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Assessment, diagnosis, and treatment of constipation in childhood
Insights
Chronic constipation and fecal soiling in children often stem from impaired anorectal functions, not organic causes. Treatment focuses on clearing impaction and establishing regular bowel habits through enemas, laxatives, and scheduled toilet sittings.
Area of Science:
- Pediatric Gastroenterology
- Functional Bowel Disorders
Background:
- Chronic constipation and fecal soiling are common in children.
- Organic causes (anatomic, neurologic, endocrine, metabolic) are identified in less than 10% of cases.
Purpose of the Study:
- To outline the evaluation and management of chronic constipation with or without fecal soiling in pediatric patients.
- To emphasize the role of functional anorectal impairments.
Main Methods:
- Initial evaluation relies on thorough patient history and physical examination.
- Diagnostic focus shifts to anorectal functional assessment when organic causes are excluded.
Main Results:
- Over 90% of children with constipation/soiling lack a specific organic cause.
- Impairments in rectal sensation, contractility, and sphincter/pelvic floor muscle relaxation are common.
Conclusions:
- Management should prioritize addressing functional anorectal deficits.
- A comprehensive program including enemas, laxatives, and scheduled toilet sittings is effective for most children.
Abstract:
The evaluation of chronic constipation with or without fecal soiling in children must begin with a careful history and physical examination. Constipation and fecal soiling is caused in fewer than 10% of patients by anatomic, neurologic, endocrine, or metabolic conditions. No specific organic cause can be found in more than 90% of affected children, but anorectal functions--such as rectal sensation, rectal contractility, and relaxation of the external anal sphincter and pelvic floor muscles during straining for defecation--are impaired. Most patients will benefit from a program designed to clear fecal impaction with enemas, prevent fecal impaction with enemas, prevent fecal impaction with laxatives, and promote regular bowel habits with scheduled toilet sittings.