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Refractory/therapy-resistant/intractable constipation in children
Carlos Alberto Velasco-Benítez1, Wilson Daza Carreño2, Michelle Higuera Carrillo3
1Hospital Universitario del Valle, Universidad del Valle, Cali, Valle del Cauca, Colombia.
BMJ Paediatrics Open
|June 2, 2026
Summary
Paediatric gastroenterologists prefer "refractory constipation" over "intractable constipation." This new definition emphasizes symptom persistence despite optimal treatment for 2-3 months after excluding organic causes.
Area of Science:
- Pediatric Gastroenterology
- Clinical Practice Guidelines
- Constipation Management
Background:
- Intractable constipation (IC) requires clearer definition for accurate characterization.
- Understanding current definitions used by Latin and Ibero-American paediatric gastroenterologists is crucial.
Purpose of the Study:
- To determine how paediatric gastroenterologists in Latin America and Ibero-America define intractable constipation.
- To explore preferences for a unified terminology for intractable constipation.
Main Methods:
- A questionnaire survey was administered to 429 paediatric gastroenterologists.
- Data were analyzed using univariate and bivariate statistics, including odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- Most respondents (94.6%) defined IC by persistent low bowel frequency despite optimal medical treatment (OMT).
- Prior treatment failure was commonly defined as using two laxatives (51.7%).
- A majority preferred the term 'refractory constipation' (86.7%) and to include 'optimal medical treatment' in diagnostic criteria (93.0%).
Conclusions:
- Paediatric gastroenterologists in Latin and Ibero-America favor replacing 'intractable constipation' with 'refractory constipation' or 'treatment-resistant constipation'.
- The proposed definition involves persistent symptoms despite 2-3 months of appropriately prescribed, supervised, and adhered-to optimal conventional medical treatment, after excluding organic causes.
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