Although the cause of the constipation is an improper diet, most parents and even the doctors will insist on giving only laxatives or purgatives and not bother to correct the quality of the diet. One of the things that I enquire in detail when parents bring a child with constipation is about the dietary intake per day. In almost 90% of cases this will be the cause of the constipation. Correction of the diet is easier said than done. To begin with I prefer to divide the diet into 3 components: one that must be eaten on a daily basis; the second part is one that may be eaten over and above the first part; and the third component is a list of eatables that are not to be given to the child at all under any circumstances for at least a month. The parents, grandparents, uncles and aunts are strictly forbidden from interfering in the supervision of the childs diet, all in the house have to be very strict about what the child is allowed to eat or not, though it may seem cruel at times. The child soon realizes that if I don't eat the food being given to me, I may have to starve, so, I might as well eat what is given and make the best of it. The first component consists of eating adequate quantity of vegetables, salads and dals for lunch and dinner. In between lunch and dinner the child is given all fruits to eat. Over and above this compulsory component is the second one that the child may have is roti, rice and bread daily but not at the cost of the first. Also the child may be given non vegetarian food if desired like meat eggs, chicken. The last component is those foods that are to be avoided like chocolates, biscuits, chips and other miscellaneous food. Under strict supervision and a regular follow up, some stool softeners are given together with digestives. However, once the diet is normal and balanced, these medications are discontinued. The time required from starting the therapy to successful completion may vary from months to years depending on an individual child and the family.

In some children with constipation from birth, that persists despite proper diet, a local cause must be looked for or, a systemic disease. A common complaint by the parents would be that the child cries a lot when passing stool and there may be some blood in the stool at times. This is caused by a split in the tender skin just at the edge of the anal opening called a Fissure. The crack in the skin is highly painful and passage of hard stool makes it worse. The child gets pain during defecation and hence tries to hold back the stool, this in turn makes the stool dry and harder than before and therefore when passing such a stool with pressure, the anal opening has to open wider and also the fissure gets stretched and pains and the cycle continues unless broken. In such children the ideal initial therapy is to apply local anesthetic cream or gel to the peri anal area to anesthetise the fissure, take away the pain and the fear of the pain, let the child pass stool painlessly and freely. Once the rectum gets emptied well, the child regains appetite, eats well, passes soft stool and the fissure heals. In some children, this may not work and the child gets a spasm or continuous contraction of the sphincter due to the pain. In such cases I take the child under anesthesia and stretch the sphincter to break the spasm, allow the child to pass stool without the spasm causing constipation and give rest to the fissure allowing it to heal.

There are a few children who are born with an abnormal intestine mainly the large intestine. In this condition, there is an absence of a type of cell known as Ganglion cell in the intestine of the child. The passage of food in small intestine and passage of feces in large intestine is based on segmental peristalsis pushing the bolus forward. There is a contraction of the segment containing the bolus and this is followed by relaxation to allow the next bolus to enter the intestinal segment, and this goes on. In children with absence of Ganglion cells (Aganlionosis), this ability to relax a segment of the intestine is lacking, hence the large intestine containing the fecal matter reaches a point till Ganglion cells are present, and then the intestine is in a permanent state of contraction with no relaxation to allow the next bolus to come in and hence the child goes into constipation. The segment of intestine that is abnormal may vary from a very small segment to at times the entire large intestine. In such children, there is no easy therapy other than removal(excision) of the diseased segment of the intestine. In this disease called Hirschprung Disease, the abnormality starts from the anal opening and progresses upwards to give the length of the abnormal segment. Thus removal of the abnormal segment has to followed by bringing the normal intestine down to the anal opening to form a new rectum that is free from disease. Thus this condition needs an accurate diagnosis before proceeding for the correction.