Functional Constipation in Children-Utility of Repertory of Hering Guiding Symptom

November 15, 2024 admin Homeopathic Repertory 0

Dr Pooja Dongre.

  ABSTRACT

  • FUNCTIONAL CONSTIPATION: It’s also known as chronic idiopathic constipation, it does not have a physical (anatomical) or physiological (hormonal or other body chemistry) causes, it may have a physical neurological psychological or psychosomatic cause
  • Study shows the individual clinical presentation of functional constipation in children. and interpret the related rubrics to constipation in Repertory of Hering guiding symptoms of our Materia medica by Calvin B. Knerr’s repertory.

Key word: Functional constipation, diagnosis, Rome lll and lv, criteria Bristol stool chart, management, chi-square test.

INTRODUCTION
Constipation occurs in all paediatric age groups during stages of life Infant During weaning, Toddler-During toilet training, and school going children .Normal variation in stool leads to over diagnosis of constipation.22 The passage of hard stool can be perceived as painful, and the most frequently reporting event resulting in constipation ,pain led to stool with holding because the child becomes afraid of defecation ,withholding behaviour during infancy include arching the back ,and stiffening the legs ,were older children tightly cross their legs or exhibit other un usual posture. Parents may misinterpret withholding as straining or an attempt to defecate, withholding behaviour can cause contraction of external anal sphincter and gluteal and pelvic floor muscle. The fecal mass than move out of rectal ampulla and back into recto-sigmoid colon were the stool become hard and large, bowel movement become decreased because the rectum accommodates the stool .and urge to defecate goes away. Toilet training is the second most and often reported event leading to functional constipation, it can be a challenge for some parents to toilet their children. Stool frequency depend on the age group

Stool frequency in infants, two recent studies from EURPE (12,1994) healthy children 1-4 months from UK. (5)600 healthy infants from NEATHERLAND have shown that median stool frequency as 1 month of age was 3t/day, and it is significant decreased at 3month of age 2t/day. More-over there was significant difference in stool frequency between breast fed, and formula fed, at 1month of age. 22

The average stool frequency of Indian children is as follows: :<1 month age :3-

4 times/day; 1 month to 1 year age:1.5-2 times/day;1-to-2-year age :1-2 times /day, mostly formed; older than 2-year age :1 time /day [1,2].22

Constipation is common problem in children and it accounts 3% of visits to general pediatric clinics and as many as30%of visits to Pediatric Gastroenterologist in developing countries.

Constipation is common problem during childhood and 0.7-29.6% children are constipated. Nearly the childhood constipation is functional, but 5-10% are due to organic cause.

Constipation is an underestimated but common health problem worldwide.

Discussion:

  • Functional constipation is a common condition in childhood with significant impact on patient quality of life and on health care resources,
  • It is characterized by decreased bowel movements and /or hard stools, which cause significant distress for children and their caregivers.

Age– The study shows that, maximum incidence of functional constipation was seen in the age group of (2-9) Years, in toddlers and Pre-adolescence, minimum incidence was seen in the age group of (10 – 15).

 Sex : Maximum incidence of functional constipation seen in female children, total 36female children out of 60.

Presenting complaints : presenting complaints includes the frequency and character of stool,

The character of stool was considered according to the Bristol stool chart –

Character of stool –

  • character of stool is Hard, lumpy and large stool in 40 cases, BRISTOL STOOL CHART (TYPE 1) (stool and rectum: Stool; large to, (Stool and rectum: stool: large), hard 
  • Hard, dry scanty stool in 15 cases, BRISTOL STOOL CHART (TYPE 2), (Stool and rectum: stool: hard stone like) and soft pasty liquid stool was found in 5 cases (stool and rectum: stool: hard pasty then liquid)
     (Stool and rectum) stool: Hard one, (stool and rectum):

Frequency of stool: This study shows that incidence of maximum frequency of stool was 3Times /w, in 50 cases,2Times /w in 40 cases, liquid pastry stool seen in 10 cases,

Past history: in this study past history shows H/O- Bottle fed and breast-fed children

Ailment from:

