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Your child's health care provider will
ask many questions about the child's medical history,
toilet training history, diet, lifestyle, habits, medications,
and behavior. A thorough physical examination will be done
to assess the child's general health as well as the
status of the colon, rectum, and anus. The examiner may
insert a gloved finger into the child's rectum to
feel for stool and to make sure the anal opening and rectum
are of normal size and that the anal muscles are of normal
strength.
In most cases, blood tests are not part of
the evaluation of constipation and/or encopresis. In some
cases,
an x-ray
of the child's abdomen or pelvis is performed to
determine how much stool is present in the colon and assess
if the colon and rectum are enlarged. Occasionally, a barium
enema is performed. This is a special type of x-ray. A
small tube is inserted into the child's rectum, and
the colon is slowly filled with a radiopaque dye (barium).
X-rays are taken throughout the procedure to see if areas
of narrowing, twisting, or kinking in the lower intestine
are causing the child's symptoms.
In some cases,
anorectal manometry may be performed. With this test, a
small tube is inserted into the child's rectum.
The tube has several pressure sensors in it. During the
test, the doctor can determine how the child is using his
or her abdominal, pelvic, and anal muscles during defecation.
Many children who have chronic constipation and/or encopresis
do not use their muscles in a coordinated fashion during
bowel movements.
The main objective of manometry is to
confirm increased pressure within the anus. Manometry can
also show whether
the nerves controlling the anal sphincter, anus, and rectum
are present and working by measuring reflexes in this area.
Manometry can measure how far the rectum is distended and
whether sensation in this area is normal. Abnormal contractions
of the muscles in the pelvic floor can be documented by
using manometry.
Anorectal manometry can also be helpful to
rule out Hirschsprung disease, a very rare cause of constipation
without encopresis.
If Hirschsprung disease is seriously considered as a cause
of your child's constipation, a biopsy of the rectum
may be necessary. A biopsy is the removal of a very tiny
piece of tissue for examination under a microscope. This
is done to look for characteristic signs of Hirschsprung
disease in the tissue.
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