Constipation develops as a consequence of diseases of the digestive tract, becomes a chronic condition. The condition is uncomfortable and can lead to serious complications. Constipation from vitamins, medicines is a hidden cause that patients do not suspect.

The balance of biologically active substances provides vigorous health and strong immunity. But uncontrolled intake of various dietary supplements and medications in violation of the dosage leads to stool retention. It could be side effect- an individual reaction of the body.

Minerals and vitamins are responsible for:

• assimilation of carbohydrates and fats;
• protein synthesis;
• participate in chemical reactions.

Deficiency of certain substances provokes disturbances in the body: rickets, muscle atrophy, osteoporosis, decreased visual acuity, etc. It is difficult to get components from food and you have to take additional complexes. With excessive use of fat-soluble E, A, D, the work of the gastrointestinal tract and a number of important organs is disrupted.

It is dangerous to take incompatible vitamins and minerals at the same time! Possible unexpected reactions!

What vitamins cause constipation

Difficulty with defecation occurs in pregnant women. It is difficult for the body to get rid of toxins, emptying is difficult with long periods. Some observing obstetricians-gynecologists believe that for the full development of the fetus, a woman must maintain the balance of nutrients in the body and prescribe vitamin and mineral supplements. Popular are Elevit, Vitrum Prenatal, Femibion, Multi-Tabs, Alphabet, Pregnavit.

The vitamin set in the complexes is not always properly absorbed and processed by organisms. As a result, constipation and pregnancy are inseparable concepts. The kid needs nutrients, but in the right dosage.

Folic acid - prevents the development of defects during intrauterine development. It is recommended to take with an iron supplement, which increases the need for a pregnant body.

Vitamins of group B are a companion of women. Combines with magnesium. The combination relaxes smooth muscles, prevents premature birth, relieves convulsive muscle contractions, and improves the process of hematopoiesis.

To prevent constipation, the tablet is taken at bedtime or with food. For better assimilation, a large volume of pure water is used. Juices and teas are not combined with vitamins, completely neutralize the action and beneficial properties.

In what cases is there a violation of the gastrointestinal tract

There are many medicinal and vitamin preparations, prescribed by doctors to eliminate one or another violation in the work of vital organs and systems. But often, against the background of therapy, an unpleasant side effect develops - disturbed stools. The following three drugs are most commonly reported.

When taking magnesium

Magnesium is a mineral that has an impact on physical development and health. Responsible for maintaining blood pressure, blood sugar levels, proper functioning of the heart muscle and the defenses of the immune system.

Magnesium has a direct effect on muscles and on the digestive tract, where everything is made up of muscle fibers. Mineral and constipation are closely related. If its deficiency is observed, the feces become viscous, peristalsis worsens.

A magnesium preparation is able to get rid of the problem. Its effectiveness is due to its property of attracting water to the intestines. As a result, muscle contraction increases and feces move to the exit.

The laxative effect occurs as a result of a combination of two factors:

• an increase in the amount of water and softening of feces;
• relaxation of muscles.

It is important to increase your fluid intake while taking magnesium! If this recommendation is not followed, then the opposite effect may appear - constipation from Magne B6 (b6), other similar drugs of group B.

Loperamide

The medication is prescribed in order to eliminate acute diarrhea of ​​a non-infectious nature, in cases of mild infectious diarrhea. The medicine acts quickly, preserves therapeutic effect within 4-6 hours.

It has a stimulating effect on the receptors of the intestinal walls, leads to inhibition of intestinal motility, an increase in the period required for the transit of digested food. Loperamide affects the anal sphincter muscles, increasing tone and decreasing the frequency of urge to empty. The amount of mucus produced in the colon decreases.

The combination of mechanisms of action on the digestive and excretory systems further leads to stool retention. Constipation after loperamide does not cause painful sensations, gas formation, uncomfortable sensations, the abdomen is soft to the touch.

To solve the problem, it is enough to wait a while until the intestines restore their functions and the motor skills improve. For each person, this period has an individual time frame. You can speed up the process by diluting the diet with foods rich in fiber, prunes, and fermented milk products.

Constipation after taking the drug Loperamide disappears within 1-2 days.

Viferona

The drug in the form of a suppository is prescribed as part of a therapeutic treatment infectious diseases caused by bacteria or viruses. Viferon has many positive reviews from doctors, as it allows you to avoid or reduce the intake of antibiotics, cytostatics, hormones. Consumers complain of a side effect of stool disturbance - diarrhea or diarrhea.

A suitable explanation about the origin of constipation from taking Viferon is the contraction of the sphincter, prolonged stay of the intestinal muscles in good shape. After the introduction of the candle, the child feels the urge to go to the toilet, trying to keep the feces inside. Against this background, the feces harden and come out with difficulty.

If a similar reaction is observed, doctors recommend replacing the suppositories with interferon preparations in a different form. The medicine is selected by the doctor!

A representative of the probiotic group, containing the necessary amount of bacteria to treat problems with defecation against the background of dysbiosis. Can be taken by a child, a pregnant woman, an adult, old man... Linex eliminates disturbances in the digestive tract.

Various factors can provoke diarrhea or constipation; treatment is not based only on Linex. To identify the reasons, it is necessary to undergo examinations, pass tests and receive the correct treatment.

Constipation from Linex is a common occurrence in adults and children. This is due to the uncontrolled intake of the drug in the wrong dosage. Beneficial bacteria restore microflora if there is a deficiency. You cannot make appointments yourself. The intestine is a complex structure. It is necessary to adequately approach the setting and restoration of its functions.

How to get rid of constipation after taking medications and vitamins

If a vitamin or medication provokes stool retention, and it is impossible to cancel therapy for a number of indicators, it is necessary to help your body overcome this difficult period with the help of recommendations.

• increase the amount of fruit juices, clean water in the diet. If you drink about 2 liters of liquid, then the stool will become softer. Cleansing will take place naturally in the next day;
• include vegetable salads, raw vegetables, fruits, nuts in the diet different types... Coarse fiber is capable of cleansing the body;
• Limit the consumption of sausages, meat and other meat products. They are difficult to process, tend to linger in the digestive tract and rot;
• with severe attacks, when the stomach begins to ache unbearably, gas formation, nausea is observed, you can take magnesium. The pharmacy sells without a prescription. Enough 1 pack. the drug diluted in 0.5 cups of pure water. Take on an empty stomach.

If the problem of constipation torments a long period, the point is not in Loperamide, Linex or vitamins, but in the health of the gastrointestinal tract. Seek the advice of your doctor to determine the factor causing the abnormalities in the emptying process. Lingering stool simulates intestinal tumors and other serious diseases that require timely diagnosis and treatment. Do not risk your health, do not endure pain, do not hide a delicate problem, you need help. If constipation is tolerated for a long time, hemorrhoids, cracks in the anus, colitis, etc. appear.

Constipation problem in children pediatric practice- one of the most common. Parents are often worried about the child's absence of stool for several days, difficulties with the act of defecation and the related complaints of children about pain, children's refusal from the pot.

What is constipation?

Constipation is a slow progression feces the intestines. This is a problem that can appear at any age, including a newborn baby and a preschooler. Constipation is believed to be the most common condition gastrointestinal tract in children. Some parents do not pay enough attention to this side of the child's life, others have a misconception about what the stool should be and its frequency. Not all parents come to the doctor with this problem in their children or do not apply immediately, because they do not attach due importance to it or do not know whether this kind of stool in a child is the norm or pathology.

What is normal stool?

Stool frequency in children of different ages is different. A breastfed newborn may have stool as many times as it is fed. This is an ideal option, stool is allowed from 10-12 times a day, but little by little, about a teaspoon, up to 1 time a week with a large volume. Constipation can be talked about when the child has solid stool consistency. For children who are bottle-fed, up to a year constipation is considered to be the absence of an independent chair during the day. In this case, the consistency of the stool should be mushy, and the appearance of shaped feces ("sausage") is regarded as a tendency to constipation. From 4-6 months, the frequency of bowel movements usually decreases to 2 times a day. From one year and older - it should be 1-2 times a day. From 6 months to 1.5-2 years old, feces can be either formalized or mushy, from two years old it should be formalized.

