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Management of constipation and encopresis in infants and children
1Department of Pediatrics, University of California, School of Medicine, San Francisco.
Insights
Chronic functional constipation in children requires understanding the defecation process. Effective management involves dietary changes, stool softeners, and behavioral strategies, avoiding painful interventions.
Area of Science:
- Pediatric Gastroenterology
- Childhood Functional Disorders
Background:
- Chronic functional constipation is a prevalent condition in pediatric populations.
- A fundamental understanding of the defecation process is crucial for effective diagnosis and treatment.
Purpose of the Study:
- To outline a rational diagnostic and therapeutic strategy for pediatric chronic constipation.
- To emphasize the role of primary care physicians in prevention and early intervention.
Main Methods:
- Initial management focuses on colonic evacuation, stool softeners, dietary adjustments, and behavioral training.
- Avoidance of painful or invasive treatments like laxatives, suppositories, and enemas is key.
- Advanced evaluations, such as manometric tests, are reserved for complex cases.
Main Results:
- Most pediatric patients with constipation can be successfully managed as outpatients.
- Primary care interventions, including anticipatory guidance and dietary modifications, play a significant preventive role.
- Biofeedback therapy shows promise for refractory cases.
Conclusions:
- A comprehensive, non-invasive approach is effective for most children with chronic constipation.
- Early detection and intervention by primary care physicians can prevent complications.
- Further research into advanced therapies like biofeedback is warranted for treatment-resistant cases.
Abstract:
Chronic functional constipation is common in childhood. Basic understanding of the defecation process is essential to formulate a rational diagnostic and therapeutic approach to pediatric patients with chronic constipation, with or without encopresis. Primary care physicians can perform a major preventive function by anticipatory guidance and early dietary intervention. Most patients referred to pediatric gastroenterologists can be effectively treated as outpatients with use of an approach consisting of colonic evacuation, stool softeners, dietary manipulations, bowel training, and behavioral management. Avoidance of painful (laxatives) and invasive (suppositories, enemas) modalities is an important part of successful management. Further evaluation, including manometric tests, are reserved for patients with a history or physical findings suggesting an underlying disorder predisposing the patient to difficulty with defecation. Biofeedback therapy is likely destined to play a role in the subgroup who respond poorly to traditional therapeutic methods.