New possibilities for drug therapy for chronic constipation

Disturbances in the functional state of the colon or constipation are a fairly common disease in childhood. In the medical literature in recent years it has been called “Irritable Bowel Syndrome”. It occurs in children of all ages, but especially often in younger schoolchildren and children attending preschool institutions. In most cases, this suffering does not always bring painful sensations to the child, therefore, clearly insufficient attention is paid to this pathology. Parents learn about this suffering in their child quite late, especially if the child is shy and secretive.

Treating constipation is a long, stressful and not always rewarding task; a purely medical approach to this problem does not solve most problems. Children with chronic constipation become lethargic, irritable, fearful, and their school performance quickly 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 preschool institutions 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 help to obtain 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), difficult and painful bowel movements, a small amount of stool (dry and hard). ), lack of physiological feeling of complete bowel movement.

The human colon is the site of fecal mass formation and is approximately U-shaped. The length of the entire colon in a child over 3 years old is on average 1–1.5 meters. Feces are formed from undigested and undigested food residues. This occurs through partial dehydration and various types of peristaltic movements of the intestine, forming and moving feces towards the exit. A significant part of the feces consists of a huge number of microbial bodies. According to microbiologists, 30 to 40 billion microorganisms are found in 1 gram of feces of a healthy person.

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

The second important point in the formation of functional constipation is considered to be a sedentary lifestyle, which excludes full loads on the muscles of the anterior abdominal wall, and the latter play an important role in potentiating intestinal movements. Predisposing factors to the occurrence of chronic constipation in children are also congenital anomalies of the colon, such as dolichosigma (elongation of the sigmoid colon) and dolichocolon (elongation of the entire intestine). Constipation can be caused by intestinal parasites (roundworms, whipworms, bovine or pork tapeworm). Protozoan microorganisms (Giardia) rarely cause stool retention in childhood.

The state of the child’s nervous system plays an important role in regulating 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 the general condition of 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 has a beneficial effect on the course of the disease.

Prolonged retention of a child's feces leads to the absorption of rotting and fermentation products from the intestines into the blood, which has a negative effect on the child's entire body (toxic effect). Children complain of headaches, increased fatigue, decreased appetite, and disturbed sleep. Children become irritable, whiny and sometimes “uncontrollable.” If there is no stool for several days, he may experience severe abdominal pain, vomiting, and increased body temperature.

Very often, dense feces, accumulating for a long time in the final section of the colon, stretch the anus when trying to empty. This may cause cracks to form. Cracks are always accompanied by acute pain in the anus during and after bowel movement. The child is afraid of these painful sensations and tries to avoid attempts to empty the intestines, which leads to even greater compaction of the feces. In advanced cases, with a prolonged absence of stool, as a result of increasing intraintestinal pressure, such an unpleasant condition as stool may appear, that is, spontaneous leakage of feces through the anus. 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, and the feeling of fear exceeds all reasonable limits.

Chronic constipation in a child can also appear when the child loses the habit of bowel movements at the same time (usually in the morning). Parents are often to blame here because they pay little attention to their child’s life and do not teach them from early childhood to defecate at a certain time. We have noticed that some teachers in kindergarten or school, for strange, sometimes indescribable reasons, do not allow young 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. This harmful reflex easily becomes established and causes chronic constipation. This phenomenon is facilitated by an unusual environment for a child who has started attending kindergarten or school for the first time: a public toilet with the presence of a large number of strangers of different ages. This has a particularly unfavorable effect on shy, shy children, especially boys brought up in the strictest puritanical principles. We observed a 7-year-old child with severe constipation due to the fact that the child, having started going to school, held back bowel movements due to the fact that there were no stalls in the school toilet and the children could watch each other.

What should parents do if their child has chronic constipation? The main thing is not to self-medicate, but to immediately seek advice from a gastroenterologist. Children should definitely undergo the necessary examination.

ORGANIZATION OF RATIONAL NUTRITION IS THE BASIS OF HEALING

Parents in most cases consider nutritional recommendations to be of little significance, demanding the prescription of new drugs that can eliminate constipation within a few days. It should be said right away - such drugs do not exist! Since disorders of the motor function of the colon in the vast majority of cases are associated precisely with eating disorders in the family, therefore, organizing the digestive diet is the most important task of treatment.

