Managing chronic constipation & IMPACTED STOOL IN INFANTs and young children in smaller settings

A normal stool in the infants and children is soft, easy to pass, and its colour may vary from green, yellowish to brown. The rectum is usually empty until it’s time for bowel movement. If the stool remains in large bowl for long it becomes hard due to absorption of water and results in hard stool and makes it difficult for these young children for bowel movement ending in constipation. Defecating less than three time a week, or a complaint of a painful bottom, a bloated tummy, passing large hard stools, excessive straining while pooing, loss of appetite, and irritability are some of the common signs of constipation. Faecal impaction is a condition when the constipation becomes so severe that children are unable to pass any formed stool. All the poo in their bottom clumps together to form a large mass, making it difficult to expel. Daily addition of poo in the large bowel, leads to the children passing of small bits of stools, and lots of gas with bad odour. Usually, a faecal impaction can be identified by palpating a hard mass of stool in left iliac fossa on physical examination or finding a large amount of stool in a dilated rectum on rectal examination or finding excessive stool in the colon on an abdominal radiograph. As there is no uniform definition of childhood constipation reported prevalence rates range between 1% and 30%. It is the principal complaint in 3-5% of all visits to outpatient clinics and as many as 35% of all visits to Paediatric gastroenterologists. It is important to differentiate these two conditions as the management changes. When there is an evidence of a faecal impaction, therapy should be directed at evacuating the colon. Apart from stool softeners and laxatives, digital evacuation comes to rescue in cases which do not respond to conservative management. This article is based on 2 cases managed by the author, one in January 2024, and another in 1990 both resolved by digital evacuation of impacted stool and dilatation of the anal sphincters apart from managing such 1-2 cases annually out of about 100 cases of chronic constipation each year. Materials and Methods: Details of 2 cases managed by the author, one in January 2024, and another in 1990 both resolved by digital evacuation of impacted stool and dilatation of the anal sphincters at home apart from managing such 1-2 cases annually in the clinics. Global Literature review on the subject and practices adds to the personal experience.