Chronic Refractory Constipation in Children: Think Beyond Stools

Abstract

Chronic refractory constipation (CRC) is defined as children who are unable to pass stools in spite of being on maximum laxative therapy and require daily rectal stimulation in the form of enemas or suppositories to pass stools for >3 months. Children are often referred for treatment of refractory constipation that may result from uncontrolled underlying disease or ineffective treatment. Constipated children can be managed by a variety of medical therapeutic options that yield satisfying results in most cases. However, a subset of constipated children fails to benefit from conventional treatments. On treatment failure or on suspicion of organic disease the patient should be referred for further evaluation. Treatment options for treatment-resistant patients are presented. Pharmalogical and non-pharmalogical treatment modalities are reviewed and an algorithm for refractory constipation in children are presented.

The ten “hard” questions in pediatric functional constipation

“…This condition has never been formally defined and standardized; it is generally defined as failure of maximal laxative therapy and/or need for daily rectal stimulation (enemas or suppositories) for > 3 months. In these patients it is necessary to carefully evaluate compliance with treatment and exclude the presence of secondary causes of constipation, before escalating to more invasive treatments, including the new pharmacological agents not yet approved in pediatrics [ 8 , 9 ].…”

Chronic constipation in children: diagnosis and treatment through the prism of time

“…Среди детей старшего возраста частота функциональных запоров составляет 12-14% случаев. Согласно данным исследований, частота возникновения запоров у детей грудного возраста варьирует в пределах 18,5%, а у детей старшего возраста от 14,1 до 15% [10]. В Российской Федерации достаточно мало эпидемиологических исследований по распространенности запоров у детей.…”

Resection of the extravertebral portion of the filum terminale with posterior internal sphincterotomy, a surgical technique for managing chronic constipation and encopresis in children

“…(3) Chronic refractory constipation poses a challenge for approximately 30 % of patients experiencing constipation. (4) It can be linked to various underlying or coexisting conditions, with poor treatment compliance being a common factor. Additionally, conditions such as Hirschsprung's disease, celiac disease, cow milk allergy, primary hyperparathyroidism, and connective tissue disorders may be associated.…”

“…Additionally, conditions such as Hirschsprung's disease, celiac disease, cow milk allergy, primary hyperparathyroidism, and connective tissue disorders may be associated. (4) Rectal hyporeflexia, resulting from structural abnormalities affecting rectal innervation in the parasympathetic center of the spinal cord, can also contribute to these etiologies. (5) Another contributing factor is achalasia of the internal anal sphincter, where the lack of parasympathetic innervation at the internal anal sphincter hinders proper emptying during defecation.…”