Is Lockdown Good for Constipation?

ABSTRACT

Background Children's routines have been disturbed during the last 2 years due to national lockdowns with school closures. It is acknowledged that daily routine is important for a healthy bowel habit and we therefore had concerns that this may have a detrimental effect on children with constipation. Aim of Study To examine the effects of lockdown due to COVID19 on children's symptoms of constipation. Method Prospective data was obtained by questionnaires, which were handed to 50 children and parents attending a childhood constipation clinic in the normal way following the easing of lockdown. The questionnaires asked about symptoms that would normally be asked in the clinic appointments. Parents were asked if the child's symptoms had become worse, improved or stayed the same and asked respondents to give reasons for their answers. The questionnaires were then collated and common themes noted. Ethics approval was not required. Results 38% of parents reported improvement in symptoms 34% of parents reported deterioration in symptoms 28% of reported no change in symptoms. The reasons given for improvements in symptoms included an increase in the ability of parents to monitor children's fluid intake and toileting routines at home, easier access to toilets and less with holding behaviour, usually adopted to avoid using school toilets. These children were also reported as being generally more relaxed and happier to be at home. Of note in this group were reports that symptoms often deteriorated on returning to school. The reasons given for a deterioration in symptoms included a lack of physical activity, lack of routine in toileting and taking medication, and changes in diet. This group also commonly included reports of children and parents experiencing anxiety, isolation, anger and lack of motivation. The most common symptom to be reported as problematic was children either beginning to soil or their soiling becoming more frequent. Most who gave reasons in the group reporting no change did recognise some of the above observations and in some cases positive aspects such as easier access to toilets were counterbalanced by lack of exercise. Summary Many reasons for changes in symptoms of childhood constipation during the national lockdowns were reported. There was a balance, with almost equal numbers, reporting improvements and a worsening of symptoms. Others did not notice any change in their child's condition. Physical, behavioural and emotional reasons were cited as being responsible for changes in children's experience of constipation. Conclusion Lockdown due to COVID19 has had a varied effect on symptoms of constipation in children. The assumption that children's constipation would become worse has been challenged in that slightly more children improved during this time with some then deteriorating again when lockdown was eased. These results re-iterate the need to tailor approaches to treatments and care of children with constipation on an individual basis. It is also important to equally understand the anxieties of being in school for some but the effects of social isolation and uncertainty for others.