Lock at children – difficulty of process of depletion of intestines, lack of an independent chair within a day and more. As manifestations of a lock at children can serve urezheny frequencies of defecation, a firm consistence of a chair, tension or concern of the child at defecation. For clarification of the reasons of a lock for children the rectal manual research, ultrasonography, endoscopy, a X-ray contrast research of intestines, analyses a calla can be conducted. The basic principles of treatment of locks at children are: development of a reflex on defecation, a dietotherapy, physical activity, massage, medicamentous therapy, physical therapy, if necessary – statement of enemas.
Lock at children
Lock at children – the violation of evakuatorny function of intestines consisting in increase in intervals between acts of defecation, change of character of a chair or systematic insufficient depletion of intestines. Locks represent an urgent problem of pediatrics and children's gastroenterology: 15-30% of children suffer from them, at the same time preschool children are 3 times more often. High prevalence of locks among babies is caused by the low level of natural feeding, increase in cases of perinatal damage of TsNS, food allergy; among children of advanced age – improper feeding, stresses, a hypodynamia. Regular locks negatively influence growth and development of the child, worsen quality of life, lead to different complications.
Classification of a lock at children
Considering a polietiologichnost of dysfunction of intestines, allocate the following forms of locks at children:
- the alimentary locks connected with the wrong food mode
- the functional diskinetichesky locks caused by violation of motility of a thick gut (spastic and hypotonic). Spastic locks at children are characterized by an otkhozhdeniye of the dense fragmented kalovy masses ("sheep" a calla), hypotonic – a chair delay for 5-7 days with the subsequent otkhozhdeniye a calla in the form of the cylinder of big diameter.
- the organic locks caused by the anatomic reasons
- the conditioned-reflex locks caused by the neuropsychogenic reasons
- the intoksikatsionny locks connected with toxic influences
- the endocrine locks caused by violations of hormonal regulation
- yatrogenny (medicamentous) locks
Depending on expressiveness of manifestations, during a lock at children distinguish the compensated, subcompensated and dekompensirovanny stages which demand the differentiated medical tactics. At the compensated stage defecation happens 1 time in 2–3 days; the child complains of belly-aches, incomplete depletion of intestines, painful defecation. The delay of a chair from 3 to 5 days, abdominal pains, a meteorizm is typical for the subcompensated stage. Quite often defecation happens only after reception of laxatives or statement of a cleaning enema. At a dekompensirovanny stage the delay of a chair makes to 10 and more than a day. For depletion of intestines it is necessary to resort to statement of a hypertensive or siphon enema. Are characteristic endogenous intoxication, , a palpation of kalovy stones on the intestines course.
The lock reasons at children
Alimentary locks at children can develop at various options of violation of food: defective diet, hypovitaminosis, dysfunction of digestive glands insufficient drinking mode, early transfer to artificial feeding, etc. If the child receives insufficient amount of breast milk (at a gipogalaktiya at mother, sluggish sucking, crevices of a lip and sky, vomiting), lack of a chair is regarded as a false lock or a pseudo-lock.
The temporary delay of a chair (passing lock) is often noted at children in the period of sharp feverish states in connection with dehydration of kalovy masses owing to high temperature, perspiration, vomiting.
Organic locks at children are connected with anatomic defects - malformations of various departments of a large intestine. At children a dolikhosigma, the disease of Girshprunga, a rectum atresia, an ektopiya of back pass, etc. occur among the congenital reasons of organic locks; among the acquired anatomic changes - polyps, tumors, hems of anorektalny area, an adhesive disease, helminthoses.
In most cases locks at children have functional character. In formation of diskinetichesky locks at children plays a special role hypoxemic – ischemic and traumatic defeat of TsNS most of which often is clinically shown by a gipertenzionno-gidrotsefalny syndrome. Hypotonic locks occur at children against the background of rickets, a hypotrophy, a chronic gastroduodenit, stomach ulcer, a myasthenia, an inactive way of life, a long bed rest. Spastic locks can develop at children with laktazny insufficiency, cerebral palsy, neuro diathesis. At dysbacteriosis at children the lock arises owing to violation of structure of the normal intestinal flora producing lactic acid and stimulating intestinal motility.
Conditioned-reflex locks can occur at children at diaper dermatitis, anal cracks, paraproktita, rectum fistulas. The psychogenic lock at children can arise at a violent excommunication from a breast, compulsory schooling of the child to a pot, inconveniences of visit of a public toilet in kindergarten or school. If the act of defecation was followed by morbidity, or visit of a toilet was psychologically uncomfortable, the child can ignore desires to defecation. In this case the kcal collects in a rectum, due to absorption of water becomes firmer that causes still big morbidity of depletion of intestines and aggravation of a lock in children.
Intoksikatsionny locks at children develop at sharp or chronic intoxication toxic agents, infectious and toxic – at dysentery, nonspecific ulcer colitis. Locks of endocrine genesis at children can be connected with a hypothyroidism, miksedemy, diabetes, giantism, feokhromotsitomy, nadpochechnikovy insufficiency. At children can lead uncontrolled use of some medicines to locks – enterosorbents, enzymes, diuretic, iron medicines and so forth. Frequent statement of enemas and reception of laxatives lead to oppression of own reflex on depletion of intestines.
