It is the purpose of this communication to present the symptoms and the findings associated with chronic fecal impaction in children, and to outline a method of treatment. This distressing condition is not rare, and it may easily go unrecognized. It causes disturbing psychologic problems for both the child and the parents — problems that can quickly abate when the cause is known and the treatment started.
The more cases of constipation I see the greater is the number in which the cause seems to me to be of a nervous or mental nature. In scores of cases I have seen it come and go according as the patient’s mind was agitated or at rest. This is not so surprising when, as usually happens, the X-ray shows no sign of abnormality in the tract; the remarkable thing is that the same observation can be made in people with definite lesions interfering with colonic action.
It is now accepted that adequate preparation for most barium enema examinations is essential, particularly if the double contrast technique is to be used (Fisher 1923; 1925; Case, 1937; Welin, 1958). Several studies have shown that preparation with laxatives may be as good as, or better than, colon washout (Sowerbutts, 1960; Prat, Peynon and Prie, 1965; Mitchell, 1967), and may cause the patient far less discomfort. Controlled trials have demonstrated the superiority of a standardised senna preparation (Senokot) over cascara (Duncan, 1957), and of bisacodyl (Dulcolax) over glycerine suppositories (Church, 1959) and over castor oil (Keogh and Fraser, 1958; Popell and Bangappa, 1959; Ritan, 1962).
There is perhaps no drug which has attained such a wide and universal currency for this purpose in the civilized world of today. Its acceptance is based on the belief that mineral oil is a bland and innocuous intestinal lubricant, while the numerous and considerable deleterious effects which may follow its continued administration have failed to be recognized. The rectum is not a reservoir.
Before beginning the treatment of a case of alleged constipation one should ascertain whether the patient really is constipated or only believes himself to be so. He should therefore be instructed to stop all aperients for three days, taking only a teaspoonful or two of paraffin at night to keep the contents of the bowel soft. If at the end of that time there has been no proper relief, constipation may be diagnosed.