Constipation is a violation of bowel function, manifested in an increase in the intervals between bowel movements. Constipation is also considered those cases when a child has painful defecation with dense feces, even if the frequency of stools corresponds age norm... Defecation in a child can be daily, but accompanied by straining, a change in the nature of the stool ("large" diameter of the fecal cylinder, "sheep" feces - dense, divided into small fragments). This situation is also typical for dysfunction of the large intestine and can be characterized as chronic constipation, the presence of an act of defecation less than 6 times a week for children under 3 years of age and less than 3 times a week for children over 3 years of age. Constipation, in children, is often accompanied by abdominal pain, to which they often react with crying and anxiety. The movement of feces is carried out due to the contraction of the intestinal muscles under the influence of nerve endings. The movement of feces from top to bottom through the intestines is carried out due to its wave-like contractions - peristalsis. The urge to defecate occurs when feces enter the rectum, stretch it and irritate the nerve endings that are there. In older children, defecation is carried out deliberately under the control of the central nervous system. The general immaturity of the neuromuscular apparatus of children in the first months of life can contribute to the retention of feces.

Constipation can be divided into organic and functional.

Organic constipation is associated with malformations (anatomical defects) of any part of the large intestine. Most often, organic constipation manifests itself from birth in the form of a lack of independent stool. Among the organic causes of constipation, the most common are Hirschsprung's disease and dolichosigma. Acquired anatomical changes (tumors, polyps, adhesive disease after operations). Fortunately, these diseases in children are extremely rare and developmental anomalies often appear already in the first year of a child's life. Pediatric surgeons treat such constipation and surgery is usually required.

In the overwhelming majority of cases, children have functional constipation, that is, dysregulation of the gastrointestinal tract. The causes of functional constipation in young children are:

1. Incorrect diet of a nursing mother.

2. Insufficient drinking regime of the child with artificial feeding.

3. Insufficient drinking regime of a child who is on natural feeding with the introduction of complementary foods (they introduced "thick" complementary foods, but did not give the baby water).

4. Early transfer of the child to artificial feeding.

5. Fast transfer of the baby from one mixture to another (in less than 7 days).

6. Inappropriate diet of the child (the child receives high content proteins, fats that are poorly absorbed).

7. The presence of rickets in an infant, in which there is a decreased muscle tone, including the muscles of the intestinal wall. In some cases, 2-3 weeks after the appointment of vitamin D, the child's constipation disappears.

8. Consequences of damage to the central nervous system, which developed during the wrong course of pregnancy and childbirth.

9 dysfunction thyroid gland(hypothyroidism). One of clinical manifestations hypothyroidism is constipation.

10. Iron deficiency anemia - with iron deficiency, an insufficient supply of oxygen to the intestinal musculature occurs, and therefore, its muscle weakness is noted.

11. Intestinal dysbiosis - a violation of the intestinal microflora, which leads to an increase in the processes of putrefaction, a decrease in the motor activity of the intestine.

12. Food allergy (to the protein of cow's milk, eggs, fish, soy, cereals containing gluten (gliadin)), leading to inflammatory changes of an allergic nature in the intestinal wall.

13.A significant role in the development of functional constipation in children is played by violations of the act of defecation due to oppression or lack of development of a reflex to defecate (conditioned reflex, psychogenic constipation). This type of constipation is often observed in shy children during the period of adaptation to new conditions (nursery, Kindergarten). Suppression of the reflex to defecate leads to compaction of feces, trauma to the rectal mucosa, the development of inflammation, pain during defecation, there is a "fear of the pot", neurotic disorders are aggravated.

14.Uncontrolled use of certain drugs (smecta, imodium, bifidumbacterin, enzyme preparations). Frequent use enemas and laxatives inhibit their own reflex to empty the intestines. Constipation can develop with prolonged use drugs: antispasmodics - drugs that eliminate smooth muscle spasm, for example, intestines, anticonvulsants, diuretics (diuretics), psychotropic drugs, antibiotics, etc.

15. Helminthic invasion is often accompanied by constipation.

As a result of the influence of various of the above reasons, the muscle tone of the intestine changes. With an increase in the tone of any part of the intestine, a spasm occurs, the feces cannot quickly pass this place. This is the mechanism for the development of spastic constipation, the external manifestation of which is the presence of dense, fragmented, "sheep" feces. Another type of functional constipation is hypotonic constipation, which is characterized by stool retention, with its release in the form of a fecal cylinder.

Children may experience temporary stool retention - "transient constipation". This may be due to inaccuracies in the diet, with dehydration of feces during acute febrile conditions (if the child has a high fever, severe sweating, loss of fluid with vomit, etc.). For babies who are on breastfeeding so-called "false constipation" may develop. It occurs due to the fact that babies receive a small amount breast milk, as well as the presence of congenital defects in the oral cavity (for example, clefts of the hard and soft palate), sluggish sucking, regurgitation. In these cases, it is not yet worth talking about constipation and taking emergency measures. With the elimination of the cause that caused the stool retention, its normalization occurs on its own. Sometimes, to solve this problem, it is enough to adjust the diet and drinking regimen.

The effect of constipation on the body.

Constipation is accompanied by the development in the child of chronic lethargy, weakness, decreased appetite against the background of impaired digestion and increased absorption harmful substances from feces. With the accumulation of feces in the lumen of the intestine, the nutrition of its mucous membrane is disrupted. Chronic stool retention leads to a violation of the intestinal microflora, an increase in the amount of disease-causing and a decrease in the level normal microflora... There is a violation of the absorption of vitamins and microelements, leading to other metabolic disorders in the cells and tissues of the whole organism; iron deficiency gradually develops. An inflammatory process in the intestines (colitis) may develop, intestinal motility will increase, which is accompanied by the appearance of abdominal pain, the diameter of the intestine will expand, which will lead to an even greater increase in constipation. Long-term constipation can cause various complications. Most often, in children, there are violations of the intestinal microflora, which entails, a violation of the processes of digestion and absorption in its departments. In the future, intoxication increases, due to an increase in the processes of putrefaction in the intestines, the accumulation of harmful substances. Possible violation of blood circulation in the intestinal wall, the development of an inflammatory process in the colon and expansion of the intestinal lumen. Most often, with constipation in children of different ages, rectal cracks are observed, accompanied by the appearance of scarlet blood on the surface of the feces. Persistent constipation can cause prolapse of the rectal mucosa. When these symptoms appear, you can not self-medicate, you must urgently consult a doctor. In young children, painful bowel movements lead to fears of this process.

"Ambulance.

At home, if constipation occurs in a child over a year old, a cleansing enema can be used as a first aid before the doctor's examination. Boiled water is used for a cleansing enema. room temperature... To increase the laxative effect of the enema, glycerin is added to the water - 1-2 teaspoons per glass of water. In no case should you induce stool with soap (it causes strong chemical burn mucous membrane), cotton swabs or a thermometer. This leads to additional trauma to the rectal mucosa and further inhibits the natural reflex to defecate. Can be used as emergency candles with glycerin (can be used from birth), but you should not get carried away with them.

If the baby is breastfed, the stool is dense, streaked with blood, you should definitely consult a doctor!

If the child is older, you should see a doctor in the following cases:

Constipation is accompanied by complaints of abdominal pain, bloating, decreased appetite;

Blood is seen in the child's stool;

The child holds a chair for emotional reasons, especially when planted on a potty;

The child periodically has calomazation (encopresis), in which solid feces accumulate in the rectum, and liquid feces are involuntarily released outward due to the child's loss of control over the muscular apparatus of the rectum.

First of all, you need to visit a pediatrician, it is he who must determine the need for consultations with other specialists (pediatric neurologist, endocrinologist, surgeon).

Treatment.

The main condition successful treatment constipation in children is the achievement of such consistencies of intestinal contents and the speed of its transit through the large intestine, which would make it possible to have regular, preferably daily (or - at least once every two days) stool at the same time of day.

This treatment requires an individual approach from the doctor in each case and depends on many factors: the reasons that caused constipation, the age of the child, the severity and duration of the disease, the independence and frequency of the act of defecation, the presence of dyspepsia and pain, as well as concomitant diseases of the gastrointestinal tract and other organs and systems.

In the treatment of constipation, five main areas can be distinguished:

1. General guidance. The doctor needs to explain the physiology of bowel movements and the consequences of constipation. Explain to parents how to treat and how to solve problems, especially in cases with a long course and for patients who previously had other attending physicians. We must promise children that the stool will soften and that it will not cause pain during bowel movements afterwards. At the same time, you need to ask the child not to retain feces. Make sure that if he adheres to the treatment, the fecal contamination will disappear. The main task in relation to the child is to eliminate pain. When addressing parents, we ask them not to make unnecessary and demeaning comments. It is not their fault and it should not create a psychological problem. Nevertheless, it is necessary to remove from their consciousness ideas about anatomical causes. It takes 3 months to 2 years before the situation returns to normal. The time required for this depends on the previous duration of constipation, correct adherence to treatment, and the invested calmness and patience. It is important that parents develop a positive reaction when children begin to control bowel movements and avoid punishing children in cases of relapse.

