Jaipur
Mobile No. – 9610951425
Email Id:- dr.nats@yahoo.com