Skip to main content

Advertisement

SpringerLink
Log in

Approach to constipation in children

  • Review Article
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Purpose

There is a scarcity of literature, and prevalent misconceptions about constipation in India.

Methods

A literature search in PubMed was conducted with regard to epidemiology, clinical features, and management of constipation. Special emphasis was paid to functional constipation and refractory constipation. English language studies available full text over the last 25 years were considered and relevant information was extracted.

Conclusions

Estimated prevalence of constipation is 3% among toddlers and pre-school children worldwide and 95%, of them are considered functional. A careful history and thorough physical examination is all that is required to diagnose functional constipation. Management includes disimpaction followed by maintenance therapy with oral laxative, dietary modification and toilet training. A close and regular follow-up is necessary for successful treatment. In most of the cases laxative needs to be continued for several months and sometimes years. Early withdrawal of laxative is the commonest cause of recurrence. Refractory constipation is less common in primary care set up. Radiological colon transit study is useful in picking up Slow transit constipation. Antegrade continence enema plays an important role in the management of slow transit constipation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006;101:2401–9.

    Article  PubMed  Google Scholar 

  2. Khanna V, Poddar U, Yachha SK. Constipation in Indian children: need for knowledge not the knife. Indian Pediatr. 2010;47:1025–30.

    Article  PubMed  Google Scholar 

  3. Rajindrajith S, Devanaryana NM, Adhikari C, Pannala W, Benninga MA. Constipation in children: an epidemiological study in Sri Lanka using Rome III criteria. Arch Dis Child. 2012;97:43–5.

    Article  PubMed  Google Scholar 

  4. Aziz S, Fakih HAM, Di Lorenzo C. Bowel habits and toilet training in rural and urban dwelling children in a developing country. J Pediatr. 2011;158:784–8.

    Article  PubMed  Google Scholar 

  5. Steer CD, Emond AM, Golding J, Sandhu B. The variation in stool patterns from 1 to 42 months: a population bases observational study. Arch Dis Child. 2009;94:231–4.

    Article  CAS  PubMed  Google Scholar 

  6. den Hertog J, van Leengoed E, Kolk F, van den Broek L, Kramer E, Bakker E, et al. The defecation pattern of healthy term infants up to the age of 3 months. Arch Dis Child Fetal Neonatal Ed. 2012;97:F465–F470.

    Google Scholar 

  7. Tunc VT, Camurdan AD, Ilhan MN, Sahin F, Beyazova U. Factors associated with defecation patterns in 0 to 24 months old children. Eur J Pediatr. 2008;167:1357–62.

    Article  PubMed  Google Scholar 

  8. Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/ toddler. Gastroenterology. 2006;130:1519–26.

    Article  PubMed  Google Scholar 

  9. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A. Childhood functional gastrointestinal disorders: child/adolescents. Gastroenterol. 2006;130:1527–37.

    Article  Google Scholar 

  10. Levine MD. Children with encopresis: a descriptive analysis. Pediatrics. 1975;56:412–6.

    CAS  PubMed  Google Scholar 

  11. Taitz LS, Water JKH, Urwin OM, Molnar D. Factors associated with outcome in management of defecation disorders. Arch Dis Child. 1986;61:472–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Amendola S, De-Angelis P, Dall’Oglio L, Di Abriola GF, Di Lorenzo M. Combined approach to functional constipation in children. J Pediatr Surg. 2003;38:819–23.

    Article  CAS  PubMed  Google Scholar 

  13. Loening-Baucke V. Constipation in early childhood: Patient characteristics, treatment and long-term follow up. Gut. 1993;34:1400–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Loening-Baucke V. Chronic constipation in children. Gastroenterol. 1993;105:1557–64.

    Article  CAS  Google Scholar 

  15. Partin JC, Hamill SK, Fischel JE, Partin JS. Painful defecation and fecal soiling in children. Pediatrics. 1992;89:1007–9.

