Constipasi (Nutrisia) by Dr Badriul Hegar

7/30/2019 Constipasi (Nutrisia) by Dr Badriul Hegar

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DEFECATION PATTERN

IN CHILDHOOD


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A normal recto-anal inhibitory reflexes only in newborn after 26weeks of gestation

Voluntary bowel control is achieved around 18 months of age

The age at which complete control is attained is very variable

Many cultures have different age limits

North America and Europe: age of 2-3 years

Indonesia ?

Below the age of six, the child become fully responsible fordefecating in the accepted place

Volun tary bowel con tro l


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Breast fed infants had more bowel movement with

a greater range in number,butby 16 weeks

(introduce solid food), no difference in stool freq.

The increase in frequency of stool is related to the

volume of milk ingested

Unfed infants had a defecation rate of 1 stool per day. For each 50 ml/kg increase in volume milk showed the

further increase of 1 stool passed per day

Stool frequency ~ m ilk intake


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Stoo l frequency ~ age

A decline in the frequency of defecation withage

During the 1st week of life: 1-9 stools/day

2nd 20th week of life: 1-7 stools/day

60-80% of 1-4 years children: 1 or 2 stools.day

Only 30% of the children opened their bowels

less than 1 a day

Weaver LT et al, Arch Dis Child 1994;59

Fontana M et al, Act Pediattr Scand 1989


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Countries Bowel movement

USA

FranceEngland

Thailand

1 day 1.5 x/day

5 day 4.4 x/day0-3 months 2.0-2.9 x/day

6-12 month 1.8 x/day

1-3 years 1-2 x/day

Neonatal 3.3 x/day

4-6 years 1 x/day

Stool frequency

Baker SS, 1999; Osatakul,1995


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Frequency of defecat ion

infants 0-4 mon ths of age

0

1

2

3

4

5

mo 1 mo 2 mo 3 mo 4

Edi S, Hegar B, Firmansyah A, 2003


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Consis tency of stoo l

Normal value for weight of stool output vary widely

as consequence of dietary difference,

variation occurs even within individual subjects on a fixed

caloric and fibre intake

The inverse relation between stool weight and transit

time

Diet high in fibre produced large stools more oftencompare to those on a low-fibre diet who passed small

stools less frequently

Reynold JC et al, 1987

Tucker DM et al, Gastroenterology 1991


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0

10

20

30

40

50

60

70

80

90

100

0-4 day 5-14 day 15-113 114-120

soft

watery

Fecal consistency




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0

10

20

30

40

50

60

70

80

90

100

day 1 day 2 day 3 day 4 day 5-14 day15-10

Black

yelow

green

Colou r of the fecal




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CONSTIPATION

ENCOPRESIS


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Const ipat ion

Children < 4 years

< 3 bowel movement per week or

painful bowel movement or

rectal impaction or

abdominal fecal mass on physical examination or

all four

Loening-Beucke V, Constipation in early childhood, Gut 1993;34:1400-4


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Const ipat ion

Children > 5 years (at least 2 of the following criteria)

Two or fewer bowel movement per week without laxatives

Two or more soiling/encopresis episodes per week

Periodic passage of very large amount of stools once every

7-30 days

a palpable abdominal or rectal mass on physical examination

Benninga MA, Thesis 1994


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Const ipat ion in

infants and preschool ch i ldren

5-10% (16% < 24 months) children had constipation

Constipation and subsequent fecal retention often beginsoon after a child has experienced a painful evacuation

Chronic constipation most often follows an inadequatelymanaged acute problem

Infants: tend to extend the body, contract the anal and

gluteal muscles

Toddlers : rise on their toe, hold their legs and buttocksstiffly

Youssef Nader N, J of Clinical Gastroenterology 2001;33:199-205

Rudolph CD, 1998


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Cons t ipat ion in school age ch i ldren

The child is brought to medical attention because of

encopresis (often of many years duration) or abdominal

pain

Encopresis

2.8% in the age of 4 year

2.2% in the age of 5-6 years

1.5-19% in the age of 6-11 years

15% in obese ch i ldren

Fishman L et al, J Pediatr 2004;145;253-4

Loening-Beucke V, Pediatric Clinnic of North America 1996;43:279-82


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0

5

10

15

20

25

30

Jan March May Jul Sept Nov total

Cons t ipat ion in chi ldren

Divis i o f Gastro enterolog y IKA-RSCM 2003


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Encopresis

The voluntary or involuntary passage ofa normal bowel movement

- in the underwear (or other unorthodox locations)

- after the age of four

- occurring on a regular basis without any organiccause

Retentive encopresis

Fecal incontinence in children with clear evidenceof constipation



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Encopresis

Parents often assume that encopresis is caused bythe reluctance of the child to use the toilet

The frequency: once or many times a day orintermittent

A periode free of soiling after a large bowel movement

Soiling resumes after several days of stool retention

Encopresis is a complication of long standingconstipation



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Defecation pattern in children is a wide range and

individual variation

Constipation is common in children and it is estimated

5-16% of pediatric patients have constipation and/or

encopresis

Conclus ion


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THANK YOU

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Constipasi (Nutrisia) by Dr Badriul Hegar