Toilet exercises. We agree with children and parents that after each meal of a significant amount, children should sit in the toilet (with a footrest) for at least 10 minutes. We explain to parents that children do not have to defecate every time, but if they try, convince them that it doesn’t hurt.

2. Health food... This is the most important measure (depending, however, on family habits), although the most difficult to implement. We need to convince parents that children with constipation, especially those with a family history of similar problems, should have a nutritious diet high in plant fiber. Sometimes it is necessary to change the habits of the whole family. Vegetables, fruits and cereals are recommended if increased consumption of food is required to promote the formation of fecal matter. The amount of fiber intake should be "age + 5-10 grams per day" for children over 2 years of age. Useful to add wheat bran for enriching a nutritious diet poor in plant fiber. Above all, you need to watch out and avoid constipation-promoting foods such as cow's milk, noodles, bananas, carrots and unpeeled apples. Provide calcium (1 g / day) and calorie supplements through the consumption of non-constipating foods such as meat, eggs, butter and vegetable oils, and mayonnaise.

It is important to ensure that you are drinking plenty of fluids and avoiding caffeinated drinks.

When treating breastfed babies in the first year of life, it is very important to analyze the nature of the drinking regime and nutrition of the nursing mother, especially if she has stool retention. It is necessary to exclude from her diet following products: contributing increased gassing(legumes, cabbage, tomatoes, mushrooms, black bread); reducing the motor function of the colon (containing tannin - blueberries, strong tea, cocoa; rich in fatty oils - turnip, radish, onion and garlic; semolina and rice porridge, slimy soups and jelly). In addition, milk is poorly tolerated, as it contributes to flatulence, especially against the background of intestinal dysbiosis.

Similar restrictions are necessary for children suffering from constipation at an older age.

For breastfed babies, adapted milk formulas are recommended, which can be divided into 4 types:

with locust bean gluten (Frisovy - 0.6%);

enriched with oligosaccharides ("Nutrilon Omneo", "Nutrilon plus");

The optimal daily volume of these mixtures for both mixed and artificial feeding is selected individually, starting with replacing half of one feeding on the first day, one full feeding on the 2nd day, followed by a daily increase of one feeding per day until stool regularity is achieved. If constipation persists, then the child is completely transferred to one of the above mixtures. When stool normalizes, the volume of the mixture is reduced, as a rule, to a maintenance dose (usually 2-3 feedings per day).

Fermented milk products (kefir, yogurt), sourdoughs ("Narine", "Evita", "Vitaflor"), as well as functional food products based on fermented milk ("Bifidok", yogurt "Activia", etc.) .).

For constipation, accompanied by signs of inflammation (colitis), depending on the activity of the inflammatory process in the intestine, diet No. 3 or No. 4 (B or C) according to Pevzner is prescribed.

2. Pharmacotherapy of intestinal motility disorders is based on modern ideas about the physiology of its motor activity. The combined nature of various disorders (hypotension and spasm) of the intestine, often observed in the clinical picture of the disease, creates certain difficulties in the drug correction of these disorders.

Traditionally, laxatives are the first group of drug therapy for constipation. According to the mechanism of action, they are divided into drugs:

Increasing the volume of intestinal contents (plant fibers, hydrophilic colloids, saline laxatives, synthetic disaccharides);

Stimulating intestinal receptors (rhubarb, senna, buckthorn - containing anthraglycosides and synthetic agents - bisacodyl, sodium picosulfite);

Emollients (synthetic disaccharides, vaseline and almond oil). All laxatives also differ in localization of action: mainly on the small intestine (saline laxatives, liquid paraffin), the large intestine (synthetic disaccharides, bisacodyl) and the entire intestine (hydrophilic colloids, saline laxatives).

Despite their variety, most of them cause a number of side effects (allergic reactions, drug diarrhea with the development of dehydration and electrolyte disturbances, intestinal obstruction, colon melanosis, endocrine disorders, dysbiosis, etc.), which is why the use of laxatives in children should be short-lived (no more than 10-14 days).

Can I give my child a laxative on my own?

Sometimes parents try to treat the child themselves, giving him various laxatives, which are now widely available in pharmacies. Children's doctors do not recommend doing this, since most laxatives are intended for adults and their effect is short-lived. Also, they can give numerous side effects, such as allergic reactions, loss of potassium, protein through the intestines, dysbiosis, suppression of one's own reflex to empty the intestines.

Medication for constipation can only be prescribed by a doctor.

However, chronic constipation requires very painstaking and long-term treatment, and this determines the choice of drugs of this spectrum of action in pediatric practice. In the first place among them is Lactulose, which is related to prebiotics by its mechanism of action, as well as food bran and seaweed.

Lactulose is the active substance of Duphalac (Solvay Pharma, Germany), which is a source of carbohydrates preferred by lactate-producing bacteria (especially various types of Bifidobacterium and Lactobacterium), and due to it significantly increase their mass, which causes a laxative effect. Lactulose, a synthetic disaccharide that is not naturally occurring, is not degraded or absorbed in the small intestine, therefore, upon reaching the colon, it undergoes bacterial degradation and breaks down into short-chain fatty acids (lactic, acetic, propionic and butyric), lowering the pH of the colon contents and by stimulating peristalsis. The decomposition of lactulose to short-chain fatty acids also increases the osmotic pressure in the intestinal lumen. Duphalac is a physiological and safe regulator of intestinal motor function and is widely used in both children and adults, including pregnant women, which makes it possible to recommend it as a basic drug in the treatment of constipation. The dose of Duphalac is recommended to be selected individually, depending on the age and degree of stool retention, starting with 5 ml of syrup, followed by an increase to the most effective (but not more than 50 ml per day). The duration of its administration can be quite long, and the withdrawal of the drug is carried out gradually. Wheat bran and seaweed are often used as agents that increase the volume of intestinal contents. When taking bran, it is recommended to drink plenty of fluids to avoid compaction of feces (1 g of bran binds 18 g of water). It is recommended to take from 15 to 50 g of dietary fiber per day. However, a large amount of them leads to a decrease in the assimilation of fats by 5-7%, proteins by 8-15%. Laminaria (kelp) belongs to mucous substances and consists of equal amounts of fiber and polysaccharides, which are unable to be absorbed in the intestines. These are insoluble substances of plant origin with a resinous consistency. In water, they swell and turn into a mucous mass, which does not allow feces to thicken, and at the same time increase its volume. Seaweed is a brown algae rich in iodine, bromide and calcium salts, polysaccharides, vitamin C. It is prescribed 1-2 teaspoons once a day (the form of release is powder). The drug is contraindicated in patients with idiosyncrasy to iodine and with long-term use can cause the phenomenon of iodism.

The second group of drugs is represented by prokinetics, which have a primary stimulating effect on the propulsive activity of the colon and antispasmodics. Until recently, prokinetics were rarely used for constipation in children. Earlier, metaclopramide (synonyms: Raglan, Cerucal, etc.) was used more often than others, which coordinates the disturbed ratio of tone and kinetics of the stomach, normalizing the evacuation from it and passage of the chyme along the duodenum. TO side effects of this drug include drowsiness, fatigue, headaches, dystonic phenomena, esophageal spasm, galactorrhea, fears, bulbar disorders.

In recent years, a new generation of prokinetic agents, domperidone, have appeared. Given the fact that this drug does not give such pronounced side effects as metaclopramide, it is widely used in gastroenterology, including for constipation in children. Domperidone is a dopamine antagonist. By blocking dopamine receptors, it affects the motor function of the gastrointestinal tract - it enhances gastric motility and normalizes its emptying, and also increases the tone of the lower esophageal sphincter. The drug to a certain extent increases the tone and enhances the peristalsis of the entire intestine, which is manifested in the elimination of flatulence and pain along the colon, normalization of the stool in some patients. Since domperidone does not cross the blood-brain barrier, it is much less likely to cause extrapyramidal disorders. The drug is prescribed at 5-10 mg 3 times a day (10 mg tablets) 10-30 minutes before meals, for 4 weeks. In young children, it is successfully used in liquid form.

Another representative of this group is Meteospazmil, which includes alverin and simethicone. Some authors attribute it to peripheral action prokinetics. It is produced in capsules and is prescribed 1 capsule 2-3 times a day for children over 12 years old.