    CAS  PubMed  Google Scholar 

  16. Tabbers MM, Di Lorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58:258–74.

    Article  CAS  PubMed  Google Scholar 

  17. Metaj M, Laroia N, Lawrence RA, Ryan RM. Comparison of breast-and formula-fed normal new born in time to first stool and urine. J Perinatol. 2003;23 624–8.

    Article  PubMed  Google Scholar 

  18. Jung PM. Hirschsprung’s disease: one surgeon’s experience in one institution. J Pediatr Surg. 1995;30:646–51.

    Article  CAS  PubMed  Google Scholar 

  19. Loening-Baucke V. Factors determining outcome in children with chronic constipation and fecal soiling. Gut. 1989;30 999–1006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bekkali N, van den Berg MM, Dijkgraaf MGW, van Wijk MP, Bongers MEJ, Liem D, et al. Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG. Pediatric. 2009;124:e1108-e15.

    Article  Google Scholar 

  21. Youssef NN, Peters JM, Henderson W, Shultz-Peters S, Lockhart DK, Di Lorenzo C. Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr. 2002;141:410–4.

    Article  CAS  PubMed  Google Scholar 

  22. Guest JF, Candy DC, Clegg JP, Edwards D, Helter MT, Dale AK, et al. Clinical and economical impact of using macrogol 3350 plus electrolytes in an outpatient setting compared to enemas and suppositories and manual evacuation to treat pediatric fecal impaction based on actual clinical practice in England and Wales. Curr Med Res Opin. 2007;23:2213–25.

    Article  PubMed  Google Scholar 

  23. Freedman SB, Thull-Freedman J, Rumantir M, Eltorki M, Schuh S. Pediatric constipation in the emergency department: evaluation, treatment and outcomes. J Pediatr Gastroenterol Nutr. 2014;59:327–33.

    Article  CAS  PubMed  Google Scholar 

  24. Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, et al. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med. 1998;339:1100–4.

    Article  CAS  PubMed  Google Scholar 

  25. Simeone D, Miele E, Boccia G, Marino A, Troncone R, Staiano A. Prevalence of atopy in children with chronic constipation. Arch Dis Child. 2008;93:1044–7.

    Article  CAS  PubMed  Google Scholar 

  26. Loening-Baucke V. Polyethylene glycol without electrolytes for children with constipation and encopresis. J Pediatr Gastroenterol Nutr. 2002;34:372–7.

    Article  CAS  PubMed  Google Scholar 

  27. Lowery SP, Srour JW, Whitehead WE, Schuster MM. Habit training as treatment of encopresis secondary to chronic constipation. J Pediatr Gastroenterol Nutr. 1985;4:397–401.

    Article  CAS  PubMed  Google Scholar 

  28. Baker SS, Liptak GS, Colletti RB, Croffie JM, Di Lorenzo C, Ector W, et al. Clinical practice guideline: Evaluation and treatment of constipation in infants and children: recommendations of the North American Society of Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43:e1–e13.

    Article  Google Scholar 

  29. Candy D, Belsey J. Macrogol (polyethylene glycol) laxatives in children with functional constipation and fecal impaction: a systematic review. Arch Dis Child. 2009;94:156–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Candelli M, Nista EC, Zocco MA, Gasbarrini A. Idiopathic chronic constipation; pathophysiology, diagnosis and treatment. Hepatogastroenterol. 2001;48:1050–7.

    CAS  Google Scholar 

  31. Loening-Baucke V. Constipation in early childhood: patient characteristics, treatment and long-term followup. Gut. 1993;34:1400–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. van Ginkel R, Reitsma JB, Buller HA, van Wijk MP, Taminiau JA, Benninga MA. Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology 2003;125:357–63.

