Evaluation and Management of Pediatric Constipation

Opinion statement

Constipation is one of the most common problems evaluated by pediatricians, pediatric gastroenterologist, and pediatric surgeons alike. A clear and concise management algorithm is needed to appropriately treat patients and avoid unnecessary outpatient and emergency department visits. Once organic causes of constipation have been ruled out, treatment should progress in a stepwise fashion until success, defined as daily bowel movements without encopresis or overflow pseudoincontinence. Therapy should begin with diet modification and progress through the use of polyethylene glycol, stimulant laxatives, daily enemas, and even formal inpatient fecal disimpaction. For those patients who fail to successfully evacuate their colons or those who have persistent incontinence secondary to severe constipation, surgical options such as appendicostomy should be explored. Ultimately, we must all accept that constipation can be a severe, life-altering problem which should be addressed with an aggressive management strategy.