Management of severe constipation in children

Area of Science:

• Pediatric Gastroenterology
• Colorectal Surgery

Background:

• Severe constipation is a frequent pediatric issue, sometimes necessitating hospitalization.
• Identifying organic causes is crucial in pediatric patients with severe constipation.

Purpose of the Study:

• To report the clinical experience in managing children with severe constipation.
• To highlight the diagnostic and therapeutic approaches for pediatric severe constipation.

Main Methods:

• Evaluated 98 children with severe constipation over 5 years.
• Utilized anorectal manometry (ARM), contrast enema (CE), and rectal suction biopsies (RSB).
• Treated anal malformations and Hirschsprung's disease (HD) surgically.

Main Results:

• 98 children (mean age 6 years) were studied; 45 had anal fissures.
• ARM showed normal recto-anal inhibitory reflex (RAIR) in 74/87 patients; 13 had absent/unclear RAIR.
• CE identified 2 positive cases, and RSB diagnosed 2 cases of HD.

Conclusions:

• Severe constipation in children warrants careful evaluation due to the significant incidence of organic causes.
• Fecaloma evacuation is the essential first step in managing these patients.