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Constipation in Children: A guide to Prompt Diagnosis and Effective Treatment

  • General Surgery (E Barksdale, Section Editor)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of review

Constipation Is a common pediatric symptom that can affect children of all ages. It impacts children both physically and psychosocially while also causing significant emotional and financial stress to their families. Constipation presenting early in life can be secondary to conditions such as anorectal malformations, anal stenosis, Hirschsprung disease, spine abnormalities, cystic fibrosis, or metabolic dysfunction. Yet, the majority of children and adolescents who struggle with constipation do so as a result of a functional disorder. Diagnosis Is primarily based on fulfilling defined clinical criteria. Despite being so prevalent, functional constipation is often misdiagnosed and inappropriately treated. Laxative use Is often avoided due to misconceptions related to their efficacy and safety. This review addresses how to effectively diagnose and treat functional constipation in children of different ages and with variable severity at the time of presentation.

Recent findings

Guidelines from several medical societies for the evaluation and treatment of a child presenting with constipation have been published. It has become increasingly clear that early treatment of functional constipation is associated with improved long-term outcomes. The diagnostic role of anorectal and colonic manometry has been clarified and these tests have been standardized in the pediatric population. New medical and surgical treatments have been developed and Are leading to improved outcomes in children who fail conventional medical and behavioral interventions.

Summary

Childhood constipation Requires a comprehensive therapeutic plan, comprised of education, behavioral intervention, and medication that jointly produce effective defecation. Children with chronic constipation who Are unresponsive to maximal medical treatment benefit from further evaluation with colonic transit studies, anorectal and colonic manometry, imaging studies of the spine, and defecography—especially if more invasive interventions such as anal sphincter botulinum toxin injection, appendicostomy, cecostomy, colonic resection, ileostomy, and sacral nerve stimulation are being considered. These children Are best evaluated in specialized centers that offer a multi-disciplinary approach to both the physical and psychosocial components of chronic constipation treatment.

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, 700 Children’s Lane, Columbus, OH, 43205, USA

    Desale Yacob MD & Carlo Di Lorenzo MD

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  1. Desale Yacob MD
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  2. Carlo Di Lorenzo MD
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Correspondence to Desale Yacob MD.

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Desale Yacob declares that he has functioned as a consultant for QOL, Inc. Carlo Di Lorenzo declares that he has functioned as a consultant for QOL Inc., Mallinckrodt, Mahana, Sucampo, Allergan, Shire.

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This article is part of the Topical Collection on General Surgery

The authors wish to thank Dr. John Schneider for reviewing their manuscript.

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Yacob, D., Di Lorenzo, C. Constipation in Children: A guide to Prompt Diagnosis and Effective Treatment. Curr Treat Options Peds 6, 101–115 (2020). https://doi.org/10.1007/s40746-020-00193-5

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