In addition to hypo- and atonic states, intestinal motor disorders such as increased motility of the colon can be observed, especially in IBS with constipation syndrome. In this case, it becomes necessary to prescribe drugs in order to reduce this function, in particular, antispasmodics. Isoquinoline derivatives (Papaverine, No-shpa) are often used in practice. These drugs have a number of side effects, and with severe intestinal hypermotility, they often turn out to be ineffective. M-anticholinergics (belladonna tincture, Platyphyllin, Metacin) as antispasmodic drugs have been used in gastroenterology for a long time. The negative effect of the use of M-anticholinergics is the systemic nature of their action. Therefore, it is advisable to prescribe selective anticholinergics, one of which is N-butylscopalamin, a blocker of M-cholinergic receptors. Interacting with cholinergic receptors in the walls internal organs, it has an antispasmodic effect on the smooth muscles of the gastrointestinal tract, urinary and biliary tract, etc. Prescribe the drug in the form of a solution or tablets inside, as well as in the form of suppositories in an age-related dosage. For children under 6 years of age, the drug is prescribed more often in a solution of 1-2 teaspoons 2-3 times a day or in candles 1-3 times a day, and for schoolchildren - 1-2 tablets 1-3 times a day before meals. The duration of the drug intake is 7-10 days.

In recent years, there have appeared effective drugs, purposefully acting on intestinal spasm. These are pinaverine bromide, a calcium channel blocker, used in children over 12 years of age at a dose of 50-100 mg (1-2 tablets) 3 times a day for 1-3 months, and mebeverine, a myotropic antispasmodic with a direct effect on smooth muscles. The latter is prescribed for older children at 100-200 mg (1 capsule) 2 times a day 20 minutes before meals for a period of 7-10 days with a subsequent dose reduction. The experience of using these drugs is still small, but it can be hoped that their clinical research will give them the opportunity to take their rightful place in the treatment of constipation in children.

The third group includes choleretic preparations of plant origin (Flamin, Hofitol, Gepabene, etc.), which have been used for many years as components of laxatives.

Bile acids are known to be natural detergents. Our observations have shown that in children with chronic constipation, in 100% of cases, cholestasis of varying severity is noted, which determines the mandatory prescription of choleretic drugs.

The rhythmic flow of bile into the duodenum gives bile acids the ability to:

participate in the hydrolysis of neutral fat and stimulation of pancreatic secretions, promoting the processes of cavity digestion;

due to the osmotic action of salts, increase the flow of fluid into the intestinal lumen and increase the pressure in it, which activates the motor function of the intestine;

alkalize the contents of the proximal section duodenum ensuring the optimal effect of pancreatic enzymes;

directly bactericidal act in the lumen small intestine, preventing bacterial overgrowth and intestinal stasis, normalizing digestion processes and preventing.

The three groups of drugs listed above are basic in the treatment of constipation in children. With recent constipation, in order to achieve a positive effect, it is enough to change the nature of the diet, the quality of food, increase the amount of fluid consumed and physical activity, in order to obtain a stable positive effect against the background of short-term basic therapy. Children who have suffered from constipation for a long time need longer and more systematic treatment.

If the child does not have an independent chair against the background of basic therapy, cleansing (0.9% sodium chloride solution) or hypertonic (10% sodium chloride solution) enemas are prescribed for 5-7 days, followed by transfer to laxative suppositories, and as you receive regular stool - for basic therapy.

3. In complex treatment constipation a large place is given to the normalization of the intestinal microflora. The addition of biological products to therapy, primarily containing lactobacilli, allows a faster and more lasting effect to be obtained.

4. In the treatment of constipation, use means that normalize the state of the central and autonomic nervous system, as well as herbal medicine. The choice of the drug depends on the affective disorders identified in the patient (asthenic, depressive, hysterical, phobic syndromes). Optimal treatment results can be obtained if the child is observed together with a neuropsychiatrist, especially when it comes to IBS.

5. Drug therapy should be complemented by physiotherapy, massage, exercise therapy.

Folk laxatives for constipation

Herbs and fees for treatment constipation Health Portal

Pour 3 g of lemon balm leaf with 1 cup boiled water... Make an enema by introducing 30-40 ml of infusion. Apply for constipation.

Brew as tea 1 teaspoon of anise fruit in 1 glass of boiling water. Insist 20 minutes, drain. Drink 0.25 cups 3-4 times a day half an hour before meals with constipation.

Pour 1 tablespoon of crushed senna leaves with 1 glass of water, leave overnight, strain in the morning. Take 1 tablespoon 1-3 times a day as a laxative. Unlike other laxatives such as rhubarb, senna does not cause abdominal pain.

Pour 1 teaspoon of crushed dandelion roots with 1 glass of water. Boil for 20 minutes. Drink 0.25 cups 3-4 times a day before meals for constipation

Pour 1-2 tablespoons of large plantain seeds with 1 glass of water, bring to a boil, boil for 10 minutes, strain the broth warm. Take 1 tablespoon 1 time per day on an empty stomach for constipation.

Pour 0.5 liters of boiling water over 2 tablespoons of horse sorrel root and cook in a water bath for 30 minutes. In small doses, this agent has an astringent effect, and in large doses, it is a laxative, which acts 10-12 hours after ingestion. For constipation, drink 1 glass at night. A smaller dose will not work.

Pour 1 tablespoon of chopped buckthorn bark with 1 cup of brittle water, simmer for 20 minutes, add water to the original volume. Drink 0.5 cups in the morning and at night for constipation.

Pour 5 g of chopped caraway seeds with 2 cups of boiling water, boil for 5 minutes, drain. Take 0.5 cups 3 times a day before meals for constipation.

Infusion of burdock seeds (burdocks) is an ancient laxative. Take mature seeds (a lump from half a fist) and pour 1 glass of boiling water. Steam for 2 hours and drink at a time (the broth will turn out to be about 0.5 cups after straining the thorns) with constipation.

Pour 1 teaspoon of flaxseed with 1 glass of boiling water, leave, wrapped, for 4-5 hours. For constipation, drink the entire infusion at a time along with the seeds at night. You can add jam to taste.

As a mild laxative, an aqueous decoction of blueberry twigs is used along with leaves: pour 15 g of raw materials with 200 ml of water, boil for 10 minutes, leave for 1 hour, strain and take 1 tablespoon 4-6 times a day.

For constipation, crushed fresh rosehip leaves mixed with sugar or drink rosehip flower juice diluted with spring water.

Food should contain black bread, vegetables, sour milk.

Eating well-cooked beets with vegetable oil has a relaxing effect.

Home remedies for constipation

In case of constipation, it is necessary to drink 1 tablespoon of water every 30 minutes between breakfast and lunch. After lunch, you can continue to drink water in the same way.

Take 1 g of carrot seed powder 3 times a day 1 hour before meals for constipation.

Take 1 teaspoon 3-4 times daily before meals with freshly prepared onion juice. The course of treatment for constipation is 3 weeks, then a 3 week break, after which the treatment is repeated.

Drink freshly prepared potato juice: 0.5 cups 2-3 times a day 30 minutes before meals. Treatment should be carried out within 2 weeks for constipation.

In case of constipation, you need to eat 1 teaspoon of ground peas every day - this regulates digestion.

With chronic constipation, you need to drink water 3-4 times a day in which oats or plums have been boiled for a long time.

Drink radish juice, sauerkraut pickle for constipation.

Drink tea from dried cherries or apples for constipation.

For constipation, eat several plums in the morning on an empty stomach or several times a day.

Insist for 3 hours a mixture of 100 g of honey and 100 ml of aloe juice (only thick leaves are taken, thin ones have little healing properties). Take 1 teaspoon 3 times a day for chronic constipation, gastritis and profuse gas.

With a tendency to constipation, grind 150 g of aloe leaves, pour 300 g of warmed up natural honey, leave for 1 day, then warm up, strain. Take 1 dessert spoon in the morning 1 hour before meals.

Ground wheat bran is useful for constipation and irritable bowel syndrome. Before adding the bran to food, pour boiling water for 30 minutes, then drain the water. Put the resulting gruel into any dish, first 1 teaspoon, after 7-10 days - 2 teaspoons, after another 7-10 days - 1-2 tablespoons 2-3 times a day.

Laxatives are contraindicated for children under 3 years of age!

Memo for constipation in children

Treatment of constipation is a long, tense and not always rewarding task, only a purely medical approach to this problem does not solve most of the problems. Children with chronic constipation become lethargic, irritable, fearful, and their school performance rapidly declines.

Violations functional state colon or constipation, a contented common disease in childhood... In the medical literature in recent years, it has received the name "Irritable Bowel Syndrome". Constipation occurs in children of all ages, but especially often in younger students and children attending preschool institutions. In most cases, this disease does not always bring painful sensations to the child, therefore, clearly insufficient attention is paid to this pathology. Parents learn about this disease in a child rather late, especially if the child is shy, secretive.

Treatment of constipation is a long, tense and not always rewarding task, only a purely medical approach to this problem does not solve most of the problems. Children with chronic constipation become lethargic, irritable, fearful, and their school performance rapidly declines. Many children, out of fear of painful sensations during the act of defecation, become isolated, independently suppress natural urges, thereby aggravating the course of the disease, a so-called "vicious circle" is formed.

