Management of Functional Constipation in Children: Therapy in Practice

Abstract

Functional constipation is a common healthcare problem among children worldwide and accounts for high healthcare usage and costs. Functional constipation is a clinical diagnosis; the evaluation primarily consists of a thorough medical history and a complete physical examination. Additional investigations are not necessary in most cases. Treatment consists of non-pharmacological and pharmacological interventions. Non-pharmacological interventions involve education and demystification, toilet training (with a reward system), and a defecation diary. Pharmacological treatment comprises three steps: disimpaction, maintenance treatment, and weaning. The treatment of first choice is oral laxatives, preferably polyethylene glycol. When this is insufficient, other therapeutic agents are available. This review discusses the evaluation and management of functional constipation in the pediatric population and provides a summary of drug treatment options.

The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers

“…Non-pharmacological treatment for functional constipation consists of education, demystification, regular dietary advice (sufficient fiber and fluid intake) and in older children toilet training, a reward system and a stool diary [67]. It is important to reduce fear and, if possible, to make the child and parents understand the underlying pathophysiological mechanisms and the need to learn how to recognize these in daily life.…”

Surgical decision-making in the management of children with intractable functional constipation: What are we doing and are we doing it right?

“…Although use of a reward system has been shown to improve therapy compliance, this measure was only used by a minority of responders [25]. Furthermore, pre-, pro-or synbiotics were used as a non-pharmacological intervention by one-fifth of responders.…”

Recommendations for pharmacological clinical trials in children with functional constipation: The Rome foundation pediatric subcommittee on clinical trials

“…Functional constipation (FC) is a common healthcare problem in children of all ages, with a worldwide prevalence ranging between 0.7% and 29.6% . Although the pathophysiology of childhood FC is incompletely understood, an important etiological factor is stool withholding behavior, often occurring after a negative experience associated with stooling—eg, a hard, painful, or frightening bowel movement . Symptoms include infrequent, hard stools, and painful defecation and affected children may have abdominal pain and fecal incontinence, which is usually the result of fecal impaction leading to overflow incontinence .…”