Thursday 22 February 2018

Tackling constipation and ear infections

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

Advice from our GP about tackling constipation in a young person and on how to deal with an outer ear infection.

Question: My three-year-old seems to be severely constipated. His diet is okay but he is a fussy eater. I have given laxatives and these help but I am worried about using them.

Dr Nina replies: Constipation is the infrequent passage of hard stool. Normal stool should have the consistency of toothpaste and be the size of a banana. Constipated stool is usually hard, small and pellet-like.

The most common cause of constipation is poor diet and an inactive lifestyle. Another common cause in young children is holding onto stool due to issues around toilet training or fear of using a toilet at school or away from home. More rarely illness or medication may play a role.

If there is a sudden change in bowel habits that lasts longer than two weeks or, if there is blood in the stool or severe pain, it is essential to see a doctor. If constipation is a more indolent, chronic problem then it is worth trying a few remedies at home.

The first thing to do is increase the amount of fibre and fluid in your child's diet. Most children don't get anywhere near the 20g or so of daily fibre that is recommended. Increase this gradually, as if you do it rapidly they may experience abdominal bloating and cramping due to increased wind.

Getting a young child to drink plenty of water can be difficult but it is an important part of the treatment of constipation.This is needed to flush stool through the bowel. Incorporate exercise and activity into the daily routine as this helps keep the bowel moving well. It is important that your child doesn't ignore the urge to go to the toilet. Having a regular toilet routine really helps. The bowel reflex is strongest after eating a meal so try sitting them on the toilet within 30 minutes of this. Squatting in the right position is also important. Some toilets can be quite high off the ground. Using a footstool to lift little feet may help promote a natural bowel movement. Allow a child to spend about 10 minutes on the toilet to ensure they have fully emptied their bowel.

Toilet training can be a particularly risky time for constipation. It is important that this doesn't become stressful for a child. Some find the toilet scary so using a potty, rather than a training seat, may help. Reading a favourite book or singing songs may allow the child to relax and allow natural bowel stimulus to function more easily.

Don't scold your child for soiling pants or requiring nappies. This will most likely result in holding onto stool and further constipation. A reward chart may help for some.

Certain foods can help encourage gut motility. Prunes are a common remedy. Many fruits are also high in fibre. Apples, pears, dried fruits and berries are a particularly good source of fibre in a tasty accessible way.

Laxatives have a role particularly in initiating bowel movement in cases of constipation. There are a number of types. Some bulk up the stool (ispaghula), others stimulate the bowel (bisacodyl) and others retain fluid in the gut (lactulose or polyethylene glycol). Talk to your pharmacist or doctor.

It is important to note that constipation and the behaviour associated may take a long time to resolve in young children so persisting with lifestyle change and using treatment for several months may be necessary.

Question: My ear is itchy and irritated lately. I keep trying to clear it out but it doesn’t help. I don’t have a cold or anything and I haven’t been swimming lately. What causes this, and what can I do to get rid of it?

Dr Nina replies: It sounds like you might have an outer ear infection. The outer ear runs from the outside of the head to the eardrum. Infections here are called otitis externa (OE).

The main symptom of OE is pain. Other symptoms can include itching, ringing in the ear, a feeling of fullness or reduced hearing and discharge. Rarely, there may be fever, redness of the ear and face, or swelling of the lymph nodes in the neck.

The outer ear normally protects itself by producing cerumen (wax). This is slightly acidic and limits the growth of bacteria and fungus. Wax helps trap dirt and debris and clears it from the ear canal by moving it to the outer part of the ear. OE is more common when the natural barriers in the ear canal are disrupted. This can occur when water is trapped in the ear canal. This condition is more common in those who take part in water sports. Water can also get trapped in the ear when showering. The passage of shampoo into the ear canal can further disrupt the natural pH. Humid weather increases ear moisture and can increase the risk.

Overzealous cleaning is not advised. Cotton buds or hair grips can damage the skin lining of the ear canal, making infection more likely. The presence of foreign bodies in the ear makes it easier for infection to take hold. The use of earplugs, headphones and hearing aids make OE more likely. Lastly, conditions that irritate or inflame the skin of the ear, such as dermatitis and psoriasis, can also lead to otitis externa.

Once an infection takes hold, it is due to a bacterial or fungal infection in the majority of cases. See your doctor for diagnosis and treatment. Infections normally resolve over five to seven days.

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