Thus, chronic functional constipation in children attending kindergartens and school acquires social significance; therefore, pediatricians almost always rely on parents for help and support in the rehabilitation of children. Only parental care and a friendly environment can help you get lasting results.

Constipation is the abnormal functioning of the colon, which is manifested by rare bowel movements in a child (less than once every two days) or their complete absence for a long time (which is very common), a difficult and painful act of defecation, a small amount of stool (dry and hard character ), lack of physiological feeling of complete bowel emptying.

The large intestine of a person is the site of the formation of feces, it has an approximately U-shape. The length of the entire colon in a child over 3 years old averages 1-1.5 meters. Feces are formed from undigested and undigested food residues. This happens by partially dehydrating them and different types peristaltic movements of the intestine, forming and advancing feces to the exit. A significant part of the feces is a huge number of microbial bodies. According to microbiologists, in 1 gram of feces healthy person between 30 and 40 billion microorganisms are found.

The causes of constipation are manifold. We, pediatricians, believe that constipation is primarily associated with poor nutrition or the so-called alimentary factor. The cause of chronic constipation is a deficiency in the diet of coarse fiber plant fiber as one of the main stimulants of intestinal peristalsis (vegetables, fruits, coarse breads, gray cereals, etc.), as well as the consumption of high-calorie, refined foods. As a result of such nutrition, a small amount of dehydrated fecal masses is formed in the large intestine, and their movement through the intestines is impaired. It has been observed that a lack of water in the feces leads to a significant delay in the movement of feces through the intestines. This is especially pronounced in the winter-spring season, when the consumption of both fresh and harvested vegetables and fruits is noticeably reduced.

The state of the child's nervous system plays an important role in the regulation of the motor function of the colon. Various stressful situations, mental, emotional and physical overload, unfavorable family and school relationships between children and adults negatively affect general state the child's nervous system, which in turn leads to disorders of the motor function of the colon. Elimination of stressful situations, normalization of the psychological situation in the family and at school, and in some cases the help of a neuropsychiatrist, have a beneficial effect on the treatment of the disease.

Long-term retention of the child's feces leads to the absorption of the products of putrefaction and fermentation from the intestines into the blood, which has a negative effect on the entire body of the child (toxic effect). Children complain of headaches, increased fatigue, their appetite decreases, and sleep is disturbed. Children become irritable, whiny and sometimes "uncontrollable". In the absence of stool for several days, he may experience sharp abdominal pain, vomiting, and fever.

Very often, dense feces, accumulating for a long time in the final section of the colon, stretch the anus when trying to empty. This can lead to cracking. Cracks are always accompanied by acute pain in the anus during and after emptying. The child is afraid of these painful sensations and tries to avoid attempts to empty the intestines, which leads to an even greater compaction of feces.

In advanced cases, with a prolonged absence of stool, as a result of increasing intraintestinal pressure, an unpleasant condition such as kalomazaniya, that is, spontaneous leakage of feces through the anus, may appear. The consequences of this condition are clear. The child becomes the object of jokes, and in some cases, more aggressive actions on the part of peers. The patient's mental state is on the verge of collapse, children refuse to go to kindergarten or school, the feeling of fear exceeds all reasonable limits.

Chronic constipation in a child can also appear when the child loses the habit of emptying the bowels at the same time (usually in the morning). It is often the fault of parents who pay little attention to the life of their child, do not teach from early childhood to defecate at a certain time.

By the way, it was noticed that some teachers in kindergarten or school, for strange, sometimes indescribable reasons, do not allow small children to go to the toilet during class. Such illiterate behavior of the teacher leads to the fact that children deliberately suppress the urge to defecate during school hours. This harmful reflex is easily fixed and causes chronic constipation.

A similar phenomenon is facilitated by an unfamiliar environment for the child, who first started attending kindergarten or school: a public toilet with the presence of a large number of strangers of different ages. This is especially detrimental to shy, shy children, especially boys brought up in the strictest Puritan principles.

What should a parent do if a child develops chronic constipation?

The main thing is not to self-medicate, but immediately seek advice from a specialist - a gastroenterologist. Children should definitely undergo the necessary examination.

The organization of a balanced diet is the basis of healing. Parents in most cases consider nutritional recommendations to be of little importance, requiring an appointment the latest drugs capable of eliminating constipation within a few days. It should be said right away: there are no such drugs! Since disorders of the motor function of the large intestine in the overwhelming majority of cases are associated with nutritional disorders in the family, the organization of the digestive diet is the main task of treatment.

The child's diet should be changed so that it contains more vegetables containing coarse vegetable fiber and pectins, i.e. components that stimulate intestinal motility. These are carrots, beets, colored and Brussels sprouts, pumpkin, zucchini, squash, plums, melons and gourds. There is not enough fiber in cucumbers, tomatoes, apples.

Vegetables and fruits should make up at least 50-60% of the daily diet and be consumed in any form (fresh or after heat treatment). During lunchtime, sick children should be offered vegetables in the form of salads, vinaigrettes, mashed potatoes, seasoning them with vegetable oil, light mayonnaise to enhance their taste. It is better not to use fatty varieties of mayonnaise and sour cream, since fats inhibit the intestines. Sour cream can be added to vegetable or cereal soup.

Pediatricians attach particular importance to the systematic intake of wheat bran. It is a valuable natural remedy obtained by grinding grain and has a number of useful properties... It is a valuable natural remedy obtained by grinding grain and has a number of useful properties:

Bran is one of the most powerful stimulants of intestinal peristalsis;

They contain a significant amount of B vitamins, which have a beneficial effect on all organs and systems. human body, especially the central nervous system;

Bran promotes the elimination of toxins, allergens from the body, their use is advisable in the complex treatment of numerous allergic diseases;

Bran removes excess cholesterol from the body and thereby helps prevent atherosclerosis.

Wheat bran can be used in any form. More often than not, we recommend using wheat bran in this way.

Spread the purchased product (usually sold at mills and pharmacies) in a thin layer (1-1.5 cm) on a metal tray and bake in an oven at a temperature of 100-150 C for 10-15 minutes. After cooling the bran, transfer it to a sealed jar, as the product is hygroscopic. Three to five tablespoons of bran, i.e. the amount that is required for the day, pour 1/2 cup of boiling water and soak for 15-20 minutes. In this case, a thickish light gray or light brown mass is formed.

The bran tastes completely tasteless, and children in most cases resolutely refuse to take them in their natural form. To improve palatability single dose bran (usually starting from 1 tsp. l. 3 times a day, gradually bringing up to 3-10 tablespoons. l. per day, depending on the degree of stool retention) add to 1/2 cup of fruit or vegetable juice, to a glass of fermented milk product , in porridge, soup, side dish. The duration of taking bran is not limited and can be calculated for years without any harm to the body.

Every day, the diet should contain fermented milk products (yogurt, fermented baked milk, varenets, one- or two-day kefir, etc.), it is better to use them in the morning on an empty stomach and at night. Fermented milk products can be enriched with bifidum flora.

First courses in the diet are required, soups are mostly vegetable or from gray cereals (buckwheat). The meat is best consumed as a cooked piece. Bread of gray and black varieties, with bran, yesterday's baked goods. Fresh rolls and cakes are contraindicated.

If you have constipation, you need to exclude foods that increase gas formation in the intestine: whole milk, sweet food, legumes.

For normal functioning of all muscles and intestines, in particular, it is necessary to eat foods containing potassium. These are baked potatoes, dried fruits, dried apricots, prunes, figs, compote from them. Parents can do the following: pour 10-20 prunes or dried apricots (or all together) with boiling water the night before, divide the portion into 3 parts in the morning and give the child to school, where he will gladly eat these berries. And in the evening at home, the child will drink the infusion obtained from the berries.

prunes - 1 part by weight,

figs - 1 part by weight,

dried apricots - 1 part by weight,

walnuts(core) - 1 part by weight.

The products are mixed in equal quantities, cut into small pieces with a stainless steel knife, 1-1.5 parts by weight of honey is added, the whole mixture is mixed again, laid out in a jar and sterilized at 80 C for 15 minutes. The dose is usually 1-2 teaspoons. l. 3 times a day after meals. It should be remembered that such a mixture can cause allergic reactions in children with a predisposition to such reactions.

It is important that during the day the child consumed more liquid: at least 4-5 glasses a day in the form of tea, compotes, broth, juices, water, etc., as well as taking cool drinks in the morning on an empty stomach (100-200 ml) ... Carbonated drinks are excluded.

Daily regime

Despite the significant role of diet, it may not have an effect if the child has not developed the habit of emptying the intestines at a certain time, preferably in the morning (6-9 hours). This habit should be developed and reinforced. To do this, immediately after getting up in the morning, the child drinks 0.5-1 glass on an empty stomach. cold water or vegetable juice.