The child's diet should be radically changed so that it contains more vegetables containing coarse plant fiber and pectins, i.e. components that stimulate intestinal motility. These are carrots, beets, cauliflower and Brussels sprouts, pumpkin, zucchini, squash, plums, and melons. There is not enough fiber in cucumbers, tomatoes, and 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 lunch, sick children should be offered vegetables in the form of salads, vinaigrettes, purees, seasoned with vegetable oil and light mayonnaise to improve their taste. It is better not to use fatty varieties of mayonnaise and sour cream, as fats inhibit intestinal function. Sour cream can be added to vegetable or cereal soup.

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

• bran is one of the powerful stimulants of intestinal motility;
• bran contains a significant amount of B vitamins, which have a beneficial effect on all organs and systems of the human body, and especially the central nervous system;
• bran helps remove toxins and 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 we recommend using wheat bran in this way. Spread the purchased product (usually sold at flour mills and pharmacies) in a thin layer (1-1.5 cm) on a metal tray and bake in the oven at a temperature of 100-150 C for 10-15 minutes. After cooling, transfer the bran to a hermetically sealed jar, since the product is hygroscopic. Three to five tablespoons of bran, i.e. the amount you need for the day, pour 1/2 cup of boiling water and leave for 15–20 minutes. In this case, a thick light gray or light brown mass is formed. Bran is a completely tasteless product and in most cases children resolutely refuse to take it in its natural form. To improve the taste of bran, add a single dose of bran (usually starting from 1 teaspoon 3 times a day, gradually increasing to 3-10 tablespoons per day depending on the degree of stool retention) to 1/2 cup of fruit or vegetable juice, in a glass with a fermented milk product, in porridge, soup, side dish. The duration of taking bran is not limited and can last for years without any harm to the body.

Your daily diet should include fermented milk products (yogurt, fermented baked milk, Varenets, one- or two-day kefir, etc.); these products are best consumed in the morning on an empty stomach and at night. Fermented milk products can be enriched with bifidum flora.

To normalize intestinal dysbiosis, which necessarily occurs with constipation, probiotics are used that do not interfere with intestinal motility, for example “Biovestin” and “Biovestin-lacto”.

" Biovestin " (liquid concentrate of bifidobacteria) is a product of high-tech, knowledge-intensive production and is an environmentally friendly beige milk emulsion. The therapeutic effect of the drug is determined by the bifidobacteria (B. Longum) contained in it in a live active form.

Mode of application. Shake the bottle thoroughly before use; foaming may occur. Biovestin is usually taken orally 20-30 minutes before meals, diluting or washing down the doses of the drug indicated below with a small amount of milk or water (with a temperature not exceeding 37-40 ° C).

Children under one year - from 1 drop to 1 ml per day. Children over 1 year - from 1 to 3 ml, once - twice a day. Adults - from 1 to 3 ml, two to three times a day. The recommended duration of taking Biovestin is 2-3 weeks, if necessary - up to 2 months. Contraindications: milk protein intolerance. "Biovestin-lacto" is a complex drug. Contains bifidobacteria and lactobacilli, representatives of normal human microflora.

It is known that various types of bifidobacteria are found in the human intestine, depending on age, diet, and other reasons. The effectiveness of colonization of the intestine by bifidobacteria can be increased by introducing several types of bifidobacteria into the composition of the drug.

Therefore, “biovestin-lacto” contains a strain of bifidobacteria B. Longum, which has high antagonistic activity against opportunistic and pathogenic microorganisms and resistance to therapeutic doses of the most common antibiotics.

In addition to bifidobacteria, “biovestin-lacto” also contains lactobacilli. In this case, a pharmacopoeial strain is used, known for its positive properties in the treatment of human dysbiosis - L.Plantarum 8RAZ.

Mode of application. “Biovestin-lacto” is recommended to be taken 20 minutes before. before meals, washed down with warm milk or water. In order to preserve biological activity, the product should not be heated above 40°C. Children under one year - from 1 drop to 1 ml per day. Children over 1 year - from 1 to 3 ml once or twice a day. Adults - from 1 to 3 ml, two to three times a day.

The product is taken from the bottle with a sterile syringe, piercing the rubber stopper with a needle. Store an opened bottle in the refrigerator for children under one year of age for no more than 24 hours, for children over one year of age and adults for no more than 3 days.

The recommended duration of taking the dietary supplement is 2-3 weeks.

