modern methods of treatment of constipations at children

Treatment of constipations depends on an aetiology, age, character of disturbance of a motility of a colon, duration of disease, presence of complications and accompanying diseases [77, 150]. The Main objective of treatment of constipations at children is restoration of a consistence of intestinal contents and rate of its transit on a colon [43].

According to references of the American academy of pediatrics, treatment should consist of following stages [77]:

1. Formation of children and parents: an explanation of the pathogenetic reasons of occurrence of constipations and treatment methods.

2. Colon clearing: elimination of fecal blockages by mechanical purification and appointment of laxatives.

3. The maintenance therapy consists of a diet, reflex development on a defecation, reception of medical products, dynamic observation.

Approximately at 15 % of children with constipations improvement against the training reducing feeling of fault, entering of clearness into an existing problem and formation of toilet skills becomes perceptible.

At treatment of constipations at children the great value is given to the correct balanced food. For children of thoracal age important as it is possible to keep natural feeding more longly. It is necessary to analyse character of a drinking regimen and a food of feeding mother, especially if at it the chair delay takes place.

The use of alimentary fibers is the extremely important. The American association of dieticians recommends to use alimentary fibers the adult to 20 - 35 g/days, to children of early age no more than 5 g in day. To children is more senior 2 years it is recommended to use quantity of alimentary fibers peer to the sum of age of the child (in years) + 5/days M.Becker, R.Rosskamp (1987) have shown, that at 86 % of children of early age (middle age 23 months), suffering the constipations, receiving a feeding up containing 4,2 g of wheaten bran, for 8th day of therapy became perceptible a regular chair, at 8 children at the age from 4,5 till 9 months became perceptible augmentation of volume of a chair at 21,5 % [138].

It is necessary to enlarge quantity of used fresh fruit and vegetables, a rasping fat, sour-milk products. Necessarily regular use of sour-milk products for the purpose of motility stimulation
Intestine and correction of the microbiocenosis, which disturbance always have secondary character [22].

At the big clump of fecal masses daily cleansing enemas for the purpose of stimulation of the certificate of a defecation are recommended. Surgeons and pediatrists have a little various views on indications to application of clysters, frequency and duration of their application, volume of an entered liquid. It is bound by that in surgical clinics there are children with organic lesions of an intestine or with a long current of a constipation is more often. At long constipations and a fecal intoxication application of clysters preferably during 3 - 4 weeks. Pediatrists face "conditioned-reflex" constipations is more often, at which it is possible to be limited to small duration of the given therapy (5 - 10 days) and small volumes of a liquid. The major principle at selection of volume of a clyster is the minimum volume at which there is a defecation (at an anorectal manometry - the minimum volume causing a desire on a defecation).

At inflammatory changes in a rectum application of oil clysters is recommended. Clysters with water of a room temperature or camomile broth are preferable, it is desirable during fixed time (in the morning, after a breakfast or in the evening before a dream). Traditionally recommended giperosmoljarnye saline or soap solutions at the child with a chronic boring of proctal area or with a fundament crack cause an acute pain, refusal of procedure. Daily, after evacuation of fecal masses, and performance of hygienic procedures, in a rectum ampoule enter the candle possessing antiinflammatory effect. Usually the therapy course lasts about 10 days.

In the absence of effect from listed above measures it is expedient to prescribe medicamental treatment (prokinetiki and-or a lactulose).

Medicamental treatment of constipations is necessary for prescribing, considering the mechanism and the reason of development of constipations. The challenge at treatment of constipations at children suffices choice of purgative preparations is. Prescribing
Laxatives, it is necessary to remember possible by-effects (an uncontrollable diarrhoeia, dehydration, formation of an organic pathology of a colon) these preparations that limits their application for children. Also many purgatives are forbidden for use at children's age. Long reception of purgative preparations owing to potassium loss in a small bowel conducts to the further weakening of a motility, and also raises risk of development of a melanosis of a wall of an intestine [3, 95, 125]. In some cases purgative preparations prescribe at alimentary, neurogenic, endocrine types of constipations at which they are not shown absolutely not [32, 89]. Also it is necessary to notice, that appointment of purgative preparations to the child with a fecal blockage or developmental anomaly of a colon can lead to pernicious consequences.

Considering above stated, more and more wide application in therapy of constipations find physical factors. The main feature of action of physical factors is that the energy brought from the outside, is absorbed by an organism, enlarges power resources, raises own juvenile possibilities providing a homeostasis [40, 57, 58].

