risk factors of constipations at children

Risk factors of development of constipations at children are various, but for each child they are individual.

To risk factors concern extremely low mass of a body at a birth [92], an allergy fiber of the cow milk [93, 108], residing at large cities [119, 133], the burdened family anamnesis [134, 139].

The role of the alimentary factor is extremely significant at preschool age when children receive peep actually identical with adults that mismatches requirements and possibilities of a children's organism. At school age a food of children is often unbalanced concerning the basic alimentary ingredients, children use in nutrition acute seasonings, refractory Adepses at insufficient quantity of vegetables and fruit. An essential role in this age period diet disturbances, long breaks between the food intakes, bound to disadvantages of the organisation of a school food, plentiful meal for the night, the use of superfluous quantity of sweets, the sweet aerated drinks get, some bad habits — elastic chewing, smoking, a hard tightening of a stomach a girdle [2, 5, 6].

One of leading risk factors in constipation development is low consumption of alimentary fibers in a ration of the child [61, 102, 111, 112, 122, 139]. Clinical research by a method a case-control (level dokazatelnosti) has taped communication between constipations and low consumption of alimentary fibers - the relation of chances 4,1 (95 % a confidential interval 1,64 - 10,32) [122].

In development of constipations the psychological factor [94, 109] has the important role. In the research spent Inan with colleagues [109], it has been taped, that at children of school age constipations arose against a physical or psychological trauma, and also in the presence of problems in private life. Probably, psychological factors caused by stressful situations, through vegetative and enteral nervous systems influence an intestine motility that conducts to constipation development.

As the reason of a psychogenic constipation early compulsory (disputed) schooling of the child to a pot can serve. Children of preschool and school age the reason of acutely arisen constipation have not comfortable conditions in a kindergarten or school. Constraining conditions force many children to suppress a reflex on a defecation that leads to inspissation of fecal masses, travmatizatsii a rectum mucosa, to development of a reactive inflammation (the proctitis, a proctosigmoiditis), morbidities at a defecation, arises-fear of a pot ”[21].

According to a number of authors, constipation development at children's age is promoted by the acute intestinal infection caused shigellami, pathogenic strains of an intestinal rod, salmonellas and other bacteria [36, 42, 141,144].

By data gastroenterologicheskogo units Izmajlovsky DGKB of Moscow, the trigger moments in development of an acute constipation more often others were medicamental therapy (antibiotics, antacids, iron preparations, ganglioblokatory, etc.) - 51,8 % and intestinal infections - 34,8 %; a little bit less often - ORVI and a long hyperthermia - 23,7 %.

In the literature there are reports that disturbance of a motility of a colon in 62 % of cases the peptic ulcer, a dyskinesia zhelchevyvodjashchih ways are bound to a pathology of overlying departments of a gastroenteric tract, such as a gastritis, gastroduodenit, a pancreas pathology [53, 79, 82]. Many authors assert, that between a chronic constipation and diseases of other organs of a digestive tube there is a feedback [7, 87, 118, 136, 138]. In the research spent by ShCherba E.G. (2010г.), it has been taped, that at 47,5 % of children with a chronic constipation the pathology of an esophagus and the bottom esophageal sphincter, that on 11,5 % more than their share in structure of diseases of the top departments of a digestive tube [71] is taped.

In a chronic constipation can result a number of endocrine diseases, such as a hypothyrosis, a hyperparathyreosis, a diabetes. Sometimes the constipation is an early and unique sign of a primary hypothyrosis. At a diabetes the motor disturbances of a colon bound to development diabetic nejropatii, pseudo-obstructions or even obstructions of an intestine are quite often registered. Feature of the constipations arising against diseases of endocrine, nervous system, and also toxic and medicinal influences, consists that the chronic constipation is only one of symptoms, and on the foreground accurately there is a clinical picture of a basic disease.

The possible reasons of development of constipations at children are presented in table 1.

Table 1.

The possible reasons of development of constipations at children [152]

According to various researches at children constipations in 95 % of cases are more senior 1 year have functional character [78, 98]. Only at 5 % of children, suffering the constipation, at inspection establishes the organic reasons, such as illness Girshprunga, congenital anomalies of development of anorectal area and a spinal cord [135].

Thus, the reasons of constipations at children are very various, in each case, at statement of the diagnosis and a choice of tactics of treatment, the individual approach to the patient is required.

1.4.