If there is an urge to stool, then the patient empties the intestines as much as possible. If there is no urge to defecate, you should first resort to physical exercises, breakfast and after a while go to the toilet. A squatting pose is taken, with legs tucked into the stomach. The act of defecation is helped by self-massage of the abdomen with hands, rhythmic retraction anus, pressure between the coccyx and anus. The appropriate conditions must be created for the child. If the child is small, then it is better to plant him not on the toilet, but on the pot (previously cleanly washed and warmed slightly above body temperature). Restoring the act of defecation is a long-term task, and it should be solved by parents and adults who are in direct contact with the child, persistently, without emotional outbursts.

With chronic constipation, daily dosed physical activity is necessary - walking, morning exercises, outdoor games, skiing, ice skating, swimming. During classes at school, in the classroom, physical culture breaks should certainly be carried out. Most of the exercises should be aimed at stimulating the muscles of the anterior abdominal wall. We offer a set of special exercises.

1. Free airing of the room. Walking in place 30 sec

2. I. p. (Starting position): sitting on a chair, arms to shoulders. Raise your arms up, tilt your torso back - inhale. Hands to the shoulders, tilt the body slightly forward - exhale 2 - 8 times

3. I. p.: Sitting on a chair. Dilution of arms to the sides - inhale. Raise the right leg, bent at the knee, press it to the stomach - exhale. Also with the left leg 2 - 8 times

4. I. p.: Sitting on a chair. Alternate pulling up and abduction to the side of the straight leg 2 - 8 times

5. I. p.: Standing. Deep breathing 2 - 4 times

6. I. p.: Sitting on a chair, support with hands behind, legs bent. Breeding legs to the sides 4 - 8 times

7. I. p.: Standing, arms to the sides. Leading the leg forward, to the side, back, alternately right, then left 2 - 8 times

8. I. p.: Standing, hands on the belt. Semi-squat with arms laid back 2 - 6 times

For small children physical exercises must be played as a game. For example, we recommend this exercise. Scatter 20-30 small toys on the floor and ask your child to collect all the toys by bending over each of the standing positions. This "exercise" should be repeated 2-3 times during the day.

In addition to the described procedures, the doctor will prescribe some medicines... They should be taken strictly in the amount recommended by the specialist. Do not self-medicate or use laxatives. Only the correct and consistent implementation of our recommendations will help children get rid of chronic diseases. And the children will delight you with cheerful laughter, excellent success in school, excellent appetite and excellent health.

Chronic constipation in children

The progress achieved by modern society has led to the fact that nature, suppressed in many areas, began to "take revenge" on humanity for its lost positions, which manifested itself in an increase in the prevalence of the so-called "diseases of civilization". There is no doubt that chronic constipation belongs to this group of diseases, the cause of which can be a lot of factors, both endogenous and exogenous.

Long-term constipation was defined as prolonged retention of contents in the intestine for more than 32 hours or delayed emptying of the intestine from compacted feces. However, observations have shown that the frequency of bowel movements cannot serve as a criterion for the diagnosis of constipation, especially in children. So for a healthy child of the first year of life, stool frequency ranges from 2 to 7-8 times a day, and from 2 years of age, the frequency varies from 3 times a day to 1 time in 2 days. This indicates the need for some other criteria, and such criteria were developed in 1992 by the International Research Group.

Defecation is stressful;

The stool is hard or lumpy;

There is a feeling of incomplete bowel movement after the act of defecation

The act of defecation takes place 2 or less than twice a week.

According to a number of pediatricians for children, the latter criterion requires correction, and the criterion for constipation should be a stool frequency of less than 3-4 times a week for children over 1 year old and less than 6 times a week for children in the first year of life.

At the same time, we can talk about chronic constipation if the above criteria are met for at least 3 months without the use of laxatives. With daily stool, but the presence of the above symptoms, chronic constipation can be called "hidden". Special group make up the so-called functional constipation, and their variant is situational constipation, most often having a psychogenic or alimentary factor under it.

Constipation is not a disease, but only a symptom of the disease. And the task of the doctor is, first of all, to identify the cause of this symptom.

There is no generally accepted classification of constipation. Constipation is conventionally divided into:

Primary,

Secondary,

Idiopathic.

The cause of primary constipation is the presence of congenital malformations of the colon (megarectum, megadolihosigma, dolichocolon, Hirschsprung's disease, stenosis of the anorectal region) or acquired structural disorders (polyps or intestinal tumors, adhesive disease, etc.).

Most frequent reasons secondary constipation in infants are: genetic predisposition, pathological course of pregnancy and childbirth, early and / or rapid transition to artificial feeding, improper daily regimen and mother's nutrition, her non-compliance with the drinking regime, the presence of constipation in the mother herself, intolerance to cow's milk protein, iron deficiency, prematurity, hypothyroidism, as well as diseases accompanied by muscle hypotension (rickets, dysembryogenesis, etc.).

The formation of constipation in children of the first year of life is greatly influenced by all kinds of feeding disorders (underfeeding, improper introduction of complementary foods, monotonous nutrition, eating disorders, frequent change of the formula, feeding with milk formulas with a high iron content, etc.).

Secondary constipation in children over a year is more often formed against the background of alimentary, neurogenic, endocrine, psychogenic, metabolic and other reasons.

It should be noted the frequent presence of cholestasis in a child with constipation, so according to different authors, 70-80% of children have some type of violation of the function of bile secretion.

V early age neuro-reflex connections are immature, the formation of the mechanism of the act of defecation occurs gradually under the influence of environmental factors and the individual characteristics of the child's body. In addition, by the time the baby is born, the intramural nervous system of the colon is also immature. "Ripening" occurs gradually during the first months of life, and full formation ends at 2-3 years of age. Immaturity of regulatory mechanisms determines the exceptional vulnerability of the vital function of bowel emptying under the influence of various unfavorable factors (toxins, drugs, stress, violation of microbiocenosis, and even more infection), a violation of the reflex relationship of the rectum with its sphincter apparatus can easily occur.

The period of most frequent manifestation of constipation is 7-10 years of age. This is due to a gradual increase in the symptoms of constipation that arose in the first year of life, the development of secondary changes in the distal colon and the addition of new risk factors for the development of diseases of the digestive system at the age of 6-7 years (the moment of enrollment in school) (change in the regime and nature of nutrition , psycho-emotional overload).

Clinical picture constipation is varied. In some cases, the child does not present any complaints. In the presence of pain, their localization can be both throughout the abdomen, and with predominant localization in the right or more often in the left abdomen. In addition, there is bloating, a feeling of pressure, bloating, disappearing after a bowel movement or passing gas. Of dyspeptic disorders, decreased appetite, belching, unpleasant taste in the mouth, rumbling in the abdomen, and persistent flatulence are more common. Characterizing the stool, it should be noted that its consistency can be different: from normal, shaped to hard dry balls and lumps ("sheep" feces); in some patients, only the initial part of the feces is compressed, and the final part is a mushy mass. With pronounced inflammatory process in the intestine with hypersecretion of mucus, "constipation diarrhea" is noted, which is caused by the soaking and liquefaction of feces with mucus. The clinical picture is largely due to the topography of the lesion. In some cases, reflex pains in the sacrum, buttocks, hips, heart area join, palpitations, shortness of breath may develop, headache disappearing after a bowel movement.

With prolonged constipation, signs of fecal intoxication appear, associated with the accumulation of metabolic products (cresol, indole, skatole), which are absorbed from the intestines and cause weakness, nausea, low-grade fever, and a decrease in the rate of physical and mental development. It can also be noted: an increase in autonomic dysfunctions, the development of depressive conditions, aggravation of dysbiotic disorders, the development of cholelithiasis, hepatosis, hypovitaminosis, immune dysfunctions, persistence of allergic diseases and pustular skin lesions. Fissures of the anal canal, proctitis, proctosigmoiditis, secondary dolichosigma and megadolihosigma can join, prerequisites are created for the development and persistence of fecal incontinence - encopresis.

It is especially important to timely identify constipation, determine and correct the causes of its development. Without this, it is impossible to choose the correct tactics for examining patients and prescribing adequate therapy.

First of all, a thorough history taking by the district pediatrician is necessary to identify children at risk for the development of constipation (children of parents with constipation, intestinal dysfunction and intestinal infections history, dysbiosis phenomena in the first year of life, improper diet). From laboratory methods, a scatological study should be performed, an analysis of feces for helminth eggs and dysbiosis, general and biochemical analysis blood.

