Abstract
Pain and discomfort during bowel movements in children are among the most common symptoms in the modern civilized world. The most common cause of these symptoms is chronic constipation, which is often treated by a pediatrician or pediatric gastroenterologist. In differential diagnosis, it is very important to distinguish between chronic symptomatic constipation and functional (without an organic basis), which are most common in childhood. Organic causes of constipation are usually dealt with in cooperation with specialized specialists. The main pathophysiological mechanisms of functional constipation are stress, pain during emptying, and fear of further painful bowel movements. The clinical picture is dominated by infrequent and difficult defecation of a large amount of hard stools. If the history, laboratory and other additional studies indicate functional constipation, and there are no warning signs of chronic symptomatic constipation, complex treatment can be started. Therapy includes psychological preparation of the patient and his family, working with the correct technique of defecation, dietary and regimen measures, sufficient physical activity, the use of osmotic laxatives. The presence of warning signs requires a rational differential diagnostic procedure, which varies depending on the age of the child.
Highlights
important to distinguish between chronic symptomatic constipation
which are most common in childhood
The clinical picture is dominated by in
Summary
Доля функциональных запоров в детстве составляет около 95 % [2, 4]. Причины многофакторны: наследственные, диетические, психосоциальные и биологические. Например, это боязнь посещения общего туалета, нехватка времени утром, вечером – перед выходом из детского сада и т. Д. В настоящее время актуальной проблемой является также пандемия COVID-19 [11, 12], поскольку увеличился уровень стресса не только для взрослых, но и для детей. В дальнейшем стул у ребенка задерживается чаще и весь механизм повторяется. Если твердый стул в ампуле прямой кишки окружен жидким стулом, мы говорим о энкопрезе, который родители могут принять за диарею. Энкопрез встречается примерно у 2,8 % детей в возрасте 4 лет и у 1,6 % детей в возрасте 10 лет, причем чаще у девочек [2, 4, 14, 15]
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