Your report and quotes in it from Prof Monica Lakhanpaul emphasise the health burden and personal misery for young people and their families due to constipation and related complications (Primary-age child constipation rates up 60% in England, 18 February). Meanwhile, the services to prevent or treat this problem remain utterly inadequate across the UK.
Unless constipation is addressed early and effectively, some children can rapidly develop a “megarectum”. They lose the sensation that might give them the urge to defecate when necessary. This, combined with behavioural problems inherent in this presentation, can lead to overflow soiling and chronic faecal incontinence.
When matters reach this state, it takes an expert team of clinicians and therapists months or years to help tackle it. In most parts of the UK, these services are poorly resourced or absent, so the problem carries on indefinitely.
This is never discussed. The child lives in a secret state of shame. They are socially isolated and cocooned from normal childhood perks. They are reluctant to take part in activities such as sport or school trips, or even visit other people’s houses. Even if the problem is resolved, some are psychologically scarred for life and are unlikely to fulfil their potential.
Dr Ieuan Davies
Consultant paediatric gastroenterologist
• While there is no doubting the several contributory factors mentioned in your report and the article published with it (Laxatives and nappies: how schools are coping with constipation in pupils, 18 February), little emphasis seems to be placed on the importance of exercise or the causatory effect of hours spent sitting in front of a screen, often alone in a bedroom.
Life is difficult for parents, more so since the pandemic, but there are basic tasks that they should not be falling behind on unless there are barriers that require additional help. Toilet training is one, along with dressing and eating in socially acceptable ways, and regular, meaningful communication – even pre-birth. The number of parents glued to a phone rather than communicating with their child is worrying and depressing, and can only have deleterious effects on the development of youngsters.
Jacqueline Simpson
Retired teacher, Leeds
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