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Treatment Options for Refractory Childhood Constipation
Nader N. Youssef1, Carlo Di Lorenzo
1Children's Hospital of Pittsburgh, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, PA 15213, USA. Carlo.DiLorenzo@CHP.edu
Insights
Childhood constipation is common, with most cases resolving within two years using therapies or behavioral changes. Persistent constipation requires further evaluation to identify causes and guide treatment strategies.
Area of Science:
- Pediatric Gastroenterology
- Child Health
Background:
- Childhood constipation is a prevalent condition affecting many families.
- Untreated constipation can lead to fecal incontinence, impactions, and emotional distress.
- Refractory constipation significantly impacts a child's daily life and family well-being.
Purpose of the Study:
- To outline the classification and management of persistent constipation in children.
- To emphasize the need for thorough evaluation in refractory cases.
- To discuss diverse therapeutic approaches for pediatric constipation.
Main Methods:
- Categorization of persistent constipation into functional, enteric neuromuscular disorders, or neurologic handicaps.
- Review of current and novel treatment strategies.
- Emphasis on comprehensive diagnostic evaluations for complex cases.
Main Results:
- Approximately 70% of children achieve successful outcomes within two years with standard therapies.
- Persistent constipation necessitates advanced medical and behavioral interventions.
- Some children may benefit from surgical interventions for refractory constipation.
Conclusions:
- Effective management of childhood constipation often requires tailored, aggressive interventions.
- Understanding the underlying cause is crucial for successful treatment.
- A range of therapeutic options, including novel approaches, are available for pediatric constipation.
Abstract:
Constipation in children is very common. Childhood constipation responds successfully to medical therapies, behavioral modifications, or a combination of both in approximately 70% of children within 2 years of diagnosis. Persistence of constipation is associated with fecal incontinence, recurrent fecal impactions, and significant emotional problems. Refractory constipation that interferes with both the child's function and the family's life requires extensive evaluations in order to uncover its cause and devise appropriate therapeutic strategies. Children with persistent constipation can be divided into three broad categories: 1) those who have functional constipation, 2) those affected by enteric neuromuscular disorders, and 3) those whose constipation is associated with neurologic handicaps. Treatment options vary widely. The majority of patients require more aggressive medical and more intense behavioral interventions. Others benefit from novel approaches, including surgical intervention.
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