Pediatric Surgery International

, Volume 25, Issue 5, pp 403–406 | Cite as

Slow-transit constipation in children: our experience

  • John M. HutsonEmail author
  • Janet W. Chase
  • Melanie C. C. Clarke
  • Sebastian K. King
  • Jonathan Sutcliffe
  • Susie Gibb
  • Anthony G. Catto-Smith
  • Val J. Robertson
  • Bridget R. Southwell
Review Article


Constipation is a common problem in children, with childhood prevalence estimated at between 1 and 30%. It accounts for a significant percentage of referrals to paediatricians and paediatric gastroenterologists. It commonly runs in families, suggesting either an underlying genetic predisposition or common environmental factors, such as dietary exposure. The peak age for presentation of constipation is shortly after toilet training, when passage of hard stools can cause pain on defecation, which then triggers holding-on behaviour in the child. At the time of the next call to stool the toddler may try to prevent defecation by contraction of the pelvic floor muscles and anal sphincter. Unless the holding-on behaviour is quickly corrected by interventions to soften faeces and prevent further pain, the constipation can very rapidly become severe and chronic. Until recently, this mechanism was thought to be the only significant primary cause of constipation in childhood. In this review, we will summarise recent evidence to suggest that severe chronic constipation in children may also be due to slowed colonic transit.


