How many ways can constipated children come to the doctor?
I am totally amazed at the myriad of presentations that constipated children present to their doctors. I remember listening to MANY complex lectures in medical school and residency about recurrent abdominal pain and trying desperately to memorize the LONG list of conditions that present as recurrent abdominal pain in children. After all these years of clinical practice, common sense has finally taken precedence. Hold onto your seats for this DocSmo pearl: “Common things are uncommonly common.” In other words, don’t look for exotic illness when, most likely, everyday maladies are probably at work. Humans have two “common” reasons their stomachs hurt:
1. A lower intestine that is not completely emptying (Constipation)
2. An overly acidic stomach that doesn’t empty well and may actually reflux (send contents backwards) into the esophagus.
Let’s take a moment to talk about the first cause, constipation. Little kids—and even big ones—sometimes find pooping unpleasant. At some level they avoid it, and it catches up with them. When it does, they come to the doctor complaining of cramping pain (hollow organ trying to empty), feeling sick after eating (nowhere for food to go from the stomach), gas (excess fermentation in the colon), burping (slow gastric emptying), back pain (referred pain), vomiting (no room in the Inn), bloating, leaking stool, rectal pain, prolapse of the rectum… and the list continues. I am sure that another 30 years will bring many new variations on the same theme.
I really think we may have been better off when we lived outdoors, pooping wherever and whenever. I doubt children growing up in those conditions ever had stomachaches for the reasons we do now. Everything has to be so perfect for our children. They need to poop at the right time (when an adult says it’s ok), only in “approved” places, and quickly and cleanly: the so called Demand Poop. No wonder all the fuss!
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