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Management of childhood constipation
1Guy's, King's, St Thomas' School of Medicine, Paediatrics, St Thomas' Hospital, London, UK. graham.clayden@kcl.ac.uk
Insights
Childhood constipation involves physical and psychological factors, creating difficult cycles of stool retention and pain. Effective management requires understanding these interactions and employing medical, psychological, and surgical strategies.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
Background:
- Childhood constipation often stems from a cycle of physical pain and psychological fear, leading to defecation avoidance.
- This avoidance results in increased fecal retention, rectal distension, and the repeated passage of hard stools.
- Overflow incontinence exacerbates the problem, causing significant distress in older children.
Purpose of the Study:
- To review the interplay of physical and psychological factors in childhood constipation.
- To outline current medical, psychological, and surgical management strategies.
- To provide the rationale behind these therapeutic approaches.
Main Methods:
- Literature review of pediatric constipation management.
- Analysis of the interaction between physical and psychological elements.
- Synthesis of evidence for medical, psychological, and surgical interventions.
Main Results:
- Identified a vicious cycle of pain, fear, retention, and incontinence in pediatric constipation.
- Highlighted the importance of addressing both physical and psychological components for effective treatment.
- Summarized various management strategies and their underlying principles.
Conclusions:
- Effective childhood constipation management necessitates a holistic approach addressing physical and psychological aspects.
- Understanding the cycle of avoidance and retention is crucial for successful intervention.
- Integrated medical, psychological, and surgical strategies offer comprehensive care options.
Abstract:
The effective management of constipation in childhood requires an understanding of the ways that the physical and psychological factors interact. The early difficulty with defecation that leads to pain, fear, and refusal to use the pot or lavatory often progresses to the formation of vicious cycles of increasing faecal retention as the rectum increases in capacity and the experience of passing large, hard stools is repeated. There is increasing distress as overflow faecal incontinence compounds the problem for the older child. The medical, psychological, and surgical management strategies are reviewed together with the rationale for their use.
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