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Updated: Dec 21, 2025
Electroacupuncture Combined with Chinese Medicine Ironing Therapy for Functional Constipation
Published on: July 5, 2024
Functional constipation or redundancy of the colon?
Carmine Noviello1, Stefano Nobile2, Mercedes Romano3
1Pediatric Surgery Unit, Salesi Children Hospital, Via Corridoni, 11, 60128, Ancona, Italy. carmine.noviello@libero.it.
Insights
Children with functional refractory constipation may have anatomical colon changes, specifically a rectosigmoid length to L2 ratio over 15, aiding targeted treatment.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Medical Imaging
Background:
- Functional refractory constipation is common in children.
- Anatomical colon alterations are hypothesized in functional refractory constipation.
Purpose of the Study:
- To investigate anatomical colon alterations in children with functional refractory constipation.
- To identify potential diagnostic markers for targeted treatment.
Main Methods:
- Clinical examination, contrast enema (CE), anorectal manometry (ARM), and rectal suction biopsies (RSB) were performed.
- Colon size and rectosigmoid length to L2 vertebral width ratio were measured using radiograms.
- Measurements were compared to age-matched controls without constipation.
Main Results:
- Out of 69 patients, 57 (82.61%) were diagnosed with functional constipation.
- No statistically significant differences were found except for rectosigmoid length.
- The rectosigmoid length/L2 ratio was significantly higher in constipated children compared to controls.
Conclusions:
- Anatomical anomalies, particularly an elevated rectosigmoid length/L2 ratio (>15), are associated with functional constipation in children.
- Identifying these anomalies is crucial for guiding specific treatment strategies.
- This finding supports a more detailed anatomical evaluation in refractory pediatric constipation.
Objectives:
Constipation is a common problem in children, and most of the time, the cause is defined as functional. Our hypothesis is that children with functional refractory constipation had anatomic alterations of the colon.
Methods:
All children with chronic refractory constipation who visited our centre underwent accurate clinical examination, contrast enema (CE), anorectal manometry (ARM) and rectal suction biopsies (RSB). In case of functional constipation, three operators measured the size of the colon using radiograms and calculated the ratio based on the width of the second lumbar vertebra. The measurements carried out were compared with those reported in the literature on patients of the same age without constipation.
Results:
Over a period of 24 months, 69 patients with chronic refractory constipation, aged between 1 and 14 years, visited our department. A CE was performed on 67, and 2 were excluded because of anal stenosis. Sixty-five underwent anorectal manometry. Rectal suction biopsies were needed in 14 children, and 2 of them were found to have colonic aganglionosis. After a complete evaluation, 57 (82.61%) patients were diagnosed having functional constipation. By comparing the data of the patients with those of normal children reported by the other authors, we found that none of the measurements was statistically significant except for the rectosigmoid length: the mean value in one-year-old patients was 19.03 vs. 9.75, and in older children, it was 19.46 vs. 9.59.
Conclusions:
Recognizing an anatomic anomaly in patients suffering from functional constipation is important for specific treatment, especially when the ratio (rectosigmoid length/L2) is higher than 15.
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