Features of cooking and nutrition. The first courses in the diet are mandatory, soups are mainly vegetable or from gray cereals (buckwheat). It is better to eat meat in a cooked piece. Bread of gray and black varieties, with bran, yesterday's baking. Fresh buns and cakes are contraindicated.

If you have constipation, you should exclude foods that increase gas formation in the intestines: whole milk, sweet foods, legumes.

For the normal functioning of all muscles and the intestines, in particular, it is necessary to consume foods containing potassium. These are baked potatoes, dried fruits, dried apricots, prunes, figs, and compote made 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 it to the child at school, where he will eat these berries with pleasure. And in the evening at home, the child will drink the resulting infusion from the berries.

As a dessert, we recommend giving children with chronic constipation a mixture of well-washed, steamed with boiling water and well-dissolved dried fruits:

• 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 finely with a stainless steel knife, 1–1.5 parts by weight of honey are added, the whole mixture is mixed again, placed in a jar and sterilized at 80 C for 15 minutes. The dose is usually 1–2 teaspoons. 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 the child consumes more liquid during the day: at least 4-5 glasses per 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.

Constipation after feeding

Complementary feeding begins to be given to a child at the age of 5-6 months. The first new food in the baby’s diet is vegetable puree or porridge. If the baby is prone to constipation, then it is better to start complementary feeding with vegetables, for example, zucchini or cauliflower. Often, with the introduction of vegetables, the problem of constipation is solved.

But sometimes starting complementary foods can also lead to constipation. Constipation can be caused by the composition of food that is unusual for the child, or by its insufficiently liquid consistency.

Constipation during complementary feeding primarily indicates that the baby’s body is not ready to accept new food. Therefore, it is recommended to discontinue the product that caused constipation until normal bowel movements are restored.

During the introduction of complementary foods, it is recommended to give the child probiotics to prepare his digestive system for acquaintance with new foods.

For more information on introducing complementary foods, see the article “Complementary feeding for infants”

DAILY REGIME

Despite the significant role of diet, it may not be effective if the child does not develop the habit of emptying his bowels 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 1/2 - 1 glass of cold water or vegetable juice on an empty stomach; if there is a 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 exercise, breakfast and after a while go to the toilet. The pose is taken in a squatting position, with the legs tucked to the stomach. The act of defecation is aided by self-massage of the abdomen with hands, rhythmic retraction of the anus, and pressure between the tailbone and the anus.

Appropriate conditions must be created for the child. If the child is small, then it is better to sit him not on the toilet, but on the potty (previously washed clean and warmed slightly above body temperature). Restoring the act of defecation is a long-term task and should be carried out persistently, without emotional outbursts, by parents and adults in direct contact with the child.

EXERCISE STRESS

For chronic constipation, daily dosed physical activity is necessary - walking, morning exercises, outdoor games, skiing, skating, swimming. During classes at school, physical education breaks should definitely be held during lessons. Most exercises should be aimed at stimulating the muscles of the anterior abdominal wall, for example, the complex that we offer.

For young children, physical exercise should be in the form of play. For example, we recommend this exercise. Scatter 20-30 small toys on the floor and ask the child to collect all the toys, bending over each one from a standing position. This “exercise” should be repeated 2-3 times during the day.

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

Take Biovestin probiotics and stay healthy!

Benefit

Probiotics can effectively eliminate dysbiosis , help prevent the occurrence of intestinal infections and eliminate their consequences, increase immunity and make it possible for newborns, including premature babies and those suffering from lactose intolerance, to acquire their own resistance. Probiotics are also used to prevent recurrences of bacterial and fungal infections.

Prebiotics contain substances that feed beneficial flora; they are not suitable for pathogenic flora. With the help of prebiotics, you can effectively maintain the state of intestinal microflora .

How to choose a probiotic and prebiotic

Probiotics. It is important to pay attention to:

• best before date;
• the presence of living strains of bacteria;
• mandatory presence of lacto- and bifidobacteria ;
• a combination of several strains of beneficial microorganisms.

There is ongoing debate about the best form to take probiotics: liquid or dry powder capsules. The thing against dry matter is that probiotics undergo additional processing, which reduces the viability of bacteria.

Prebiotics , according to experts, include carbohydrates that:

• cause active growth of beneficial intestinal bacteria, selectively fermented by colon microflora;
• are not absorbed in the upper parts of the digestive system;
• have the ability to influence the balance of intestinal microflora in the direction of increasing the number of beneficial microorganisms.