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Clinical practice

Diagnosis and treatment of functional constipation

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Abstract

Childhood functional constipation has an estimated prevalence of 3% in the Western world and is probably the most common gastrointestinal complaint in children. It is characterized by infrequent painful defecation, faecal incontinence and abdominal pain. Only less than 5% of children with constipation have an underlying disease. Only recently two evidence-based guidelines (the Netherlands and Great Britain) have been developed concerning the diagnostic and therapeutic approach for childhood constipation which we both discuss in this article. At present, a thorough medical history and complete physical exam are usually sufficient to confirm the diagnosis of functional constipation. Further laboratory or radiological investigations should only be performed in case of doubt, to exclude an underlying disease. Treatment of childhood constipation consists of four steps: (1) education, (2) disimpaction, (3) prevention of re-accumulation of faeces and (4) follow-up. Surprisingly, there is only limited evidence that laxative treatment is better than placebo in children with constipation. However, according to the available evidence, the Dutch guideline recommends lactulose for children <1 year as first-choice treatment. For children below the age of older than 1 year, both lactulose and polyethylene glycol (PEG) with or without electrolytes can be used as first-choice treatment. According to the National Institute for Health and Clinical Excellence guideline, PEG plus electrolytes is the first-choice treatment for all ages. Conclusion: Children with functional constipation should be diagnosed and treated according to recently developed evidence-based guidelines.

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Abbreviations

NICE:

National Institute for Health and Clinical Excellence

PEG:

Polyethylene glycol

RCT:

Randomised controlled trial

References

  1. Bardisa-Ezcurra L, Ullman R, Gordon J (2010) Guideline development group. Diagnosis and management of idiopathic childhood constipation: summary of NICE guidance. BMJ 340:c2585

    Article  PubMed  Google Scholar 

  2. Bekkali NL, van den Berg MM, Dijkgraaf MG, van Wijk MP, Bongers ME, Liem O, Benninga MA (2009) Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG. Pediatrics 124:e1108–e1115

    Article  PubMed  Google Scholar 

  3. Benninga M, Candy DC, Catto-Smith AG, Clayden G, Loening-Baucke V, Di Lorenzo C, Nurko S, Staiano A (2005) The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr 40:273–275

    Article  PubMed  Google Scholar 

  4. Benninga MA, Voskuijl WP, Taminiau JA (2004) Childhood constipation: is there new light in the tunnel? J Pediatr Gastroenterol Nutr 39:448–464

    Article  PubMed  CAS  Google Scholar 

  5. Bongers ME, Benninga MA, Maurice-Stam H, Grootenhuis MA (2009) Health-related quality of life in young adults with symptoms of constipation continuing from childhood into adulthood. Health Qual Life Outcomes 7:20

    Article  PubMed  Google Scholar 

  6. Bongers ME, van Wijk MP, Reitsma JB, Benninga MA (2010) Long-term prognosis for childhood constipation: clinical outcomes in adulthood. Pediatrics 126:e156–e162

    Article  PubMed  Google Scholar 

  7. Brazzelli M, Griffiths P (2006) Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children. Cochrane Database Syst Rev 19(2):CD002240

    Google Scholar 

  8. Candy DCA, Edwards D, Geraint M (2006) Treatment of fecal impaction with polyethylene glycol plus electrolytes (PEG+E) followed by a double blind comparison of PEG+E versus lactulose as maintenance therapy. J Pediatr Gastroenterol Nutr 43:65–70

    Article  PubMed  CAS  Google Scholar 

  9. Dupont C, Leluyer B, Maamri N, Morali A, Joye JP, Fiorini JM, Abdelatif A, Baranes C, Benoît S, Benssoussan A, Boussioux JL, Boyer P, Brunet E, Delorme J, François-Cecchin S, Gottrand F, Grassart M, Hadji S, Kalidjian A, Languepin J, Leissler C, Lejay D, Livon D, Lopez JP, Mougenot JF, Risse JC, Rizk C, Roumaneix D, Schirrer J, Thoron B, Kalach N (2005) Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children. J Pediatr Gastroenterol Nutr 41:625–633

    Article  PubMed  CAS  Google Scholar 

  10. Gremse DA, Hixon J, Crutchfield A (2002) Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr (Phila) 41:225–229

    Article  Google Scholar 

  11. Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J (2006) Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 130:1519–1526

    Article  PubMed  Google Scholar 

  12. Lee-Robichaud H, Thomas K, Morgan J, Nelson RL (2010) Lactulose versus polyethylene glycol for chronic constipation (review). Cochrane Database Syst Rev 7:CD007570

    PubMed  Google Scholar 

  13. Loening-Baucke V (1993) Constipation in early childhood: patient characteristics, treatment, and longterm follow up. Gut 34:1400–1404

