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- Jennifer M. Colombo, MD*
- Matthew C. Wassom, PhD†
- John M. Rosen, MD*
- *Division of Gastroenterology, Children’s Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO.
- †Division of Developmental & Behavioral Sciences, Children’s Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO.
AUTHOR DISCLOSURE
Drs Colombo, Wassom, and Rosen have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Educational Gap
A recent study in Pediatrics concluded that 25% of children with functional constipation continued to experience symptoms at adult age, suggesting that referral to specialized clinics at an early stage for children who are unresponsive to first-line treatment may help improve outcomes. (1)
Objectives
After completing the article, the reader should be able to:
Know that constipation is a common problem in childhood with a diverse clinical presentation.
Understand that functional constipation is a symptom-based diagnosis that does not require extensive testing.
Recognize that most children who present with fecal incontinence or encopresis have associated constipation.
Describe the treatment of constipation and encopresis, which should include a medical-behavioral approach that focuses on maintaining soft and regular bowel movements and improving toileting behavior.
Introduction
What do the following children have in common?
A 12-month-old girl with hard pellet-like stools.
A 3-year-old girl with frequent complaints of dysuria and hard stools.
An 8-year-old boy with a weekly stool that is large enough to clog a toilet.
A 12-year-old boy with daily loose stools in his underpants.
Answer: They share a familiar diagnosis: functional constipation.
Constipation is a common pediatric problem and parental concern. In general, a complaint of constipation accounts for 5% of general pediatric office visits and 25% of all referrals to pediatric gastroenterologists. The estimated worldwide prevalence is 0.7% to 29.6%. (2) Constipation rarely signifies a serious disease, but it has an unfavorable impact on patient quality of life, parental satisfaction, and health-care costs. Children with constipation often complain of abdominal pain, decreased appetite, and painful stooling, which can be distressing to both the child and the parents. Common transient …
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