Nonpharmacologic Treatments for Childhood Constipation: Systematic Review

Abstract

OBJECTIVE:To summarize the evidence and assess the reported quality of studies concerning nonpharmacologic treatments for childhood constipation, including fiber, fluid, physical movement, prebiotics, probiotics, behavioral therapy, multidisciplinary treatment, and forms of alternative medicine. METHODS:We systematically searched 3 major electronic databases and reference lists of existing reviews. We included systematic reviews and randomized controlled trials (RCTs) that reported on nonpharmacologic treatments. Two reviewers rated the methodologic quality independently. RESULTS:We included 9 studies with 640 children. Considerable heterogeneity across studies precluded meta-analysis. We found no RCTs for physical movement, multidisciplinary treatment, or alternative medicine. Some evidence shows that fiber may be more effective than placebo in improving both the frequency and consistency of stools and in reducing abdominal pain. Compared with normal fluid intake, we found no evidence that water intake increases or that hyperosmolar fluid treatment is more effective in increasing stool frequency or decreasing difficulty in passing stools. We found no evidence to recommend the use of prebiotics or probiotics. Behavioral therapy with laxatives is not more effective than laxatives alone. CONCLUSIONS:There is some evidence that fiber supplements are more effective than placebo. No evidence for any effect was found for fluid supplements, prebiotics, probiotics, or behavioral intervention. There is a lack of well-designed RCTs of high quality concerning nonpharmacologic treatments for children with functional constipation.

Probiotics

“…lactis DN-173 010 in this category of patients [103]. No evidence for any effect was found for fluid supplements, prebiotics, probiotics, or behavioral intervention [104]. Until more data are available, probiotics for the treatment of constipation condition should be considered investigational [105].…”

Constipation in children: From misty to understanding

“…Several trials including different types of fibres failed to show any clinically meaningful therapeutic benefit in children 80,81 . Two systematic reviews also illustrate limited clinical value of fibre in the management 82,83 . In addition, increasing dietary fibre intake with extensive behavioural interventions does not reduce the requirement of laxatives 84 .…”

Dietary fibre and childhood constipation

“…Tabbers MM et al systematically reviewed nonpharmacologic treatments for childhood constipation 6 . They concluded that there is some evidence that fibre supplements are more effective than placebo but no evidence for any effect for fluid supplements, prebiotics, probiotics, or behavioural intervention 6 .…”