Comparison of the frequency of obsessive-compulsive disorder in children with and without functional constipation referred to the pediatric clinic of Amirkabir Hospital in the year

Dissertation for receiving a professional doctorate degree in the field of medicine

Persian abstract

Title: Comparison of frequency of obsessive-compulsive disorder in children with and without functional constipation referred to the pediatric clinic of Amirkabir Hospital in 2013

Introduction: Constipation in childhood is a common problem that causes discomfort to the child and parents due to the occurrence of symptoms such as delay in defecation, difficulty in defecation and incontinence due to the formation and retention of dense masses of fecal matter in the rectum. Obsessive-compulsive disorder is a complex neurological-psychiatric syndrome whose main characteristic is unwanted, repetitive and disturbing thoughts as well as repetitive and annoying behaviors and the ritualization of obsessive actions that are done in order to avoid anxiety or neutralize obsessive thoughts. The aim of the present study is to investigate the prevalence of obsessive compulsive disorder in children with functional constipation disorder.

Methodology: 97 children aged 4 to 18 years with functional constipation (case group) and 97 healthy children (control group) referred to Amirkabir Arak Hospital were included in the study. The above-mentioned patients did not have any underlying problems, chronic diseases, structural problems, or drug use, and they were matched with the control group in terms of sex, age, and demographic information, and after filling out the relevant questionnaire, the obtained information was entered into the SPSS statistical software and analyzed. Findings: In the frequency distribution of obsession-algebraic levels based on the foa questionnaire in the children of the case group, 56.7% had mild obsessive-compulsive disorder and 43.2% had mild obsessive-compulsive disorder. In the control group, 76.2% did not have obsessive-compulsive disorder and 23.7% had weak obsessive-compulsive disorder, which according to P value = 0.001, there was a statistically significant difference between the two groups of cases and controls. The results of our study generally showed that obsessive-compulsive disorder was more common in children with functional constipation, and it is possible to help them recover more by treating mental problems in children with resistant types of constipation.

Key words: obsessive-compulsive disorder - children - functional constipation

1- Expression Problem

Constipation can be defined as having a bowel movement longer than normal (less than three times a week), or insufficient bowel movement. In the normal state, the rest of the food consumed in a breakfast reaches the large intestine the next morning, the act of excretion usually takes place 12 to 72 hours or a little more after consuming the food. The type of food you eat has some effect on the duration of excretion. For example: foods rich in fiber resist the digestive enzymes during the digestion process and become bulky by absorbing some water, which itself stimulates the act of excretion (1). Defecation

b) Hard and dry stool

c) Feeling of incomplete emptying after defecation

d) Defecation twice or less per week

Symptoms such as a feeling of fullness in the anus, a feeling of bloating and gas, a feeling of needing to defecate immediately but not being able to defecate completely, abdominal pain and Abdominal muscle cramps and nausea may also be present along with constipation (2).

Constipation in childhood is a common problem that causes symptoms such as delay in defecation, difficulty in defecation, and incontinence caused by the formation and retention of dense fecal masses in the rectum, causing discomfort to the child and parents and incurring medical expenses.

Foods and liquids They begin their long journey in the digestive system by passing quickly from the mouth to the stomach.The stomach muscles relax to accommodate the swallowed food, but liquids enter the small intestine within 20 minutes and solids a few minutes later. Although this process begins in the stomach and mouth, most of the digestion process takes place in the small intestine.  As food and fluids enter the bloodstream, the intestinal contents become more compact and rigid (3).

The intestinal wall has muscles that contract rhythmically and push the food forward. A huge network of nerves coordinate these contractions and different hormones regulate this process (3).

In healthy people, it takes about six hours for food to pass through the small intestine. The food then enters the large intestine (or colon). Excess water from food is absorbed in the large intestine, and the millions of bacteria that live there give it the characteristic smell and color of the stool (1).

Involuntary contractions of the muscles of the colon wall push the food contents forward through it. The time required for substances to pass through the colon is different and in healthy people it reaches 18 to 20 hours on average.

Then it is the turn of the right intestine at the end of the colon. The large intestine is able to store a large amount of stool. When the rectum is full of stool, it signals the need to empty. In this case, the two muscle rings that close the anus and prevent material from leaking out, start to relax. At the same time, the muscles of the large intestine contract to push the stool out, and the voluntary contraction of the abdominal muscles facilitates this. Disturbance in this complex process can cause many problems (3).

Most causes of constipation are related to lifestyle, especially insufficient amount of fiber in food and lack of exercise.

Of course, in some cases, an underlying disease slows down bowel function. Although constipation can be caused by a serious disease, it is not considered a health risk by itself (4). rtl;"> Medicines including aluminum-containing antacids, "calcium channel blockers" drugs such as Adalat, which are used to treat high blood pressure, antihistamines or anti-allergic drugs, tricyclic antidepressants such as imipramine, narcotic drugs such as codeine, non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, etc., anticholinergic and anti-inflammatory drugs Parkinson's.

Food supplements, including iron and calcium supplements.

Endocrine diseases including diabetes and hypothyroidism.

Metabolic disorders, such as low potassium levels and high blood calcium levels.

Diseases Neurological such as MS or multiple sclerosis, Parkinson's and spinal diseases.

Psychological disorders including depression and anxiety.

Intestinal diseases including tumors, irritable bowel syndrome, inflammatory bowel diseases, narrowing of the excretory canal (due to ulceration) and rectal diseases (5).

Constipation itself does not cause serious illness. But straining can cause complications in the intestine that are accompanied by pain. Hemorrhoids are the most common of these complications. Hemorrhoids are swollen veins that can cause bleeding from the anus. In case of blood clots, they experience severe pain. Straining with hard stools can tear the anal tissue and create a fissure or fissure (5).

Fissures are so painful that patients refuse to defecate to escape the pain. In older men and women, hard, dry stools can accumulate in the rectum and prevent normal bowel movements. Straining can also cause rectal tissue to come out of the anus. This condition, which is called rectal prolapse, may require surgical treatment. Low-fiber foods, which generally cause chronic constipation, are associated with diverticulosis and diverticulitis.