Functional Constipation and Dyssynergic Defecation in Children

Abstract

Defecation is a complex physiological process, which relies on intricate mechanisms involving the autonomic and somatic nervous system, the pelvic floor muscles, and the anal sphincter complex. Anorectal dysfunction may result in constipation, a bothersome defecation disorder that can severely affect daily lives of children and their families. In this review, we focus on different mechanisms underlying anorectal dysfunction and specific treatment options aimed at improving defecation dynamics in children with functional constipation.

Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report

“…One important aspect of childhood development is the acquisition of toileting skills and establishment of continence. The establishment of bowel control usually starts between 21 and 36 months of age, and is completed by the age of four [16] . Thus, dyssynergic defecation is an acquired behavioral problem.…”

Characterisation of patients with paediatric dyssynergia, a single centre experience

“…Several patients were reported to have social issues needing adjustments at school. Unlike withholding behaviour in children is thought to be voluntary, and conditioned based on negative emotional experiences [7]. These psychosocial comorbidities may shape the cognitive schemas of a child, making one more prone to a negative emotional experience which can lead to voluntary withholding.…”

“…Biofeedback therapy can provide an opportunity for patients to learn muscle coordination [5] Pelvic oor physiotherapy has also been shown to bene t childhood dyssynergia [6]. Variable outcomes have been reported with anal sphincter botulinum toxin injections, anterograde colonic irrigations and colonic resections [7].…”

Childhood functional constipation : Parents' everyday life experiences

“…Faecal incontinence is present in 75-90% of children presenting with FC (Vriesman et al, 2019). The peak incidence of defecation problems in children occurs around the same age as toilet training does, indicating that behavioural factors such as withholding behaviour play an important role in the development of FC (Koppen & Benninga, 2022). Beliefs about constipation and children's normal elimination behaviours originate from parents' own preconceived ideas, their individual mental perspectives of the condition.…”

“…Education about physiological defecation dynamics and explaining of the role withholding behaviour plays in the pathophysiology are key. Regular follow-ups from healthcare professionals are important, initially weekly, and then sparser, to ensure regular stool evacuation and adherence to treatment (Koppen & Benninga, 2022). In cases of comorbid psychological disorders counselling with assistance and guidance in resolving difficulties related to toileting are to be offered (Koppen et al, 2016).…”