Physical factors promote conservation and health strengthening, and in a rational combination to etiotropic, pathogenetic therapy considerably raise efficiency and quality of medical aid to children. Advantages of physiotherapeutic influence on an organism of the child are: universality since physical factors possess

raznonapravlennym action on pathological process; fiziologichnost because the majority of physical factors are natural stimuluses for a children's organism and their action is realised on anatomoyofiziologicheskim to ways; efficiency, absence of toxicity, by-effects and an organism allergization, painlessness, a long after-action, good compatibility with other medical agents, availability and profitability. Therefore the apparatus physiotherapy is everywhere applied in stationary, out-patient-polyclinic, sanatorium
Establishments and house conditions at the minimum financial expenses [40, 41, 44, 46, 57, 58, 63].

The primary goals of regenerative correction HZ by means of physiotherapy methods are normalisation of a passage of a feces, a tonus sfinkternogo the apparatus of a rectum and muscles tazovogo bottoms, reflex restoration on a defecation and reduction astenovegetativnyh disturbances.

From the big variety of methods of apparatus physiotherapy the impulse currents possessing a number of advantages are most widely used: a small power load on a children's organism, possibility of purposeful action on various organs and systems, ability to influence on smooth and poperechnopolosatuju muscles [74, 75].

At the constipations bound with diskoordinatsiej of reductions of muscles tazovogo of a bottom and an external sphincter of an anus, there can be effective a method of a biological feedback, carrying out of rectal stimulation. By means of this method of treatment conditioned-reflex communications which have been broken by a long current of serious forms of the constipations sometimes combined with an incontience of a feces are restored. These procedures are usually spent in a hospital or the centres having the corresponding equipment. It is barefooted-THERAPY (the technique of a biological feedback) is based on 2 types of trainings. 1) it is barefooted-TRAINING, at which sensory gauges place in the proctal channel and monitorirujut activity of cross-section muscles or pressure in the proctal channel, and the feedback to the patient, thus, is provided; 2) stimulirovannaja a defecation in which the patient trains a defecation with the imitated chair. According to various researches it is barefooted-THERAPY has proved to be as an effective and safe method of treatment of the constipations caused by anorectal dysfunction [86, 116, 149].

Last years data about efficiency of application for children with HZ dynamic elektronejrostimuljatsii are obtained. nejropodobnye impulse currents,
Possess the expressed stimulating action on a motility, a circulation and a colon trophicity at HZ at children [46].

Also, now in complex treatment of chronic constipations the method magnitoimpulsnoj stimulations is widely used. Owing to application magnitoimpulsnoj an induction the anaesthetising effect in most cases becomes perceptible, the independent, daily chair is established. The impulsive magnetic field of the big amplitude activly improves microcirculation and causes reduction as superficial, and glubokoraspolozhennyh muscular fibers. Under influence magnitoimpulsnoj an induction there is a reduction of expansion of a rectum, normalisation of a thickness of a muscular layer, that positively influences on motorno-evakuatornuju colon function. Medicinal magnetophoresis with use of impulsive magnetic fields of high intensity promotes penetration into the centre of a lesion of enough of medicinal substance for reception of optimum response to fiziko-pharmacological influence more purposefully. Thus for magnetophoresis use the medicinal preparations traditionally applied at treatment of constipations [44, 57, 58].

Last years efficiency kriomassazha is proved stomach area. The mechanism of action of massage of a forward abdominal wall a coolant, is based on local abduction of heat from an organism with the subsequent reflex answer in the form of a vasodilatation of internal organs and muscles that improves microcirculation in a zone of influence with the subsequent long rise in temperature of tissues and change of character of the general and local reactance of an organism. Kriomassazh soothing, antiinflammatory, antispastic an effect has, improves krovo - and a flow of lymph [50, 63].

As contraindications to physiotherapy carrying out extensive erozivno-cankers of a colon, a colitis of a tubercular aetiology or proceeding against the chronic dysentery, a bleeding hemorrhoids, polyps of a direct and sigmoid intestine, suspicion on malignant neoplasms of an intestine serve.

The physiotherapy exercises (LFK) - take the important place in a complex of treatment-and-prophylactic actions. It is one of most biologically proved methods of treatment at whom movement is required. But at appointment LFK character of disease, in particular a condition of a tonus of an intestine should be considered. At prevalence of the spastic phenomena it is necessary to give special attention to a choice of the starting positions promoting a relaxation of a forward abdominal wall. At the lowered tonus of an intestine it is necessary to prescribe exercises for prelum abdominale intensifying. At hypo-and atonic constipations in parallel with LFK it is necessary to prescribe stomach massage.

