5. Constipation and toileting issues in children

Abstract

Constipation is common in children, with prevalences ranging from 0.3% up to 28%. In most children, constipation is functional (ie, without objective evidence of a pathological condition). Painful defecation has been proposed as the primary precipitant of functional faecal retention in early childhood. Faecal soiling is often secondary to constipation, and may occur during spontaneous relaxation of the sphincters precipitated by rectal distension. Management in general practice combines behavioural modification techniques with prolonged courses of laxatives. Treatment is usually successful, but may take up to 6–12 months. Significant numbers of children with initially good responses to therapy for constipation relapse in the long term. Long‐term relapse is more frequent in children under 4 years at onset of symptoms and in whom there is a history of faecal soiling associated with constipation.

Factors relating to hospitalisation and economic burden of paediatric constipation in the state of Victoria, Australia, 2002–2009

“…The age and gender figures in this study confirm and complement overseas studies . Higher admission rates for constipation during early childhood (<5 years) could be due to factors such as genetic predisposition, organic factors (congenital defects, colonic dysmotility), shorter breastfeeding durations, excessive cows milk consumption and dietary transitions from breast‐milk to formula or solids . Incidence peaks with toilet training in children, when painful bowel movements cause fear and trigger stool‐withholding behaviour …”

“…[19][20][21] Higher admission rates for constipation during early childhood (<5 years) could be due to factors such as genetic predisposition, 22 organic factors (congenital defects, colonic dysmotility), 23 shorter breastfeeding durations, 24 excessive cows milk consumption 24 and dietary transitions from breast-milk to formula or solids. 25,26 Incidence peaks with toilet training 21 in children, when painful bowel movements cause fear and trigger stool-withholding behaviour. 23 Arguably, constipation has become more widespread in developed countries because in part of urbanisation, associated with sedentary life-styles and consumption of highly processed foods.…”

Tips for managing treatment‐resistant enuresis

“…Constipation treatment focuses on ensuring that the child's fluid and fibre intake is adequate and may also include the use of laxatives such as stool softeners and stimulants and regular toilet sits after meals (timed with the gastrocolic reflex) using correct toilet posture to enhance bladder/bowel emptying. 32 Successful treatment of constipation alone in children who have constipation and enuresis can result in the resolution of enuresis in 63%. 27 The child failed alarm training Although enuresis alarm therapy is the most effective treatment for enuresis, one third of children fail alarm therapy, and 50% relapse after initial alarm success.…”

Polyethylene Glycols with or without Electrolytes for Constipation in Children: A Network Meta-Analysis

“…Constipation, defined as difficulty or pain on defecation, is a common problem in children which can be challenging to manage. Constipation most commonly first appears amongst toddlers (ages 2 to 4 years) [1] but can also occur in babies often when weaning on to solids [2] and affects up to a third of children [3]. In children, constipation usually occurs without evidence of an underlying disease (functional constipation) and is often the result of stool retention associated with toilet training, changes in diet or routine, stressful events, illness or withholding [4].…”

“…The management of constipation in children involves education, establishing a regular toileting routine, behavioural modification, the treatment of faecal impaction and laxative maintenance therapy [2,6].…”