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5. Constipation and toileting issues in children
1Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia. tony.cattosmith@rch.org.au
Insights
Functional constipation is common in children, often starting with painful defecation. While treatable with behavior changes and laxatives, long-term relapse is more likely in young children with a history of soiling.
Area of Science:
- Pediatric Gastroenterology
- Child Health
- Functional Gastrointestinal Disorders
Background:
- Constipation affects a significant percentage of children, with most cases being functional.
- Functional constipation in children is often initiated by painful defecation, leading to faecal retention.
- Faecal soiling is a common secondary symptom resulting from rectal distension and sphincter relaxation.
Observation:
- Pediatric constipation management typically involves behavioral modification and extended laxative use.
- Treatment duration for constipation in children can range from 6 to 12 months.
- While initial treatment is often successful, a notable proportion of children experience long-term relapse.
Findings:
- Long-term relapse of constipation is more prevalent in children diagnosed before the age of 4.
- Children with a history of faecal soiling alongside constipation exhibit higher rates of long-term relapse.
- Early onset and associated soiling are key indicators for predicting long-term treatment challenges.
Implications:
- Understanding risk factors for relapse is crucial for optimizing long-term management strategies in pediatric constipation.
- Early identification of children at high risk for relapse can guide proactive interventions.
- Further research into the underlying mechanisms of functional constipation and relapse is warranted to improve patient outcomes.
Abstract:
Constipation is common in children, with prevalences ranging from 0.3% up to 28%. In most children, constipation is functional (ie, without objective evidence of a pathological condition). Painful defecation has been proposed as the primary precipitant of functional faecal retention in early childhood. Faecal soiling is often secondary to constipation, and may occur during spontaneous relaxation of the sphincters precipitated by rectal distension. Management in general practice combines behavioural modification techniques with prolonged courses of laxatives. Treatment is usually successful, but may take up to 6-12 months. Significant numbers of children with initially good responses to therapy for constipation relapse in the long term. Long-term relapse is more frequent in children under 4 years at onset of symptoms and in whom there is a history of faecal soiling associated with constipation.
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