Clinical Features of Severely Constipated Children: Comparison of Infrequent Bowel Movement and Fecal Soiling Groups
Gyung Lee1, Jae Sung Son1, Sun Hwan Bae1
1Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea.
Insights
Infrequent bowel movements and fecal soiling in children indicate advanced chronic functional constipation. These conditions are associated with later onset and longer symptom duration, often requiring PEG 4000 treatment.
Area of Science:
- Pediatric Gastroenterology
- Clinical Research
- Digestive Health
Background:
- Chronic functional constipation is a common pediatric issue.
- Infrequent bowel movements and fecal soiling are key symptoms.
- Understanding their clinical features is crucial for effective management.
Purpose of the Study:
- To compare clinical features, diagnostic findings, and medications in children with infrequent bowel movements and/or fecal soiling.
- To differentiate between constipation with and without soiling.
- To analyze subgroups based on the presence of fecal soiling.
Main Methods:
- Retrospective analysis of 333 children diagnosed with functional constipation (Rome III/IV criteria).
- Classification into groups based on bowel movement frequency and fecal soiling.
- Data collected included clinical characteristics, colon transit time (CTT), and medications.
Main Results:
- Children with fecal soiling only (G3-c) were older and had later onset and longer symptom duration.
- Fecal soiling (G2-b) was associated with later onset and longer symptom duration compared to no soiling (G2-a).
- Polyethylene glycol 4000 (PEG 4000) use was significantly higher in children with fecal soiling (p<0.0001).
Conclusions:
- Infrequent bowel movement and fecal soiling represent an advanced stage of chronic functional constipation.
- These symptoms are linked to later onset and prolonged disease duration.
- Treatment often involves medications like PEG 4000, particularly in soiling cases.
Purpose:
To compare the clinical features, diagnostic findings, and medications of children with infrequent bowel movements or fecal soiling.
Methods:
This study enrolled 333 children (189 male; age range, 1 month to 18 years) diagnosed with functional constipation by Rome III or IV criteria. We classified them into 3 groups (infrequent bowel movement without fecal soiling [G3-a], infrequent bowel movement with fecal soiling [G3-b], and fecal soiling only [G3-c]) and into 2 subgroups of fecal soiling (G2-b) or not (G2-a). Retrospective data on clinical characteristics, colon transit time (CTT) test results, and medications were collected. The Wilcoxon rank-sum test, Kruskal-Wallis test, Chi-square test, and Fisher's exact test were used for the statistical analysis.
Results:
The median age (months) and interquartile range (IQR) was 33 (45) in G3-a, 54 (40) in G3-b, and 73 (48) in G3-c (p<0.0001). G3-c had the latest onset (median, 18; IQR, 18; p=0.0219) and longest symptom duration (24 [24], p=0.0148). PEG 4000 was used in 60.6% (G3-a), 96.8% (G3-b), and 83.2% (G3-c) of patients (p<0.0001). The median age (months) and IQR were 33.0 (45.0) in G2-a and 63.5 (52.5) in G2-b (p<0.0001). G2-b had later onset (median, 12; IQR, 19.5; p=0.0062) and longer symptom duration than G2-a (24 [12], p=0.0070). PEG 4000 was used in 60.6% (G2-a) and 88.3% (G2-b) of children (p<0.0001). No statistically significant intergroup differences were seen in maintenance laxative dose, CTT, or CTT type.
Conclusion:
Infrequent bowel movement and fecal soiling represent the advanced stage of chronic functional constipation.
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