Children's experiences of functional constipation: A qualitative reflexive thematic analysis

Childhood functional constipation, a common concern within child healthcare, necessitates oral and rectal medical treatments, that are mostly administered by parents in the home environment. It is important to gather children's perspectives in child- and family-centred care. The private nature of toileting, bowel movements, and faecal incontinence are areas of taboo and stigmatisation. Research is scarce on how children perceive this common but private situation of oral and rectal constipation treatment.

To explore children's experiences of functional constipation and its treatments.

A qualitative interview study with a constructionist epistemology and a predominantly experiential orientation.

Individual interviews were conducted in the child's home, in the child's familiar outpatient clinic, or on university premises. Open and permissive conversations about bowel habits, constipation, medical treatments, faecal leakage, and related feelings were digitally recorded and transcribed.

Twenty children (thirteen boys and seven girls) with functional constipation, aged 6-14 years, from four different outpatient clinics in southeast Sweden, who had experiences of oral and rectal medical treatments, were purposively recruited. Exclusion criteria were anorectal malformation or prior rectal surgery.

Transcripts were analysed using reflexive thematic analysis by Braun & Clarke.

This study provides a deeper understanding of why children choose not to go to the toilet. It explains how children perceive constipation treatment as simultaneously good and bad, and describes how faecal incontinence is strongly associated with the fear of exposure. The study also outlines the hopes and prospects of a cure. Four themes were created: 1) Procrastinating toilet visits - focus elsewhere, 2) Dreading exposure in a vulnerable position, 3) Enemas, a nightmare and a relief, 4) A doubtful hope during the treatment journey.

Care providers must acknowledge and validate the child's perspective in constipation treatment situations. Our study provides an understanding of this perspective, which should be incorporated into clinical conversations with children about their diagnosis and proposed constipation treatment regimen. Adopting an approach that acknowledges children's views based on this new information may enhance collaboration between care providers, parents, and children during constipation care.