    Article  PubMed  Google Scholar 

  33. Clayden GS. Management of chronic constipation. Arch Dis Child. 1992;67:340–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Southwell BR, King SK, Hutson JM. Chronic constipation in children: organic disorders are a major cause. J Pediatr Child Health. 2005;41:1–15.

    Article  CAS  Google Scholar 

  35. Kwshtgar A, Ward HC, Clayden GS. Diagnosis and management of children with intractable constipation. Semin Pediatr Surg. 2004;13:300–9.

    Article  Google Scholar 

  36. Benninga MA, Voskuijl WP, Akkerhuis GW, Taminiau JA, Buller HA. Colonic transit times and behavior profiles in children with defecation disorders. Arch Dis Child. 2004;89:13–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Benninga MA, Buller HA, Staalman CR, Gubler FM, Bossuyt PM, van der Plas RN, et al. Defecation disorders in children, colonic transit times versus the Barr-score. Eur J Pediatr. 1995;154:277–84.

    Article  CAS  PubMed  Google Scholar 

  38. Rao SS. Dyssynergic defecation and biofeedback therapy. Gastroenterol Clin North Am. 2008;37:569–86.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Winter HS, Di Lorenzo C, Benninga MA, Gilger MA, Kearns GL, Hyman PE, et al. Oral prucalopride in children with functional constipation. J Pediatr Gastroenterol Nutr. 2013;57:197–203.

    Article  CAS  PubMed  Google Scholar 

  40. Hyman PE, Di Lorenzo C, Prestridge LL, Youssef NN, Ueno R. Lubiprostone for the treatment of functional constipation in children. J Pediatr Gastroenterol Nutr. 2014;58:283–91.

    Article  CAS  PubMed  Google Scholar 

  41. Randall J, Coyne P, Jaffray B. Follow up of children undergoing antegrade continent enema: experience of over two hundred cases. J Pediatr Surg. 2014;49:1405–8.

    Article  PubMed  Google Scholar 

  42. Hutson JM, Mc Namara J, Gibb S, Shin YM. Slow transit constipation in children. J Pediatr Child Health. 2001;37:426–30.

    Article  CAS  Google Scholar 

  43. Wheatley JM, Hutson JM, Chow CW, Oliver M, Hurley MR. Slow transit constipation in childhood. J Pediatr Surg. 1999;34:829–33.

    Article  CAS  PubMed  Google Scholar 

  44. Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet. 1990;336:1217–8.

    Article  CAS  PubMed  Google Scholar 

  45. Chait PG, Shandling B, Richards HF. The cecostomy button. J Pediatr Surg. 1997;32;849–51.

    Article  CAS  PubMed  Google Scholar 

  46. Van den Berg MM, Hogan M, Caniano DA, Di Lorenzo C, Benninga MA, Mousa HM. Colonic manometry as predictor of cecostomy success in children with defecation disorders. J Pediatr Surg. 2006;41:730–6.

    Article  PubMed  Google Scholar 

  47. Villarreal J, Sood M, Zangen T, Flores A, Michel R, Reddy N, et al. Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions. J Pediatr Gastroenterol Nutr. 2001;33:588–91.

    Article  CAS  PubMed  Google Scholar 

  48. De Caluwe D, Yoneda A, Akl U, Puri P. Internal anal sphincter achalasia: outcome after internal sphincter myectomy. J Pediatr Surg. 2001;36:736–8.

    Article  PubMed  Google Scholar 

  49. Florian F, Puri P. Comparison of posterior internal anal sphincter myectomy and intrasphincteric botulinum toxin injection for treatment of internal anal sphincter achalasia: A meta-analysis. Pediatr Surg Int. 2012;28:765–71.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, Uttar Pradesh, India

    Ujjal Poddar

Authors
  1. Ujjal Poddar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ujjal Poddar.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Poddar, U. Approach to constipation in children. Indian Pediatr 53, 319–327 (2016). https://doi.org/10.1007/s13312-016-0845-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-016-0845-9

Keywords

Search

Navigation