Pediatric Functional Constipation
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Definition[edit | edit source]
Overview
Constipation can be broadly described as infrequent bowel movements of hard or dry stool. It can be further categorized into two subtypes, Organic and Functional Constipation. Organic constipation happens in 5% of pediatric cases, and is the result of structural, neurologic, toxic/metabolic or intestinal disorders. This overview will focus on Functional Constipation (FC), which is more common and involving reasons beyond organic causes[1].
ROME IV Diagnostic Criteria for FC:
Must include 2 or more of the following occurring at least once per week for a minimum of 1 month with insufficient criteria for a diagnosis of irritable bowel syndrome[2]:
· 2 or fewer defecations in the toilet per week in a child of a developmental age of at least 4 years
· At least 1 episode of fecal incontinence per week
· History of retentive posturing or excessive volitional stool retention
· History of painful or hard bowel movements
· Presence of a large fecal mass in the rectum
· History of large diameter stools that can obstruct the toilet
After appropriate evaluation, the symptoms cannot be fully explained by another medical condition[2].
NB: The ROME IV revisions published in May 2016, highlight that while functional bowel disorders (functional diarrhea, functional constipation, IBS with predominant diarrhea [IBS-D], IBS with predominant constipation [IBS-C], and IBS with mixed bowel habits) have their own distinct diagnostic criteria, they are considered to be on a continuum rather than independent entities (see Figure 1) and may share similar treatment strategies[3].
Insert figure 1
FC definition is not to be confused with:
Intractable constipation: Constipation not responding to treatment for at least 3 months[4]. For children with severe intractable constipation that is unresponsive to pharmacological management, referral to a specialized pediatric gastroenterologist is recommended. Surgery may be indicated as a last resort[5].
Fecal impaction: Hard mass in the lower abdomen identified during a physical exam, or a dilated rectum filled with a large amount of stool on rectal examination, or excessive stool in the distal colon viewed on abdominal Xray[4]. Long term constipation can develop into fecal impaction. Fecal impaction can cause pain and vomiting, and may require emergency treatment or hospitalization[6].
Prevalence
The prevalence of pediatric FC ranges from 0.7-29.6%[7]. The wide range reported may be due to the use of different FC criteria and cultural influences[2]. Peak incidence of constipation occurs at the time of toilet training, median age of onset approximately 2.3 years, with no sex differences[8][2]. FC is distributed equally amoung different socio-economic backgrounds, with no relationship to family size, ordinal position of the child in the family, or parental age. Boys with constipation have high rates of fecal incontinence compared to girls[2].
Impact
There are higher healthcare costs associated with children with constipation, mostly because of ambulatory care costs and, to a lesser degree, costs related to hospitalizations and emergency room visits[9]. Constipation symptoms may lead to reduction in health-related quality of life, poor school performances and difficult social interactions at a time that the child is known to lay social and educational foundations[10]. Despite currently available treatment options, quality of care in FC is limited by lack of guidance for management, a poorly defined condition characteristics, and insufficient data on drug and alternative therapies[11].
Mechanism of Injury / Pathological Process[edit | edit source]
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Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Medical Management[edit | edit source]
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Physiotherapy Intervention[edit | edit source]
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References[edit | edit source]
- ↑ Consolini DM. Constipation in Children - Pediatrics [Internet]. Merck Manuals Professional Edition. Merck Manuals; 2018 [cited 2019Apr1]. Available from: https://www.merckmanuals.com/en-ca/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children?query=Constipation in Children
- ↑ 2.0 2.1 2.2 2.3 2.4 Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2016 May 1;150(6):1456-68.
- ↑ Schmulson MJ, Drossman DA. What is new in Rome IV. Journal of neurogastroenterology and motility. 2017 Apr;23(2):151.
- ↑ 4.0 4.1 Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, Staiano A, Vandenplas Y, Benninga MA. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of pediatric gastroenterology and nutrition. 2014 Feb 1;58(2):258-74.
- ↑ Koppen IJ, Lammers LA, Benninga MA, Tabbers MM. Management of functional constipation in children: therapy in practice. Pediatric Drugs. 2015 Oct 1;17(5):349-60.
- ↑ Harvard Health Publishing. Constipation and Impaction [Internet]. Harvard Health. 2016 [cited 2019Apr1]. Available from: https://www.health.harvard.edu/a_to_z/constipation-and-impaction-a-to-z
- ↑ Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best practice & research Clinical gastroenterology. 2011 Feb 1;25(1):3-18.
- ↑ Malowitz S, Green M, Karpinski A, Rosenberg A, Hyman PE. Age of onset of functional constipation. Journal of pediatric gastroenterology and nutrition. 2016 Apr 1;62(4):600-2.
- ↑ Choung RS, Shah ND, Chitkara D, Branda ME, Van MT, Whitehead WE, Katusic SK, Talley NJ. Direct medical costs of constipation from childhood to early adulthood: a population-based birth cohort study. Journal of pediatric gastroenterology and nutrition. 2011 Jan;52(1):47-54.
- ↑ Bongers ME, van Dijk M, Benninga MA, Grootenhuis MA. Health related quality of life in children with constipation-associated fecal incontinence. The Journal of pediatrics. 2009 May 1;154(5):749-53.
- ↑ Sood M, Lichtlen P, Perez MC. Unmet Needs in Pediatric Functional Constipation. Clinical pediatrics. 2018 Nov;57(13):1489-95.