According to the indications, instrumental methods research - sigmoidoscopy, irrigoscopy (graphy), colonoscopy, if possible with targeted biopsy, manometry, sphincterometry, balloonography, myography and others.

In recent years, it has become widespread to conduct ultrasound examination with filling the intestine to assess its function. This method made it possible to develop a classification of functional disorders distal colon, depending on the echographic picture and the criteria for anomalies in the development of the distal intestine, which in turn allows a more differentiated approach to the appointment of X-ray methods and reduce radiation exposure. The accuracy and sensitivity of ultrasound diagnostics reaches 90%.

Treatment of chronic constipation should be comprehensive and include, first of all, the treatment of conditions that caused stool retention. There are the following areas of therapy:

1. Alimentary correction. Includes selection of special milk formulas (Bifidus, Samper Baby-1 and Baby-2, Frisovoy) or one-day fermented milk products for children of the first year of life, the inclusion in the diet of foods containing vegetable fiber.

2. Pharmacotherapy of motor function disorders. Includes the appointment of prokinetics, antispasmodics, choleretic and laxatives.

3. Prescription of drugs with anthelmintic action and drugs for the correction of dysbiotic disorders (probiotics, prebiotics).

4. Correction of metabolic disorders (vitamin therapy, calcium and magnesium preparations, limontar, etc.).

5. Herbal medicine.

6. Physiotherapy procedures and physiotherapy, massage.

With prolonged stool retention, laxatives are most often used, which differ from each other in the mechanism of action.

However, most laxatives are more or less addictive, have side effects in the form of allergic reactions, medicinal diarrhea with metabolic disorders, melanosis of the colon, and sometimes intestinal obstruction, which limits their use in children.

In the emergency treatment of constipation and in preparation for diagnostic studies, as a rule, water cleansing or hypertensive enemas are used. The introduction into the intestine of large volumes of water, which are necessary to obtain the effect and adequate preparation for research, is accompanied by discomfort, and in the case of hypertensive enemas and painful sensations, and in some cases it is contraindicated. In addition, there is a high risk of developing water intoxication due to the absorption of water containing fecal components, the occurrence of edema and even seizures. It was also established that enema waters wash out not only feces, but also the bacterial flora, which can lead to aggravation of dysbiotic disorders of the intestine, colonization of the distal parts of the intestine with pathogenic microorganisms. Enema waters can cause inflammation of the intestinal mucosa.

Now many young parents often abandon the previously accepted standards for the prevention of a number of diseases in children in the first years of life. This applies not only to vaccination, but also to the appointment of vitamin D to infants. Such an approach to the health of a child is not permissible, since the consequences of a cholecalciferol deficiency in the body can be the most severe.

Vitamin D is prescribed to babies for the purpose of:

• Prevention of improper development of muscle and bone tissue.
• Strengthening the work of immunity.
• Strengthening connective tissue.

Cholecalcefirol has a positive effect on the functioning of the nervous system and heart, reduces the risk of developing malignant tumors, participates in hematopoiesis. The lack of a biologically active substance leads to the development of rather serious pathologies and parents, before refusing the drug prescribed to their baby, must assess all subsequent risks.

Often the intake of cholecalciferol is stopped due to the fact that its use by the mother is associated with the fact that the baby begins to have problems with stool. Yes, constipation is indeed possible, but only if an overdose of vitamin D occurs. Such a side effect is also indicated in the annotations to any of the drugs containing cholecalciferol.

It is quite difficult to determine that constipation is due precisely to the intake of the prescribed drug, since dozens of other provoking factors can negatively affect the work of the intestines of the baby. Do not forget that from about two weeks of a newborn's life and up to three to four months, the active formation and development of the digestive system takes place. That is why during this period, babies most often have severe colic, problems with defecation and regurgitation. Vitamin D is prescribed for use most often at this age, due to which the appearance of constipation is attributed to the use of the drug.

If constipation occurs, it is necessary to review the child's nutrition, to establish whether he receives enough water for his age, the child's physical activity is of no small importance. If the baby feeds exclusively on mother's milk, then it should be established whether foods with intestinal-strengthening properties predominate in the woman's diet.

Vitamin D does not often lead to constipation. If such an adverse reaction to the drug occurs, then it is accompanied by other symptoms of an overdose, these are:

• Sleep disturbance in a baby.
• Capriciousness.
• Insufficient weight gain.
• Sweating.
• Intense thirst and production of large quantities of urine.

When such changes appear in the baby's well-being, the intake of cholecalciferol should be stopped and a pediatrician should be consulted.

Constipation when using vitamin preparations may appear and as a result allergic reaction for these drugs. Allergies are often accompanied by the appearance of a rash on the body, redness of the cheeks, dryness of certain parts of the body, and severe diaper rash. Such reactions are also not normal and require establishing the cause of their occurrence.

The likelihood of constipation when using vitamin D increases many times over if the baby additionally takes other vitamin and mineral complexes and a number of medications. It is impossible to accurately understand the reasons for the appearance of long-term problems with bowel movement on your own, the child must be examined, which can only be done under the supervision of a pediatrician.

How to avoid constipation while preventing rickets

Vitamin D and constipation are not mutually exclusive concepts in the event that an overdose of cholecalciferol occurs. That is, it is possible to avoid problems with stool in children if it is necessary to prevent rickets only if vitamin D is in the body in the right amount, no more and no less. You can prevent the development of hypervitaminosis and, accordingly, constipation by following the following recommendations:

• The drug must be prescribed by a doctor for the child. Not all children need medicine, some babies receive vitamin D with other drugs, or they need this substance only in the form of separate courses with a certain duration.
• The dosage of cholecalciferol must be observed. Most often, for prevention, it is enough to give the baby 1-2 drops every day or every other day, but some children also need a larger dose of the drug.
• If the doctor prescribes other vitamin complexes, then it is necessary to take into account how much vitamin D is in them. Most often, in such cases, the separate use of cholecalciferol is canceled.
• In the summer months of the year, you need to walk in the sun with your baby as much as possible. The sun's rays on the exposed skin stimulates its own production of the vitamin, which means that in the summer the baby does not need artificial additives.

The use of vitamin D in infants can cause constipation even if the child eats formula. Modern baby food contains many additional vitamins, including those needed for the normal formation of muscles, bones and the skeleton as a whole. That is, an artificial child needs an additional intake of vitamin D much less compared to babies receiving mother's milk. In this regard, with artificial feeding, the dosage of the drug with cholecalciferol should be recalculated taking into account how much vitamin D is received by the infant from the mixtures. Only a qualified pediatrician can do this correctly.

Often, the occurrence of constipation when taking vitamin D is due only to the form of the medicine, in most cases, children are prescribed water solution cholecalciferol - Aquadetrim. If a child has a stool retention during its use, then you can try to prevent rickets with an oil solution of vitamin D or a medicine such as Vigantol. In some children, these analogs do not cause any adverse reactions.

Vitamin D plays a very important role in the development of all systems of the body of a young child. Both deficiency and deficiency of this substance can negatively affect the health of the baby. To prevent this from happening, it is necessary that a preventive course of taking cholecalciferol be prescribed by a doctor. It is impossible to give the vitamin on your own, especially since in some cases its use can harm the baby.

Much depends on which mixture you are using. Firstly, D, as a rule, is a part of adapted milk formulas. The daily prophylactic dose is usually contained in about 1 liter of the mixture. Even if the baby does not eat so much of the mixture so far, still less vitamin D preparations should be given (it is required to recalculate how much vitamin D the baby receives per day. 400-500 IU is required for the prevention of rickets. take 1000 IU every day). The district police officer - or, if necessary, I can help to calculate the dose. In general, from about May to October (again, depending on the place of residence), they stop taking vitamin D for prophylaxis - they just walk more with the baby. Vitamin D is produced in the skin when exposed to sunlight. It is enough for the hands and face of the child to be open during the walk. in principle, it can be a side effect when taking vitamin D preparations, especially in irrational doses (however, in case of obvious poisoning, diarrhea will be more likely). Probably, in your situation, I would at least reduce the dose to 1 drop - and when the heat is established, I would generally switch to walks with prophylaxis with natural ultraviolet rays. By the end of summer, the baby will be 7 months old; can be limited to vitamin D from the mixture, egg yolk and / or. Secondly, after 2 weeks of age, babies often have stool disorders. The reason for this is age-related functional insufficiency of the gastrointestinal tract. It usually lasts up to 3 months. If the baby receives hypoallergenic mixtures with partially split protein, stool color change is natural. When using hydrolyzate mixtures, the stool becomes dark green or swampy and smells unpleasant. Maybe you need to use fermented milk, and not the usual mixture. For constipation in a child, it is recommended to use fermented milk mixtures with probiotics - "NAN fermented milk", "Nutrilon Omneo 1", "Samper Bifidus", "Lactofidus", "Mamex plus". Sometimes children tolerate Nutrilon comfort well (it contains partially hydrolyzed protein). If the baby has a tendency to regurgitate, which also often happens at this age, you can "kill 2 birds with one stone" (regurgitation and constipation), using antireflux mixtures with locust bean gum (guar gum) 1-2 times a day or at the beginning of feeding: they both help keep the mixture in the stomach and relax. Check with your pediatrician if it makes sense for you to change the mixture. With already developed constipation, a quick effect can be obtained with candles (from glycerin to), a gas outlet tube and even a cleansing enema. (The main thing is not to use enemas too often, so that the baby does not lose the habit of "working" himself). As laxatives in pediatrics, drugs are usually used - "Normaze" and "Duphalac". The dose is selected individually (from 1/2 to 1 teaspoon per day). From phytopreparations, you can use an infusion of chamomile flowers and. For the prevention of constipation, I would also add tummy massage, gymnastics (movements with legs like "bicycle"); would more often lay the child on his stomach and stimulate the lifts of the upper body, and after 3 months - and turns to the side, so that the abdominal muscles are strengthened. Good luck!

