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Signs and symptoms of slow-transit constipation versus functional retention
Yeon Myung Shin1, Bridget R Southwell, Michael P Stanton
1Department of Surgery, Kosin University, Kosin, Korea.
Insights
Children with slow-transit constipation (STC) and functional fecal retention (FFR) present similarly, but STC more often involves bloating, soiling, and softer stools. Diagnosis requires a nuclear transit study (NTS), not just symptoms.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Pediatric Surgery
Background:
- Slow-transit constipation (STC) is a recently described condition in children.
- Differentiating STC from functional fecal retention (FFR) is crucial for effective management.
Purpose of the Study:
- To determine diagnostic differences between STC and FFR in children.
- To correlate symptoms, signs, transit times, and immunohistochemistry in pediatric constipation.
Main Methods:
- Retrospective study of 180 children with intractable constipation.
- Clinical assessment, nuclear transit study (NTS), and optional laparoscopic colonic muscle biopsy were performed.
- Patients were categorized into STC or FFR groups based on NTS results.
Main Results:
- Bloating and soiling were more prevalent in STC patients.
- STC patients more frequently experienced soft stools and infrequent bowel movements (<1/week).
- Delayed meconium passage (>24 hours) occurred in both STC and FFR groups.
Conclusions:
- Children with STC and FFR share overlapping symptoms and signs.
- Bloating, soiling, softer stools, and prolonged intervals between bowel actions are more characteristic of STC.
- Diagnosis of STC or FFR necessitates NTS; clinical presentation alone is insufficient.
Background/Purpose:
Slow-transit constipation (STC) has been described recently in children. This retrospective study correlated symptoms, signs, transit times, and immunohistochemistry to determine the diagnostic differences between STC and functional fecal retention (FFR).
Methods:
One hundred eighty children with intractable constipation underwent clinical assessment, nuclear transit study (NTS), with or without laparoscopic colonic muscle biopsy. Patients were divided by NTS into those with STC and those with FFR. Parents completed questionnaires on presenting symptoms.
Results:
In 161 patients with STC and 19 with FFR, there were no differences in gender, gestation, or timing of symptom onset. Over 20% had the first meconium delayed more than 24 hours after birth even in FFR (4 of 19). Bloating and soiling were more common in STC. There were no differences between patients with STC but different histology on biopsy. More STC patients had soft stools (39%) than FFR (16%), and a lower stool frequency of less than once a week (STC 26% compared with 11% FFR). FFR was managed more often with medication or diet alone (53%) compared with STC (29%), where enemas, lavage, or surgery were more common.
Conclusions:
Children with STC showed similar symptoms and signs to those with FFR, but more had bloating and soiling, softer stools, and longer intervals between bowel actions. Delayed meconium stool beyond 24 hours after birth was common in both groups. Diagnosis of STC or FFR required NTS and was not possible on symptoms alone.