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Occult constipation: faecal retention as a cause of recurrent abdominal pain in children
Carolien F M Gijsbers1, C M Frank Kneepkens, Yvonne Vergouwe
1Department of Pediatric Gastroenterology, Juliana Children's Hospital/Haga Teaching Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands, cfm.gijsbers@planet.nl.
Insights
Constipation, often hidden, significantly contributes to recurrent abdominal pain (RAP) in children. Identifying key predictors like cystitis history, early satiety, and flatulence aids in diagnosing and treating children with RAP effectively.
Area of Science:
- Pediatric Gastroenterology
- Functional Abdominal Pain Disorders
Background:
- Recurrent abdominal pain (RAP) in children is frequently presumed functional.
- Many children with RAP achieve pain relief through laxative therapy, suggesting underlying constipation.
Purpose of the Study:
- To determine the prevalence and role of occult constipation in pediatric RAP.
- To identify historical and physical examination predictors for diagnosing occult constipation in children with RAP.
Main Methods:
- A 2-year prospective study included 200 children (age 4-16) meeting Apley criteria for RAP.
- Exclusion of infections and food intolerance; laxatives were administered for persistent pain.
- Occult constipation defined by pain resolution with laxatives and no recurrence within 6 months; Rome criteria were not met.
Main Results:
- Occult constipation was identified in 46% (92/200) of children with RAP.
- A multivariate model identified past history of cystitis, early satiety, and flatulence as significant predictors.
- The risk of occult constipation increased significantly with the presence of these predictors.
Conclusions:
- Laxative therapy is crucial for resolving RAP in children with underlying constipation.
- A simple predictive model effectively identifies children at risk for occult constipation, guiding targeted treatment.
Unlabelled:
Recurrent abdominal pain (RAP) in children is generally believed to be functional. In practice, many children with RAP become pain-free with laxative therapy. The aims of the study were to establish the role of (occult) constipation in RAP and to investigate whether patients diagnosed with (occult) constipation could be identified by history and physical examination. During 2 years, all patients (age 4-16 years, secondary referral) fulfilling Apley criteria of RAP were included. After exclusion of gastrointestinal infections and food intolerance, laxatives were advised when pain persisted. (Occult) constipation was defined as 'abdominal pain disappearing with laxative treatment and not reappearing within a 6 month follow up period'; 'occult constipation' was diagnosed in patients who did not fulfil the Rome criteria of constipation. Two hundred children (87 M; median age 8.8 years) were evaluated. (Occult) constipation was found in 92 patients (46 %). Of these, 18 had considerable relief of pain when treated for a somatic cause but experienced complete relief only after laxative measures; they were considered to have two diagnoses. Using multivariate analysis, a simple model was developed with cystitis in past history, early satiety and flatulence as predictors for (occult) constipation. The risk of (occult) constipation ranged from 18/58 if no predictor was present to 4/4 if all three were present.
Conclusion:
Laxatives played a pivotal role in the recovery of patients with RAP. We developed a simple model to identify patients at risk of having (occult) constipation.
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