The reflexotherapy is the conventional method of treatment based on influence on biologically active zones, corresponding to certain sites ekstero - and proprioretseptornogo the apparatus, various physical factors [56].

Acupuncture (acupuncture) - a method of medical influence on an organism by means of acupuncture or cauterisation (heating) of biologically active points (Bath). At the heart of acupuncture (IRT) the empirical system drevnevostochnoj medicine in which concept health of the person is caused by circulation of vital energy in the so-called meridians uniting to organs and systems of an organism and providing its communication through vital points with environment [55] lays.

Because the centre of a pathology formed exo - and internal causes, can simultaneously cause changes both in an organ, and in vegetative nervous system, the boring of last often is early
Implication of a pathology of an organ. Certainly, vegetative nervous system is the basic place of the appendix of the mechanism of an acupuncture. Influencing to Bath, it is possible to receive instantly necessary reaction from various organs and systems [28].

During more than two thousand years localisation Bath and a course of meridians practically did not vary, but only were supplemented (Tabeeva D.M., 2001). Now it is known more than thousand points of an acupuncture, including classified on the basis of a so-called meridian, vnemeridiannyh, "new" points and the points located on an auricle.

Bath possess a number of unique functional and structural properties. Bath have the small area, the lowered electric resistance, the raised electric potential; their temperature on 0,2 - 0,5 0С above, than at surrounding zones; here oxygen consumption is raised also, higher level biohemoljuminestsentsii becomes perceptible. To Bath more than in other skin, various receptors, as free, and not the free. As a rule, Bath is in a zone a nerve, a hypodermic vein or an artery with perivascular nervous plexuses, wide lymphatic vessels, clumps of mast cells. In a false skin covering Bath, the quantity of cells Merkelja possessing neuroendocrinal function both allocating endorphines and enkephalins - endogenous modulators of painful sensitivity and immune reactions is enlarged. Vegetative correction through Bath reduces painful sensitivity and normalises hemodynamic reactions [27].

Existence of a point of an acupuncture on a skin proves to be true long-term practice of acupuncture and cauterisation, and also data akupunkturnoj diagnostics, distinct dependence of efficiency of treatment on accuracy of local influence with occurrence of characteristic sensations thus. As shown in a number of clinical and experimental works the basic role in realisation of effects of reflexotherapy is played by nervous system [28]. In process
Fauna evolutions the segmentary principle of an innervation when certain sites of a body and corresponding organs or departments of internal organs receive an innervation from the same groups of nervous cells was generated. This principle is presented not only at spinal segmentary level, but also in all other structures of a brain, up to a cortex.

Bath through a number of structures or it is immediate (the free nervous terminations in a false skin and a derma, paravazalnye nervous plexuses), or oposredovanno (through cells Merkelja, mast cells) are included in vegetative reflex arches that does possible purposefully to control organism functions in norm and a pathology. Concrete Bath there correspond certain organs, their parts, and also various departments of vegetative nervous system [27, 28]. By a feedback principle, at influence on concrete dermal segments of a body of the person, functions of concrete vegetative plexuses and organs are stimulated or braked, and the combination of punctual and segmentary influence potentsiruet each other and effect of treatment increases [39].

According to the structurally functional theory of the mechanism of action of the acupuncture offered by V.S.Gojdenko (1990) allocate some stages of the mechanism of medical effect of an acupuncture. The first link is bound to damaging action of metal akupunkturnoj needles on a skin and a hypodermic fatty tissue, result of that is formation in a place of influence of a zone of the raised metabolism (activation proteolytic and lizosomalnyh enzymes, the cellular reactions referred on liquidation of damaging agent and damaged tissues).

The second link of the mechanism of medical influence of an acupuncture is bound to the reflex apparatus of nervous system. Local reflex answers are provided with entering of the information from an influence place on
To eisodic fibers in a spinal cord to intercalary segmentary neurones, and then to efferent neurones of the same or nearby segment.

With local reflex answers English researcher C.A. Vincent (1990) binds long medical action of reflexotherapy. According to the author the acupuncture causes a reflex relaxation of muscles on a reflex arch by stimulation of trigger points, and it reaches long-term effect of reflexotherapy.

At an explanation of the mechanism of action of auricular reflexotherapy, it is supposed, that in integration of medical effects accept immediate participation neurones of kernels of trigeminal and solitary tracts as the auricle innervation is carried out by several nerves (branches of wandering, trigeminal, facial and glossopharyngeal nerves). Definitive integration of somatic and visceral eisodic signals occurs in a hypothalamus, a thalamus and a somatosensory cortex of the big hemispheres of a brain.

