The purpose of the study was to assess constipation and encopresis treatment strategies of primary care providers and determine reasons to refer to a pediatric gastroenterology specialist. A closed-ended questionnaire was mailed to a convenience sampling of 237 pediatric primary care providers. Ninety-one questionnaires were returned with a 38% response rate: 74 (81%) pediatricians and 17 (19%) nurse practitioners. The majority of responders recommended pharmacologic treatment and diet changes. Many providers (73%) estimated a 75%-100% success rate when managing constipation, whereas 19% providers estimated a greater than 80% success rate with encopresis patients. The number one reason to refer was unresponsiveness to treatment (71%), followed by parents want a second opinion (15%), rule out organic cause (9%), and management is too time-consuming (5%). Both primary care providers and pediatric gastroenterologists use medication strategies, but diet recommendations are not the same. Unresponsiveness to treatment is the main reason for referral. If better management can occur in the primary care setting, costly specialty services may be avoided and possibly reduce healthcare costs.

1. Explain the criteria for functional constipation diagnosis. 2. Manage children with functional constipation using the most current evidence-based recommendations. 3. Discuss first-and second-line medications for fecal disimpaction and maintenance therapy.

Constipation and encopresis are two common conditions seen in the pediatric gastroenterology setting. Organic causes cannot be excluded although they are rarely diagnosed in infants and children with defecation disorders. To successfully treat these disorders, a combination of family education, disimpaction and maintenance medications, a well-balanced diet, and behavior management is essential.

Fecal disimpaction in the hospital setting may be necessary for a constipated child's condition to improve. This study evaluated the efficiency of 2 disimpaction therapies: nasogastric GoLYTELY (polyethylene glycol-electrolyte solution) compared with oral magnesium citrate. Retrospective chart review of 103 children was conducted to determine the time from the start of the clinic cleanout until abdominal radiograph verification of successful stool evacuation. The children were in an age range of 1-18 years, with average age of 8 years. Forty-five were female and 59 were male. Forty-six (45%) children received nasogastric polyethylene glycol-electrolyte and 57 (55%) drank magnesium citrate. The children receiving nasogastric polyethylene glycol-electrolyte on average required 2.5 enemas, and the children receiving magnesium citrate required 3.0 enemas. The average time for a nasogastric polyethylene glycol-electrolyte cleanout was 5 hours 15 minutes (range: 3 hours 30 minutes to 7 hours) and 5 hours 30 minutes for magnesium citrate cleanout (range: 2 to 8 hours). Seven (15%) children who received nasogastric polyethylene glycol-electrolyte and 6 (10%) of those who drank magnesium citrate did not achieve clearance of stool on the second radiograph. Vomiting was an adverse effect of both medications, and 7 (12%) children were unable to drink the entire magnesium citrate dose. Both methods of disimpaction take the same amount of time. Magnesium citrate can be difficult to drink; however, it is less invasive and less costly than nasogastric polyethylene glycol-electrolyte.

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