Lock symptoms at children
The lock at children can be shown by intestinal (local) and extra intestinal (general) symptoms. Treat local manifestations: a rare rhythm of defecation or lack of a chair, change of a consistence of kalovy masses, feeling of incomplete depletion of intestines after a campaign in a toilet, pain and an abdominal distension, blood impurity availability in Calais, pain at defecation, a paradoxical incontience a calla.
Normal rate of a chair at children changes with age. So, at the newborns receiving breastfeeding, the frequency of defekation coincides with the number of feedings (6-7 times a day). With age there is a reduction of frequency rate of a chair, and by 4–6 months (time of introduction of feedings up) the rhythm of defekation decreases to 2 times a day. At the children receiving artificial feeding, the chair is usually not more often than 1 time a day. From age of 1 year chair frequency at the child is also more senior has to make 1-2 times a day. More rare rhythm of depletion of intestines at children is regarded as a lock.
Up to 6 months a normal consistence of kalovy masses - kashitseobrazny; from 6 months to 1,5-2 years kashitseobrazny or issued. Presence at the child very firm a calla in the form of "balls" or "a dense sausage", the frequent issued chair in the small portions – also confirm a lock.
Owing to a koprostaz the child has intestinal gripes, a meteorizm, pressure sense in the field of an anus. The concern of the child and pain at defecation are caused by gut wall restretching the dense kalovy mass of big diameter that quite often injures mucous the anal channel. In these cases in a chair often there is a small amount of scarlet blood at a look a streak. Enkoprez (a kalomazaniye, a paradoxical incontience a calla) usually develops after the previous long delay of kalovy masses.
Except local manifestations, at the children suffering from locks the extra intestinal manifestations testifying to kalovy intoxication are noted. The general weakness, fatigue, a headache, irritability, anorexia, nausea, anemia, pallor of integuments, tendency to emergence of pustulous rashes and acne concern to them.
Accumulation in a gleam of a gut of kalovy masses, frustration of food of her mucous membrane, violation of intestinal microflora can promote development of colitis that causes bigger strengthening of a lock in children. Besides, persistent locks at children can lead to loss of a rectum.
Diagnostics of a lock at children
Inspection of the children suffering from locks has to take place with participation of the pediatrician, children's gastroenterologist or proctologist. From the anamnesis time of the beginning and the loudspeaker of a disease, frequency and a consistence of a chair is specified. At survey the abdominal distension comes to light, at a palpation kalovy stones are determined by the course of a sigmovidny gut. In the course of the manual research of a rectum assessment of standing of an ampoule, sphincter force is made, organic malformations are excluded.
Methods of laboratory diagnostics at locks at children include a research a calla on dysbacteriosis, a koprologiya, eggs of helminths; general and biochemical blood test. Within complex assessment of a condition of a GIT ultrasonography of a pancreas, a liver, a stomach with conducting vodyono-siphon test, EGDS can be shown to children. For the purpose of inspection of a condition of disteel departments of a large intestine the ultrasonografiya of a large intestine is carried out.
Final assessment of a structural and functional condition of intestines is possible after carrying out radiological inspection: a survey X-ray analysis of an abdominal cavity, an irrigografiya, a barium passage X-ray analysis on a large intestine. For detailed studying of motor function of intestines the enterokolonostsintigrafiya is carried out.
Endoscopy at children with locks (a rektoromanoskopiya, a kolonoskopiya) is carried out for survey of a mucous membrane and a fence of an endoscopic biopsy. Malfunction of an anorektalny zone and an anal sphincter come to light by performance of a manometriya and a sfinkterometriya.
Treatment of a lock at children
In view of the fact that the lock at children is always secondary in relation to the leading reason, within the let review perhaps speak only about the main directions of medical work. In certain cases for normalization of physiological departures sufficient is a change of character of food of the child, activization of physical activity, increase in the drinking mode. At a diet of the babies suffering from locks there have to be fruit and vegetable purees; the senior children have fermented milk products, food fibers, cellulose. Extremely important aspect of treatment of locks at children is development of a conditioned reflex on defecation.
For the purpose of elimination of hypotonia of intestines massage courses with the LFK elements are appointed. Physiotherapeutic treatment of locks at children includes galvanization (at hypotonia), pulse currents, an electrophoresis, paraffin applications on area of a stomach (at a hyper tone). The positive result at functional locks at children is yielded by acupuncture. At psychogenic locks the help of the children's psychologist can be required by children.
Medicamentous therapy at locks at children can include purpose of laxatives (a laktuloz, a sennozida, a candle with glycerin), spazmolitik (a papaverine, ), prokinetik (), probiotics. In some cases short courses of enemas are appointed (cleaning, hypertensive, oil).
The forecast and prevention and a lock at children
At elimination of the contributing reasons and implementation of individual recommendations there is a normalization of the mode of defecation and character of a chair. Otherwise the lock at children can accept a chronic current and accompany them already in adulthood. At tendency of children to locks performing medical examination is obligatory; self-treatment, especially with use of laxatives and enemas is inadmissible. Sharply developed lock at children can be a sign of intestinal impassability and other states, life-endangering.
Measures of prevention of locks at children have to include breastfeeding, daily gymnastic activity, massage courses, the balanced food, schooling of the child to defecation in certain time, creation of the favorable psychological atmosphere. Obligatory identification and elimination of the reason which led to locks is necessary.