Childhood constipation is typically characterised by infrequent bowel evacuations, large stools, and difficult or painful defecation.
Symptoms may result from low fibre, poor nutrient, and/or insufficient water intake, which leads to excessive hardening of the stool. This often starts as an acute problem but can progress to faecal impaction and chronic constipation.
Particularly in young children, any cause of painful defecation may provoke active withholding. Withholding may worsen the constipation and lead to a vicious cycle.
Duration of constipation and amount of stool burden may depend on capacity of the child's rectum, the degree of megarectum, and other factors including rectal sensory function.
After faecal disimpaction, maintenance stool softeners are essential and are often required for many months or years to reduce relapse risk.
Constipation in childhood is the infrequent passage of stools leading to 1 or more of the following: painful defecation; overflow faecal incontinence; rectal faecal impaction; or active defecation avoidance behaviour.
Director Neurogastroenterology and Motility Program
Digestive Health Institute
Children's Hospital Colorado
Associate Professor of Pediatrics
University of Colorado School of Medicine
JB-G declares that he has no competing interests.
Instructor in Pediatric Gastroenterology
Massachusetts General Hospital for Children
CZ-K has been reimbursed by Genzyme for speaking at several conferences.
Dr Jaime Belkind-Gerson and Dr Claire Zar-Kessler would like to gratefully acknowledge Dr Wael El-Matary, Dr Steffen Reinsch, and Dr Meghan McPherson, the previous contributors to this monograph. WE-M, SR, and MM declare that they have no competing interests.
Consultant Paediatric Gastroenterologist
Royal West Sussex NHS Trust
DCAC has served as a consultant to, and spoken at symposia sponsored by, Norgine Ltd.
University of Arizona
VB declares that he has no competing interests.
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
DJH declares that he has no competing interests.
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