Constipation is fecal retention in the intestines for more than three days or abnormally hard feces that can cause pain during bowel movements. Constipation is effectively treated with diet and herbs.

When diagnosing constipation, stool volume is not taken into account - it is different for each person, as well as the intervals between bowel movements. While some people need to empty their bowels three or more times a day, others do not even have this need every day. However, it is important that bowel movements are effortless and occur at a constant frequency. While changes in this frequency are common in most people, they can sometimes indicate gut problems.

Constipation symptoms

Among the most important symptoms of constipation, the following should be highlighted: poor or very dry, as well as with prolonged delays, stool, swollen abdomen, a feeling of heaviness in it, flatulence.

Causes of constipation

There are many causes of constipation, including:

Improper nutrition(eating a lot of meat, fish, eggs, milk and dairy products) When these products are abused, the beneficial intestinal flora, which contributes to proper digestion, changes; harmful bacteria begin to predominate, causing rotting and flatulence. In this case, constipation is the result of changes in the intestinal flora.

Lack of dietary intake of fruits, vegetables, legumes, whole grains, and wholemeal breads... These foods provide much needed fiber for a healthy gut. Their deficiency can be one of the causes of constipation.

A diet poor in fiber(often due to over-processing of products).

Insufficient fluid intake. If there is insufficient fluid intake, the rectum retains feces in order to extract water from them. Drinking an optimal amount of fluid promotes the timely removal of intestinal waste from the rectum.

Lack of exercise. Exercise helps maintain intestinal motility.

Lack of the habit of regularly emptying the bowels. To get this habit, you need to accustom yourself to going to the toilet as soon as the need arises. Ignoring this need leads to the development of the so-called lazy gut, which is also facilitated by the stresses of modern life. This type of constipation is typical for young children who, being carried away by the game, may not go to the toilet in time.

Laxative abuse. People who tend to cleanse their bowels with laxatives usually develop lazy bowel syndrome, so they have to resort to these drugs over and over again.

The use of certain medications. These can be antidepressants, acid neutralizers, antispasmodics, and many others.

Diseases. Sometimes constipation can be a symptom of another medical condition, such as irritable bowel syndrome, rectal cancer, hyperthyroidism, etc.

Haemorrhoids. The pain caused by hemorrhoids can be the reason that a person becomes afraid to go to the toilet. Over time, this usually leads to constipation.

Prevention of constipation

• Set aside an urgent bowel movement.
• Exercise according to your ability.
• Increase your fluid intake.
• Break the habit of taking laxatives.
• Change your diet and eat more fruits and vegetables.

Diet for constipation

Breakfast

• A glass of skim milk
• Whole wheat flour toast with apple jelly
• 4 figs or 3 dried plums

Late breakfast

• Apple

Dinner

• Various vegetable dishes
• Piece of baked pumpkin
• 100 g tofu
• 100 g strawberries with three tablespoons of yogurt and a tablespoon brown sugar
• Infusion of peach blossom or elderberry flowers

Afternoon snack

• A slice of wholemeal bread and apple compote

Dinner

• Tomato, lettuce, onion and cucumber salad
• Asparagus omelet
• Infusion of chicory

You should consume about two liters of fluid per day.

Constipation treatment

Changes in diet and habits are usually sufficient to relieve constipation. Health care required in such cases:

• Changes in stool frequency are observed, which continue for a fairly long time.
• The stool becomes painful and bloody.
• Constipation alternates with diarrhea.
• Constipation lasts more than three days and the remedies used do not help.

Chair softeners

Using vitamins, minerals, and other supplements under the supervision of a doctor and in the absence of any bowel disease can help relieve constipation. The following additives should be used:

Vitamin C and Magnesium. Vitamin C has laxative properties. Taking 3,000 mg of vitamin C daily, divided into three doses, has been shown to relieve constipation. Magnesium enhances the effect of vitamin C. The dosage of this mineral should be about 400 mg daily.

Plantain seeds. Due to its high fiber content and water-swelling property, plantain seeds enhance peristalsis and facilitate bowel movements. At the same time, their mucus has a softening effect on the intestinal walls, which helps the passage of feces. Unlike other laxatives, psyllium seeds do not cause pain or cramping. The usual dose is 1–2 tablespoons per day, diluted with water or juice. In addition to plantain seeds, bran also relieves constipation.

Brewer's yeast. Drinking brewer's yeast is also effective in relieving constipation.

Less desirable drugs

There are laxatives that can only be taken if there are no other remedies at hand or they do not help. These laxatives include:

• Cassia, or senna (Cassia spp.)
• Buckthorn (Rhamnus frangula)

Frequent use of these drugs can lead to the development of "lazy rectum", which gets used to working only with this type of laxative. These laxatives should not be taken if pregnant or breastfeeding.

Phytotherapy

In herbal medicine for constipation, plants with the following properties are used:

Laxative plants: Plants with laxative properties improve stool by regulating the passage of digested food and feces.

Viable plants: act more radically, causing complete bowel movement.

Basic laxative plants

Aloe(Aloe vera): dry extract.

Dandelion(Taraxacum officinale) and elderberry: infusion.

Mallow(Malva): 30 g of leaves and flowers boiled for 20 minutes in a liter of water, three cups a day.

Thorn, or prickly plum(Prunus spinosa) infusion of flowers.

Althea officinalis(Althaéa officinális): infusion of a teaspoon of dried leaves and flowers in a cup of water, two cups a day.

Cascara(Rhamnus purshiana): contraindicated.

Violet(Taraxacum officinale: Tincture of a tablespoon of dried flowers in a cup of water, two cups a day).

Oats(Avena sativa): fiber found in oat bran, enhances peristalsis and facilitates bowel movements, preventing constipation caused by the removal of bran from cereals and cereals.

Fucus(Fucus vesiculosus): Due to its high mucus content, Fucus promotes excretion of faeces and maintains a feeling of fullness.

Sesame, or Sesame (Sesamum indicum): Seeds mixed with food.

Plantain(Plantago spp.): Seeds with water.

Rose hip(Rosa canina): A decoction of dry leaves.

Olive Tree(Olea europaea): in case of constipation, take a couple of teaspoons olive oil on an empty stomach.

Nettle(Urtica dioica): dry leaf infusion.

Chicory(Cichorium intybus): infusion of 20 g of dry root. Take a cup after meals. You can cook fresh leaves with other vegetables

Peach tree(Prunus persica): Tincture of a teaspoon of dried flowers in a cup of water. Strain and take several cups a day.

Flax seeds

Flax seeds are very beneficial for constipation. They can either be consumed with enough water (about one to three teaspoons a couple of times a day, while drinking about eight glasses of water a day), or taken as an infusion (a teaspoon for a cup of water, a couple of cups a day). Unlike most laxatives, which tend to irritate the intestines, the protective effect of mucus makes this plant non-invasive to the intestines, although the effect is not as rapid as other laxatives.

The main carrying plants

Wearable (drastic) - fast acting remedies:

Aloe(Aloe vera): dry extract

Senna(Cassia angustifolia): dry leaf infusion

Cascara(Rhamnus purshiana): Among the plants that contain anthraquinoids and are used to treat constipation, cascara is the least irritant to the intestines and therefore the most suitable vascular plant. However, before starting treatment, you need to take into account its toxicity, contraindications and side effects.

Field bindweed(Convulvulus arvensis): infusion of dry leaves and roots

Boxwood(Buxus semperviresns): decoction of bark

Peach tree(Prunus persica): Infusion of a teaspoon of dried leaves in a cup of water, taken four times a day, half a cup.