Incidence of maximum ailment form was seen in

  • Functional constipation, after, toilet training seen in 4cases, the rubric considered (Stool and rectum: constipation: mental condition fear fright from or fear),
  • (PAIN COMPLES CHILD TO DESIST FROM THE EFFORT*): l Ign, l Lyc,
  • Prolong abuse of purgative, seen in 9 cases, considering the rubric (STOOL AND RECTUM: CONSTIPATION AFTER ABUSE OF CATHERTICS)
  • (Stool and rectum constipation: Bowel will not move without the aid of purgatives: Hard, dry, long, Dogs stool resemble like),
  • After the attaché of malaria seen in 2 cases (stool and rectum): constipation: fever with intermittent after abuse of quinine,)

Accompanying symptoms:

in this study the accompanying symptoms was considered,

  • Chronic constipation with headache seen in 3, cases, the rubrics considered for this (STOOL AND RECTUM: constipation: headache)
  • Constipation with colicky, seen in 2cases, (Stool and rectum: constipation with colicky),
  • constipation with offensive breath seen in 2 cases (Stool and rectum; constipation breath offensive),
  • constipation bronchitis in seen in 1 case (stool and rectum bronchitis in),
  • Constipation in fat flabby children were 7 (stages of life and constitution: age: children in fat flabby) and (Stool and rectum constipation; in children)
  • The rubric which used (Stool and rectum): constipation after failure of nux-v, sulphur) in 1 case,
  • Severe hardness of stool the rubric use (stool and rectum: manual assistance must be done), in 2case.
  • Due to heat of weather constipation with dry mouth (Temperature and weather: warmth air hot aggravation), Taste and tongue (Dry: constipation in). In 5 cases.
  • (Stool and rectum: constipation: torpidity offensive breath): In 2cases.
  • constipation with nasal catarrh (Stool and rectum): nasal catarrh in. in 1case.

Conclusion

  • Childhood constipation is common healthcare problem word wide.
  • The diagnosis is based on the history and physical examination in accordance with Rome lll criteria.
  • Homoeopathy is holistic system of medicine which deals with any disease condition based on individualized and symptom similarity homoeopathy has got good scope in treating constipation in children
  • This study revels that, Maximum incidence of functional constipation seen in female children, 36 cases (60%) out of 60, Under the age group of (2-9 year ).
  • The remedies selected through the Hering guiding symptoms of our materia medica was significantly effective in the management of functional constipation in children.
  • Rome lll criteria and Bristol stool chart helped in diagnosing the functional constipation.
  • The potency used frequent was 200th Which helped in the management of constipation.
  •  R ecovered40 Cases (67%),14 cases 15 Cases Improved (23%),5 cases not improved (10%) Out of 60Case.

 Reference

  1. Jojanneke e.g., Van summeren gea A. holtmN, and marjolein y. berger Management OF FUNCTIONAL CONSTIPATION IN PEDITRIC BASED ON NURSE EDUCATIONALINTERVENTION. 2021 https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30064408 1
  2. Shaman rajendrajith, niranga manjuri deva Narayana, Bonaventure jayasiri crispus perera, marc alexadar benninga physiotherapy plus conventional treatment versus conventional only in the treatment of functional constipation in children: design of a randomized controlled trail and cost effectiveness study in primary carehttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30064408/
  3. Jeong eun shin, hey -Kyung Jung and the clinical management guideline group under Korean societyhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930295/ Guidelines for the diagnosis and treatment of chronic functional constipation in Korea ,2015 revised edition
  4. Yu-Cha Hsiao, Jen-hung wang, Chia-Ling Chang Hsieh, Ming Chun Chen, Publication: 2020 Jan 28, Association between constipation and childhood nocturnal enuresis in Taiwan; a population -based matched case -control studyhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986027/#
  5. Ivana RDos SANTOS et al. Paediatric child health ,2021 Jul https://doi.org/10.1111/jpc.15368
  6. Marcela Barros Barbosa de oliverira et al.J. Pediatric gastroentrol 2021 https://doi.org/10.1097/MPG.0000000000003163
  7. DR M.T. SANTWANI Common ailments of children and their management chapter 49
  8. DR. RUDDOCK Homoeopathic treatment of infants and children 201chapter
  9. .Tomas Wester Functional constipation in children: the paediatric surgeons perspective. https://doi.org/10.1007/s00383-013-3354-
  10. Calvin B.  Knerr. Hering Guiding symptom of our materia medica .

Dr Pooja Dongre BHMS MD
Department of physiology and biochemistry
AGM Homoeopathic Medical College Hubli.
Email : Poojadongre 2905@gmail.com