Slow-transit constipation Colonic dysmotility Electrical stimulation 


  1. 1.
    van den Berg MM, Benninga MA, Di Lorenzo C (2006) Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 101:2401–2409. doi: 10.1111/j.1572-0241.2006.00771.x PubMedCrossRefGoogle Scholar
  2. 2.
    Southwell BR, King SK, Hutson JM (2005) Chronic constipation in children: organic disorders are a major cause. J Paediatr Child Health 41:1–15. doi: 10.1111/j.1440-1754.2005.00527.x PubMedCrossRefGoogle Scholar
  3. 3.
    Catto-Smith AG (2005) 5. Constipation and toileting issues in children. Med J Aust 182(5):242–246PubMedGoogle Scholar
  4. 4.
    Talley NJ (2007) Functional gastrointestinal disorders in 2007 and Rome III: something new, something borrowed, something objective. Rev Gastroenterol Disord 7(2):97–105PubMedGoogle Scholar
  5. 5.
    Taminiau J, Benninga M (2005) Pediatric clinical research will benefit from Rome III. J Pediatr Gastroenterol Nutr 41(Suppl 1):S30–S31. doi: 10.1097/01.scs.0000180295.12354.f7 PubMedGoogle Scholar
  6. 6.
    Shin YM, Southwell BR, Stanton MP, Hutson JM (2002) Signs and symptoms of slow-transit constipation versus functional retention. J Pediatr Surg 37:1762–1765. doi: 10.1053/jpsu.2002.36716 PubMedCrossRefGoogle Scholar
  7. 7.
    Sanjay J, Naughton CK, Yang M, Strickland A et al (2004) Mice expressing a dominant-negative Ret mutation phenocopy human Hirschsprung disease and delineate a direct role of Ret in spermatogenesis. Development 131:5503–5513. doi: 10.1242/dev.01421 CrossRefGoogle Scholar
  8. 8.
    Puri P, Shinkai T (2004) Pathogenesis of Hirschsprung’s disease and its variants: recent progress. Semin Pediatr Surg 13(1):18–24. doi: 10.1053/j.sempedsurg.2003.09.004 PubMedCrossRefGoogle Scholar
  9. 9.
    Benninga MA, Buller HA, Tytgat GN, Akkermans LM, Bossuyt PM, Taminiau JA (1996) Colonic transit time in constipated children: does pediatric slow-transit constipation exist? J Pediatr Gastroenterol Nutr 23:241–251. doi: 10.1097/00005176-199610000-00007 PubMedCrossRefGoogle Scholar
  10. 10.
    Hutson JM, Chow CW, Borg J (1996) Intractable constipation with a decrease in Substance P-immunoreactive fibres: is it a variant of intestinal neuronal dysplasia? J Pediatr Surg 31:580–583. doi: 10.1016/S0022-3468(96)90501-1 PubMedCrossRefGoogle Scholar
  11. 11.
    Cook BJ, Lim E, Cook D, Hughes J, Chow CW, Stanton MP, Bidarkar SS, Southwell BR, Hutson JM (2005) Radionuclear transit to assess sites of delay in large bowel transit in children with chronic idiopathic constipation. J Pediatr Surg 40:478–483. doi: 10.1016/j.jpedsurg.2004.11.029 PubMedCrossRefGoogle Scholar
  12. 12.
    Milla P, Cucchiara S, DiLorenzo C, Rivera NM, Rudolph C, Tomomasa T (2002) Motility disorders in childhood: working group report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 35(Suppl 2):S187–S195. doi: 10.1097/00005176-200208002-00017 PubMedCrossRefGoogle Scholar
  13. 13.
    van Ginkel R, Reitsma JB, Buller HA, van Wijk MP, Taminiau JA, Benninga MA (2003) Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology 125:357–363. doi: 10.1016/S0016-5085(03)00888-6 PubMedCrossRefGoogle Scholar
  14. 14.
    DiLorenzo C, Hillemeier C, Hyman P et al (2002) Manometry studies in children: minimum standards for procedures. Neurogastroenterol Motil 14:411–420. doi: 10.1046/j.1365-2982.2002.00347.x CrossRefGoogle Scholar
  15. 15.
    Stanton MP, Hutson JM, Simpson D, Oliver MR, Southwell BR, Dinning P, Cook I, Catto-Smith AG (2005) Colonic manometry via appendicostomy shows reduced frequency, amplitude, and length of propagating sequences in children with slow-transit constipation. J Pediatr Surg 40:1138–1145. doi: 10.1016/j.jpedsurg.2005.03.047 PubMedCrossRefGoogle Scholar
  16. 16.
    King SK, Catto-Smith AG, Stanton MP, Sutcliffe JR, Simpson D, Cook I, Dinning P, Hutson JM, Southwell BR (2008) 24-Hour colonic manometry in pediatric slow transit constipation shows significant reductions in antegrade propagation. Am J Gastrenterol 103:2083–2091CrossRefGoogle Scholar
  17. 17.
    Hutson JM, Catto-Smith T, Gibb S, Chase J, Shin Y-M, Stanton M, King S, Sutcliffe J, Ong SY, Djaja S, Farmer P, Southwell B, Stephen L (2004) Gans lecture. Chronic constipation: no longer stuck characterisation of colonic dysmotility as a new disorder in children. J Pediatr Surg 39(6):795–799. doi: 10.1016/j.jpedsurg.2004.02.003 PubMedCrossRefGoogle Scholar
  18. 18.
    Meier-Ruge W (1971) Casuistic of colon disorder with symptoms of Hirschsprung’s disease. Verh Dtsch Ges Pathol 55:506–510 (author’s translation)PubMedGoogle Scholar
  19. 19.
    Stanton MP, Shin YM, Hutson JM (2002) Laparoscopic placement of the Chait cecostomy device via appendicostomy. J Pediatr Surg 37:1766–1767. doi: 10.1053/jpsu.2002.36717 PubMedCrossRefGoogle Scholar
  20. 20.
    Knowles CH, Martin JE (2000) Slow transit constipation: a model of human gut dysmotility. Review of possible aetiologies. Neurogastroenterol Motil 12:181–196. doi: 10.1046/j.1365-2982.2000.00198.x PubMedCrossRefGoogle Scholar
  21. 21.
    Wald A (2002) Slow transit constipation. Curr Treat Options Gastroenterol 5:279–283. doi: 10.1007/s11938-002-0050-x PubMedCrossRefGoogle Scholar
  22. 22.
    King SK, Sutcliffe JR, Southwell BR, Chait PG, Hutson JM (2005) The antegrade continence enema successfully treats idiopathic slow-transit constipation. J Pediatr Surg 40:1935–1940PubMedCrossRefGoogle Scholar
  23. 23.
    Emmerson CA (1987) A preliminary study of the effect of interferential therapy on detrusor instability in patients with multiple sclerosis. Aust J Physiother 33:64–65Google Scholar
  24. 24.
    Chase J, Robertson J, Southwell B, Hutson JM, Gibb S (2005) A pilot study using transcutaneous electrical stimulation (interferential current) to treat chronic treatment-resistant constipation in children. J Gastroenterol Hepatol 20:1054–1061PubMedGoogle Scholar
  25. 25.
    Clarke MC, Chase J, Gibb S, Robertson V, Catto-Smith A, Hutson J, Southwell B (2009) Decreased colonic transit time following transcutaneous interferential electrical stimulation in children with slow transit constipation. J Ped Surg 44:408–412CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • John M. Hutson
    • 1
    • 2
    • 3
    • 6
    Email author
  • Janet W. Chase
    • 2
  • Melanie C. C. Clarke
    • 2
  • Sebastian K. King
    • 2
    • 3
  • Jonathan Sutcliffe
    • 2
  • Susie Gibb
    • 7
  • Anthony G. Catto-Smith
    • 5
  • Val J. Robertson
    • 4
  • Bridget R. Southwell
    • 2
    • 3
  1. 1.Department of SurgeryRoyal Children’s HospitalMelbourneAustralia
  2. 2.Douglas Stephens Surgical Research Laboratory, Murdoch Childrens Research InstituteRoyal Children’s HospitalMelbourneAustralia
  3. 3.Department of PaediatricsUniversity of MelbourneMelbourneAustralia
  4. 4.School of Health SciencesUniversity of NewcastleNewcastleAustralia
  5. 5.Department of GastroenterologyRoyal Children’s HospitalMelbourneAustralia
  6. 6.Department of UrologyRoyal Children’s HospitalMelbourneAustralia
  7. 7.Department General PaediatricsRoyal Children’s HospitalMelbourneAustralia

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