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2 1/2 yo,severe constipation, not akes herself vomit

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Please please help!!! My 2 & 1/2 year old little girl has problems with making herself vomit. She has been diagnosed with Chronic Constipation so is on medication for this however I feel she is now associating eating with going to the loo, which obviously hurts. At home she will hardly eat anything except pasta and even then it is just a few spoonfuls, and at the child minders she will have days where she will physically stick her fingers or an object down her throat until she vomits to avoid eating. Her doctor says speak to the health visitor, her health visitor says speak to the doctor!!! I am at my wits end. Because although she is a small child she is a reasonable weight no one seems to help but I cry myself to sleep at night trying to think of ways to help. She seems in so much pain sometimes going to the loo and when we increase her medication (movicol) she poos about 6 times a day and gets infections down below. Please please help as I am at my wits end.

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replied June 23rd, 2014
General Q and A Answer A47943
Thank you for asking!
Constipation at such young age is always a symptom of an underlying etiology. which needs to be sorted out.
Constipation is quite a common issue these days and quite underrated. It needs a lot of diet and lifestyle modifications and work up to sort out the cause. Lets discuss what can be done to constipation. Remember constipation remains there unless the underlying cause is addressed and taken care of
Lower gastrointestinal (GI) endoscopy, colonic transit study, defecography, anorectal manometry, surface anal electromyography (EMG), and balloon expulsion ,complete blood count (CBC),Thyroid function tests, Serum electrolytes for metabolic cause of constipation, such as hypokalemia and hypercalcemia and also potassium, calcium, glucose, and creatinine, for electrolytes imbalance and last but not the least histopathological examinations are some of the baseline workup necessary to sort out the constipation cause.
Increase fiber intake and take plenty of fluids. manual disimpaction and transrectal enemas would work for a while now. Then a complete management would be needed and should focus on dietary change and exercise rather than laxatives, enemas, and suppositories, none of which really address the underlying problem.

The key to treating most patients with constipation is correction of dietary deficiencies, which generally involves increasing intake of fiber and fluid and decreasing the use of constipating agents (eg, milk products, coffee, tea, alcohol).

Medications to treat constipation include the following:

Bulk-forming agents (fibers; eg, psyllium): arguably the best and least expensive medication for long-term treatment
Emollient stool softeners (eg, docusate): Best used for short-term prophylaxis (eg, postoperative)
Rapidly acting lubricants (eg, mineral oil): Used for acute or subacute management of constipation
Prokinetics (eg, tegaserod): Proposed for use with severe constipation-predominant symptoms
Stimulant laxatives (eg, senna): Over-the-counter agents commonly but inappropriately used for long-term treatment of constipation
Newer therapies for constipation include the following:

Prucalopride, a prokinetic selective 5-hydroxytryptamine-4 (5-HT4) receptor antagonist that stimulates colonic motility and decreases transit time
The osmotic agents lubiprostone and linaclotide,which are FDA approved for chronic idiopathic constipation, constipation caused by irritable bowel syndrome, and (in the case of lubiprostone) opioid-induced constipation in adults with chronic, noncancer pain
Get to your gastroenterologist and discuss some newer advancements like sacral nerve stimulation and some surgical interventions if need be with them and let them decide what is best for you.

take care

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