    Article  PubMed  CAS  Google Scholar 

  14. Loening-Baucke V (2005) Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr 146:359–363

    Article  PubMed  Google Scholar 

  15. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (2006) Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 43:405–407

    Article  Google Scholar 

  16. Nurko S, Youssef NN, Sabri M, Langseder A, McGowan J, Cleveland M, Di Lorenzo C (2008) PEG3350 in the treatment of childhood constipation: a multicenter, double-blinded, placebo-controlled Trial. J Pediatr 153:254–261

    Article  PubMed  CAS  Google Scholar 

  17. NVK, NHG (2009) Richtlijn obstipatie bij kinderen van 0 tot 18 jaar. Utrecht; http://www.cbo.nl

  18. Pijpers MA, Bongers ME, Benninga MA, Berger MY (2010) Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr 50:256–268

    Article  PubMed  CAS  Google Scholar 

  19. Pijpers MA, Tabbers MM, Benninga MA, Berger MY (2009) Currently recommended treatments of childhood constipation are not evidence based: a systematic review on the effect of laxative treatment and dietary measures. Arch Dis Child 94:117–131

    Article  PubMed  CAS  Google Scholar 

  20. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130:1527–1537

    Article  PubMed  Google Scholar 

  21. Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, Staiano A (1999) Childhood functional gastrointestinal disorders. Gut 45(2):II60–II68

    Article  PubMed  Google Scholar 

  22. Tabbers MM, Benninga MA (2007) Administration of probiotic lactobacilli to children with gastrointestinal problems: there is still little evidence. Ned Tijdschr Geneeskd 151:2198–2202

    PubMed  CAS  Google Scholar 

  23. Tabbers MM, Boluyt N, Berger MY, Benninga MA (2010) Constipation in children. Clinical Evidence 03:303

    Google Scholar 

  24. Thomson MA, Jenkins HR, Bisset WM, Heuschkel R, Kalra DS, Green MR, Wilson DC, Geraint M (2007) Polyethylene glycol 3350 plus electrolytes for chronic constipation in children: a double, placebo controlled crossover study. Arch Dis Child 92:996–1000

    Article  PubMed  CAS  Google Scholar 

  25. van den Berg MM, Benninga MA, Di Lorenzo C (2006) Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 101:2401–24092

    Article  PubMed  Google Scholar 

  26. van Dijk M, Bongers ME, de Vries GJ, Grootenhuis MA, Last BF, Benninga MA (2008) Behavioral therapy for childhood constipation: a randomized, controlled trial. Pediatrics 121:e1334–e1341

    Article  PubMed  Google Scholar 

  27. Vlieger AM, Blink M, Tromp E, Benninga MA (2008) Use of complementary and alternative medicine by pediatric patients with functional and organic gastrointestinal diseases: results from a multicenter survey. Pediatrics 122:e446–e451

    Article  PubMed  Google Scholar 

  28. Voskuijl W, de Lorijn F, Verwijs W, Hogeman P, Heijmans J, Makel W, Taminiau J, Benninga M (2004) PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controlled, multicentre trial. Gut 53:1590–1594

    Article  PubMed  CAS  Google Scholar 

  29. Voskuijl WP, Heijmans J, Heijmans HS, Taminiau JA, Benninga MA (2004) Use of Rome II criteria in childhood defecation disorders: applicability in clinical and research practice. J Pediatr 145:213–217

    Article  PubMed  Google Scholar 

  30. Wang BX, Wang MG, Jiang MZ, Xu CD, Shao CH, Jia LY, Huang ZH, Xu XH (2007) Forlax in the treatment of childhood constipation: a randomized, controlled, multicenter clinical study. Zhongguo Dang Dai Er Ke Za Zhi 9:429–432

    PubMed  Google Scholar 

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Conflict of interest

The authors declare that they do not have conflict of interest and no financial relationships that might have influenced the present work.

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Authors and Affiliations

  1. Department of Paediatric Gastroenterology and Nutrition, Emma Children’s Hospital/Academic Medical Centre, H7-250, PO Box 22700, 1100 DD, Amsterdam, the Netherlands

    Merit M. Tabbers & Marc A. Benninga

  2. Department of Paediatrics, Emma Children’s Hospital/Academic Medical Centre, Amsterdam, the Netherlands

    Nicole Boluyt

  3. Department of General Practice, University Hospital Groningen, Groningen, the Netherlands

    Marjolein Y. Berger

Authors
  1. Merit M. Tabbers
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  2. Nicole Boluyt
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  3. Marjolein Y. Berger
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  4. Marc A. Benninga
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Corresponding author

Correspondence to Merit M. Tabbers.

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Tabbers, M.M., Boluyt, N., Berger, M.Y. et al. Clinical practice. Eur J Pediatr 170, 955–963 (2011). https://doi.org/10.1007/s00431-011-1515-5

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  • DOI: https://doi.org/10.1007/s00431-011-1515-5

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