Participation of a hypothalamus in the specified process provides including of the third link of the mechanism of medical action of reflexotherapy - nejrogumoralnogo, an organism providing nonspecific adaptive reaction. It is supposed, that including nejrogumoralnogo a link at an acupuncture has the general with stresses-reactions points of entering of signals to a hypothalamus through limbic system. Result of participation limbiko - subthalamic area in realisation of medical action of an acupuncture are microstressful reactions in system. The action scheme the following: limbic area of a mesencephalon - a hypothalamus - emission gipofiziotropnyh hormones in capillaries of portal system of a forward share of a pituitary body - a forward share of a pituitary body - peripheric endocrine glands - obmenno-endokrinnye reorganisations in an organism [13, 16].

The numerous researches devoted to the mechanism of action of reflexotherapy, possibility of its use have been carried out at various diseases [12, 16, 38, 49, 55]. However, the works devoted to an estimation of efficiency of reflexotherapy not so many. Basically they concern any one aspect of action of reflexotherapy. It is not enough the works shining possibilities of use of reflexotherapy in children's practice. Well-known, that the reflexotherapy is most effective at treatment of diseases of functional character, that is the pathological conditions caused mainly by disturbances of mechanisms of regulation of functions. Hence, in children's practice the reflexotherapy can be applied with larger productivity for at children many diseases have functional character.

The reflexotherapy is widely applied now at children with a various pathology: diseases of nervous system, diseases of organs of breath and digestion, both as an independent method, and as a part of complex treatment [8, 15]. The basic methods and ways of reflexotherapy at various diseases are stated in D.M.Tabeevoj's fundamental managements (1994, 2001); V.G.Vogralika (1988); G.Luvsana (1986, 2000); V.S.Gojdenko (1984, 1990); R.A.Durinjana (1981, 1983). However, the scientific works devoted to an objective estimation of efficiency of an acupuncture, ways of its application for children are not numerous.

The analysis of data of the literature has shown sufficient clinical efficiency of reflexotherapy at vegetative disturbances in which basis lays disbalans sympathetic and parasympathetic activity [47, 52, 54].

The analysis of data of the literature on reflexotherapy application at treatment and preventive maintenance of diseases of organs of breath testifies to authentic efficiency of this method of treatment. In T.A.Smirnovoj's research (1995) value of an acupuncture is shown at treatment allergopatologii at children. An estimation
Efficiency of reflexotherapy it was spent on changes of indicators of immunity, the hormonal status.

In the literature there are data that the reflexotherapy favorably influences a motility of a gastroenteric tract, promotes it evakuatornoj to function. It is shown, that single procedure of an acupuncture causes changes evakuatornoj functions and practically does not influence tonic function of an intestine whereas course of treatment causes substantial improvements and tonic and evakuatornoj functions [26].

So, in randomizirovannom research in China (2012г) in which 700 adult patients took part, convincing data of have been obtained that acupuncture is an effective method of treatment of functional constipations [115]. In research Li M.K. (2010г) it has been analysed 29 clinical researches spent with 1994 for 2008 in which efficiency aurikuloterapii in constipation treatment has been shown. Enough proofs of have been received that IRT can be used as effective addition in treatment of a constipation [114].

At a digestive tube pathology methods classical korporalnoj acupunctures (children of advanced age), tsuboterapii and superficial acupuncture (patients of preschool age), aurikuloterapija [26, 37, 65] are applied. However now there are poor data about use of acupuncture for children, suffering constipations.

Thus, the purpose of our research is optimisation of rendering assistance to children with a syndrome of a constipation by means of an acupuncture method. Use IRT in treatment of children, suffering a constipation, will allow to affect various pathogenetic links of disease, to improve motorno-evakuatornuju colon function, as a whole to raise efficiency of complex therapy and quality of a life of the child.

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Scientific source IPATOV ANDREY ALEKSANDROVICH. EFFICIENCY of ACUPUNCTURE In COMPLEX TREATMENT of CHILDREN With the CONSTIPATION SYNDROME. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

Other medical related information modern methods of treatment of constipations at children:

  1. the Table of contents
  2. the List of the used literature:
  4. modern methods of treatment of constipations at children
  5. 2.2.1 Tool methods
  9. infantile intestinal gripes
  12. Clinico-Anamnestichesky and urodinamicheskie research methods.